NR511 Midterm Exam 2018

Question 1.Question : Which of the following is a crucial element of developing a

guideline?

Creating a physician expert panel

Reviewing the literature with ratings of available evidence

Conducting an external review of a guideline

Developing evidence-based tables

Points Received: 2 of 2

Question 2.Question : African American patients seem to have a negative reaction to which of the following asthma medications?

Inhaled corticosteroids

Long-term beta-agonist bronchodilators

Leukotriene receptor agonists

Oral corticosteroids

Points Received: 2 of 2

NR511 Midterm Exam 2018

Question 3.Question : Jolene has breast cancer that has been staged as T1, N0,

M0. What might this mean?

The tumor size cannot be evaluated; the cancer has not

spread to the lymph nodes; and the distant spread cannot

be evaluated.

The cancer is in situ; it is spreading into the lymph nodes,

but the spread cannot be evaluated otherwise.

The cancer is less than 2 cm in size and has not spread

to the lymph nodes or other parts of the body.

The cancer is about 5 cm in size; nearby lymph nodes

cannot be evaluated; and there is no evidence of distant

spreading.

Points Received: 2 of 2

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Question 4.Question : Sondra’s peripheral vestibular disease causes dizziness and

vertigo. Which of the following medications will help to

decrease edema in the labyrinth of the ear?

Meclizine

Diphenhydramine

Diamox

Promethazine

Points Received: 0 of 2

Question 5.Question : Mandy presents with a cauliflower-like wart in her anogenital

region. You suspect it was sexually transmitted and

document this as a:

Filiform/digitate wart

Dysplastic cervical lesion

Condyloma acuminata

Koilocytosis

Points Received: 2 of 2

Question 6.Question : Inattention and a sleep-wake cycle disturbance are the

hallmark symptoms of?

Dementia

Alzheimer’s disease

Parkinson’s disease

Delirium

Points Received: 2 of 2

Question 7.Question : You have taught Jennifer, age 15, about using a flow meter

to assess how to manage her asthma exacerbations. She

calls you today because her peak expiratory flow rate is

65%. What would you tell her?

“Take your short-acting beta-2 agonist, remain quiet, and

call back tomorrow.”

“Use your rescue inhaler, begin the prescription of oral

glucocorticoids you have, and call back tomorrow.”

“Drive to the emergency room now.”

“Call 911.”

Points Received: 2 of 2

NR511 Midterm Exam 2018

Question 8.Question : A patient is seen in the clinic with hematuria confirmed on

microscopic examination. The clinician should inquire about

the ingestion of which of these substances that might be the

cause of hematuria?

Student Answer:

NSAIDs

Beets

Vitamin A

Red meat

Points Received: 2 of 2

Question 9.Question : Which of the following is an example of tertiary prevention in

a patient with chronic renal failure?

Fluid restriction

Hemodialysis 4 days a week

High-protein diet

Maintenance of blood pressure at 120/80

Points Received: 2 of 2

Question 10.Question : Which of the following conditions is associated with

cigarette smoking?

Glaucoma

Increased sperm quality

Bladder cancer

Eczema

Points Received: 0 of 2

Question 11.Question : A chronic cough lasts longer than:

3 weeks

1 month

6 months

1 year

Points Received: 0 of 2

Question 12.Question : The ‘freezing phenomenon’ is a cardinal feature of?

Parkinson’s disease

Alzheimer’s disease

A CVA

Bell’s palsy

Points Received: 0 of 2

Question 13.Question : When administered at the beginning of an attack, oxygen

therapy may help this kind of headache?

Tension

Migraine

Cluster

Stress

Points Received: 0 of 2

Question 14.Question : Which ethnic group has the highest lung cancer incidence

and mortality rates?

African American men

Scandinavian men and women

Caucasian women

Asian men

Points Received: 0 of 2

Question 15.Question : The most significant precipitating event leading to otitis

media with effusion is:

Pharyngitis

Allergies

Viral upper respiratory infection (URI)

Perforation of the eardrum

Points Received: 2 of 2

Question 16.Question : Samuel is going to the dentist for some work and must take

endocarditis prophylaxis because of his history of:

Severe asthma

A common valvular lesion

Severe hypertension

A prosthetic heart valve

Points Received: 0 of 2

Question 17.Question : A 34-year-old patient was treated for a UTI and has not

responded to antibiotic therapy. Which of the following

actions should be taken next?

Send a urine specimen for microscopy and evaluate for

fungal colonies.

Increase the dose of antibiotic.

Order a cytoscopy.

Order a different antibiotic.

Points Received: 0 of 2

NR511 Midterm Exam 2018

Question 18.Question : Which statement best describes a carotid bruit?

It is felt with the middle three fingers over the carotid

artery.

A bruit becomes audible when the lumen is narrowed to 1

mm or less.

A low-pitched bruit is a medical emergency.

The higher the pitch of the bruit, the higher the degree of

stenosis.

Points Received: 0 of 2

Question 19.Question : Which statement is true regarding chloasma, the ‘mask of

pregnancy’?

It is caused by a decrease in the melanocyte-stimulating

hormone during pregnancy.

This condition only occurs on the face.

Exposure to sunlight will even out the discoloration.

It is caused by increased levels of estrogen and

progesterone.

Points Received: 2 of 2

Question 20.Question : Simon presents with alopecia areata with well-circumscribed

patches of hair loss on the crown of his head. How do you

respond when he asks you the cause?

“You must be under a lot of stress lately.”

“It is hereditary. Did your father experience this also?”

“The cause is unknown, but we suspect it is due to an

immunologic mechanism.”

“We’ll have to do some tests.”

Points Received: 0 of 2

Question 21.Question : A blood pressure (BP) of 150/90 is considered:

Stage 2 hypertension

Hypertensive

Normal in healthy older adults

Acceptable if the patient has DM

Points Received: 0 of 2

Question 22.Question : When teaching post MI patients about their NTG tablets, the

clinician should stress that the tablets should remain in the

light-resistant bottle in which they are packaged and should

not be put in another pill box or remain in areas that are or

could become warm and humid. Once opened, the bottle

must be dated and discarded after how many months?

1 month

3 months

6 months

As long as the tablets are kept in this special bottle, they

will last forever.

Points Received: 0 of 2

Question 23.Question : Your patient has decided to try to quit smoking with Chantix.

You are discussing his quit date, and he will begin taking the

medicine tomorrow. When should he plan to quit smoking?

He should stop smoking today.

He should stop smoking tomorrow.

His quit date should be in 1 week.

He will be ready to quit after the first 30 days.

Points Received: 0 of 2

Question 24.Question : When looking under the microscope to diagnose an

intravaginal infection, you see a cluster of small and oval to

round shapes. What do you suspect they are?

Spores

Leukocytes

Pseudohyphae

Epithelial cells

Points Received: 0 of 2

Question 25.Question : The hallmark of an absence seizure is:

No activity at all

A blank stare

Urine is usually voided involuntarily

The attack usually lasts several minutes

Points Received: 0 of 2

Question 26.Question : Which medication used for scabies is safe for children 2

months and older?

Permethrin cream

Lindane

Crotamiton lotion and cream

Ivermectin

Points Received: 0 of 2

Question 27.Question : The clinician is seeing a patient complaining of red eye. The

clinician suspects conjunctivitis. The presence of

mucopurulent discharge suggests which type of

conjunctivitis?

Viral conjunctivitis

Keratoconjunctivitis

Bacterial conjunctivitis

Allergic conjunctivitis

Points Received: 2 of 2

Question 28.Question : Gabby, aged 22, has Bell’s palsy on the right side of her

face. Her mouth is distorted, and she is concerned about

permanent paralysis and pain. What do you tell her?

“Most patients have complete recovery in 3 to 6

months.”

“Unfortunately, you’ll probably have a small amount of

residual damage.”

“Don’t worry, I’ll take care of everything.”

“You may have a few more episodes over the course of

your lifetime but no permanent damage.”

Points Received: 2 of 2

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Question 29.Question : How often should drug levels be monitored when a seizure

medication has controlled the seizures, and the drug level is

adequate?

Every 3 months

Every 6 months

Annually

Whenever there is a problem

Points Received: 0 of 2

NR511 Midterm Exam 2018

Question 30.Question : Immunizations are an example of which type of prevention?

Primary

Secondary

Tertiary

Points Received: 0 of 2

Question 31.Question : The result of the patient’s 24-hour urine for protein was 4.2

g/day. The clinician should take which of the following

actions?

Repeat the test.

Refer to a nephrologist.

Measure the serum protein.

Obtain a blood urea nitrogen (BUN) and creatinine.

Points Received: 2 of 2

Question 32.Question : Which cranial nerve is affected in a patient with a

cerebrovascular accident who has difficulty chewing?

CN V

CN VII

CN IX

CN X

Points Received: 0 of 2

Question 33.Question : Which of the following diagnostic tests should be ordered

for a patient suspected of having bladder cancer?

Kidneys, ureter, bladder x-ray

Cystoscopy with biopsy

Magnetic resonance imaging

Urine tumor marker (NMP22)

Points Received: 2 of 2

Question 34.Question : The “B” in the ABCDEs of assessing skin cancer represents:

Biopsy

Best practice

Boundary

Border irregularity

Points Received: 2 of 2

Question 35.Question : Which statement is true regarding driving and patients with a

seizure disorder?

Once diagnosed with a seizure disorder, patients must

never drive again.

After being seizure free for 6 months, patients may drive.

Each state has different laws governing driving for

individuals with a seizure disorder.

These persons may drive but never alone.

Points Received: 0 of 2

Question 36.Question : Which high-density lipoprotein (HDL) level is considered

cardioprotective?

Greater than 30

Greater than 40

Greater than 50

Greater than 60

Points Received: 0 of 2

Question 37.Question : The most common cause of CAP is?

Streptococcus pneumoniae

Klebsiella pneumoniae

Legionella pneumoniae

Pseudomonas aeruginosa

Points Received: 0 of 2

Question 38.Question : Sandra has palpitations that occur with muscle twitching,

paresthesia, and fatigue. What specific diagnostic test might

help determine the cause?

Serum calcium

Electrocardiogram (ECG)

Thyroid-stimulating hormone test

Complete blood cell count

Points Received: 2 of 2

Question 39.Question : A patient presents to the clinician with a sore throat, fever of

100.7?F, and tender anterior cervical lymphadenopathy. The

clinician suspects strep throat and performs a rapid strep

test that is negative. What would the next step be?

The patient should be instructed to rest and increase fluid

intake as the infection is most likely viral and will resolve

without antibiotic treatment.

Because the patient does not have strep throat, the

clinician should start broad spectrum antibiotics in order to

cover the offending pathogen.

A throat culture should be performed to confirm the

results of the rapid strep test.

The patient should be treated with antibiotics for strep

throat as the rapid strep test is not very sensitive.

Points Received: 0 of 2

NR511 Midterm Exam 2018

Question 40.Question : Patients with acute otitis media should be referred to a

specialist in which of the following situations?

Concurrent vertigo or ataxia

Failed closure of a ruptured tympanic membrane

If symptoms worsen after 3 or 4 days of treatment

All of the above

Points Received: 0 of 2

Question 41.Question : Which of the following tests is most useful in determining

renal function in a patient suspected of CRF?

BUN and creatinine

Electrolytes

Creatinine clearance

Urinalysis

Points Received: 0 of 2

Question 42.Question : Marci has a wart on her hand. She says she heard

something about “silver duct tape therapy.” What do you tell

her about his?

It is an old wives’ tale.

It is used as a last resort.

Salicylic acid is more effective.

It is a simple treatment that should be tried first.

Points Received: 0 of 2

Question 43.Question : What is the first-line recommended treatment against Group

A ?-hemolytic streptococci (GABHS), the most common

cause of bacterial pharyngitis?

Penicillin

Quinolone

Cephalosporin

Macrolide

Points Received: 0 of 2

Question 44.Question : Which of the following is an example of sensorineural

hearing loss?

Perforation of the tympanic membrane

Otosclerosis

Cholesteatoma

Presbycusis

Points Received: 0 of 2

Question 45.Question : Which of the following is “a linear crack extending from the

epidermis to the dermis?”

An ulcer

A fissure

Lichenification

An excoriation

Points Received: 2 of 2

Question 46.Question : A 65-year-old man presents to the clinician with complaints

of increasing bilateral peripheral vision loss, poor night

vision, and frequent prescription changes that started 6

months previously. Recently, he has also been seeing halos

around lights. The clinician suspects chronic open-angle

glaucoma. Which of the following statements is true

concerning the diagnosis of chronic open-angle glaucoma?

The presence of increased intraocular pressure measured

by tonometry is definitive for the diagnosis of open-angle

glaucoma.

The clinician can definitively diagnosis open-angle

glaucoma based on the subjective complaints of the

patient.

Physical diagnosis relies on gonioscopic evaluation of the

angle by an ophthalmologist.

Early diagnosis is essential in order to reverse any

damage that has occurred to the optic nerve.

Points Received: 0 of 2

NR511 Midterm Exam 2018

Question 47.Question : The majority of HSV-1 and HSV-2 infections are

asymptomatic so that only which elevated antibody titer

shows evidence of previous infection?

IgA

IgE

IgG

IgM

Points Received: 0 of 2

Question 48.Question : A patient is seen with a sudden onset of flank pain

accompanied by nausea, vomiting, and diaphoresis. In

addition to nephrolithiasis, which of the following should be

added to the list of differential diagnoses?

Pancreatitis

Peptic ulcer disease

Diverticulitis

All of the above

Points Received: 0 of 2

Question 49.Question : Which of the following is abundant in the heart and rapidly

rises in the bloodstream in the presence of heart failure,

making it a good diagnostic test?

B-type natriuretic peptide

C-reactive protein

Serum albumin

Erythrocyte sedimentation rate

Points Received: 0 of 2

Question 50.Question : You are doing a cerumen extraction and touch the external

meatus of your patient’s ear. He winces and starts coughing.

What is the name of this reflex?

Baker phenomenon

Arnold reflex

Cough reflex

Tragus reflex

Points Received: 0 of 2

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Question : The most cost-effective screening test for determining HIV

status is which of the following?

Western blot

Enzyme-linked immunosorbent assay

Venereal Disease Research Laboratory test

Viral load

Points Received: 0 of 2

Question 2.Question : 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)

Points Received: 0 of 2

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

which neurotransmitter?

GABA

Acetylcholine

Dopamine

Serotonin

Points Received: 0 of 2

Question 4.Question : Mrs. Thomas was seen in the office 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 differentiates 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

Points Received: 2 of 2

Question 5.Question : 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.Question : Which of the following signs or symptoms indicate an

inflammatory etiology to musculoskeletal pain?

Decreased C-reactive protein

Hyperalbuminemia

Morning stiffness

Weight gain

NR511 Midterm Exam 2018

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

Dogs

Cats

Humans

Rodents

Question 8.Question : 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.Question : 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.Question : 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 stiffness; 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.Question : Which of the following medications for type 2 diabetes

mellitus should not be prescribed during pregnancy?

Insulin

Metformin

Glucotrol

Precose

Question 12.Question : 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.Question : 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.Question : What is the most common cause of microcytic anemia?

Anemia of chronic disease

Sideroblastic anemia

Iron-deficiency anemia

Thalassemia

Question 15.Question : An 82-year-old man is seen in the primary care office with

complaints of dribbling urine and difficulty starting his

stream. Which of the following should be included in the list

of differential diagnoses?

Benign prostatic hyperplasia (BPH)

Parkinson’s disease

Prostate cancer

All of the above

Question 16.Question : 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.Question : 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.

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Question 18.Question : 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.Question : 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.

NR511 Midterm Exam 2018

Question 20.Question : 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.Question : 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.Question : The exanthem of Lyme disease is:

Erythema infectiosum

Laterothoracic exanthem

Erythema migrans

Morbilli exanthem

Question 23.Question : 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.Question : 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.Question : 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.Question : 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.Question : 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.Question : 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.Question : 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 stiffness and limited mobility of the lumbar spine Morning stiffness 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.Question : 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.Question : The clinician prescribes glipizide (Glucotrol) for a diabetic

patient. Which statement made by the patient would

indicate that your teaching has been effective?

“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.”

NR511 Midterm Exam 2018

Question 32.Question : 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.Question : The effectiveness 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.Question : 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.Question : Which of the following medications can cause

hyperglycemia?

Prednisone

Metformin

Synthroid

Cephalexin

Question 36.Question : During treatment for anaphylaxis, what site is used for the

initial injection of epinephrine?

Abdomen

Upper lateral thigh

Deltoid

Question 37.Question : 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 different medication

1 to 2 weeks after tapering off medications

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

Pregnancy

Pituitary dysfunction

Inadequate estrogen levels

Genetic disorders

NR511 Midterm Exam 2018

Question 39.Question : 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.Question : 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.Question : 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.Question : The cardinal subjective symptom of sickle cell crisis is which

of the following?

Pain

Nausea

Light-headedness

Palpitations

Question 43.Question : 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.Question : Which arthropod bite can contain cytotoxic and hemolytic

toxins that may destroy tissue?

Tick

Brown recluse spider

Wasp

Stinging caterpillar

Question 45.Question : 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.Question : 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.Question : 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.Question : 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 effective than TCAs.

SSRIs take less time to work than TCAs.

SSRIs have a more favorable side-effect profile than

TCAs.

SSRIs are not lethal in overdose.

NR511 Midterm Exam 2018

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

identical twin?

Autogenic

Autologous

Allogeneic

Syngeneic

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

of poisoning?

Arsenic

Lead

Carbon monoxide

Strychnine

Question 51.Question : Basic human needs are identified as:

Autonomy and feeling valued by others

Exhilaration and productivity

Spirituality

Career success and material rewards

Question 52.Question : 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.Question : A 22-year-old male is seen in the clinic because he found a

hard lump in his testicle when performing testicular selfexamination

(TSE). Which of the following should be

examination (TSE). Which of the following should be

included in the list of differential diagnoses?

Testicular cancer

Inguinal hernia

Varicocele

All of the above

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

testicular cancer?

Radical orchidectomy

Lumpectomy

Radiation implants

All of the above

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

lead, that are ingested as poisons?

Chelation

Dialysis

Gastric lavage

Bowel irrigation

Question 56.Question : 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.Question : 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

Question 58.Question : The clinician has instructed Sam, a 25-year-old patient with

low back strain, to use NSAIDs to manage his symptoms of

pain and discomfort. Which of the following statements

would be most appropriate when teaching Sam about the

use of NSAIDs?

“You should start with the lowest dose that is effective in

managing your pain, because long-term use of NSAIDs can

result in gastrointestinal (GI) disorders such as ulcers and

hemorrhage.”

“You should start with the lowest dose that is effective in

managing your pain to avoid developing tolerance to the

medication.”

“You should take the maximum recommended dose of

NSAIDs so that you will not need to take narcotics to control

your pain.”

“It is important to take NSAIDs on an empty stomach in

order to increase absorption.”

Question 59.Question : A history of overuse or excessive force, as opposed to a fall,

hyperextension, or the twisting of a joint, is more likely

related to which musculoskeletal injury?

A sprain

A strain

A partial fracture

A fracture

Question 60.Question : Which type of heat-related illness involves a core body

temperature of at least 104.9°F, acute mental status

changes, absent sweat, and tachypnea?

Heat cramps

Heat syncope

Heat exhaustion

Heat stroke

NR511 Midterm Exam 2018

Question 61.Question : Which of the following may be used to evaluate a person’s

suicide risk?

CAGE

SANE

SAD PERSONAS

DIGFAST

Question 62.Question : One of the initial steps in assessing patients with

musculoskeletal complaints is to determine whether the

complaint is articular or nonarticular in origin. Which of the

following is an example of an articular structure?

Bone

Synovium

Tendons

Fascia

Question 63.Question : After returning from visiting his grandchildren in England,

George, age 59, complains of a flulike illness, including

fever, chills, and myalgia. He reports having discovered a

rash or red spot that grew in size on his right leg. What

disease are you considering?

A viral syndrome

Lyme disease

Rocky Mountain spotted fever

Relapsing fever

Question 64.Question : A patient is diagnosed with hypothyroidism. Which of the

following electrocardiogram changes should the clinician

expect as a manifestation of the disease?

Sinus bradycardia

Atrial fibrillation

Supraventricular tachycardia

U waves

Question 65.Question : Which of the following tests is essential for a 46-year-old

woman who the clinician suspects is perimenopausal?

Pregnancy

Estrogen level

Progesterone level

LH level

Question 66.Question : After 6 months of Synthroid therapy, the clinician should

expect which of the following in the repeat thyroid studies?

Elevated TSH

Normal TSH

Low TSH

Undetectable TSH

Question 67.Question : A patient is 66 inches in height, weighing 200 pounds, and

newly diagnosed with type 2 diabetes mellitus (DM). Her

fasting plasma glucose level is 215 mg/dL. What is the best

initial treatment?

No treatment at this time

Diet and exercise for 6-week trial

Diet, exercise, and oral medication

Diet, exercise, and exogenous insulin

Question 68.Question : Which of the following should be considered in a patient

presenting with erectile dysfunction?

Diabetes mellitus

Hypertension

Atherosclerosis

All of the above

Question 69.Question : Mrs. Anderson is a 35-year-old woman who has been

recently diagnosed with carpal tunnel syndrome. She has

two young children and asks the clinician what the chances

are that they also will develop carpal tunnel syndrome.

Which of the following responses would be correct regarding

the risk of developing carpal tunnel syndrome?

Carpal tunnel syndrome commonly occurs in families.

Genetic factors are thought to account for about one-half

the risk of developing carpal tunnel.

Only people with occupations that require repeated

flexion extension of the wrist, use of hand tools that require

forceful gripping, or use of hand tools that vibrate are at risk

for developing carpal tunnel.

An underlying musculoskeletal disorder must be present

for a person to develop carpal tunnel.

Carpal tunnel syndrome only occurs in the presence of a

hormonal imbalance.

Question 70.Question : A 20-year-old woman is seen in the clinic because her

boyfriend was found to have gonorrhea. Which of the

following is the treatment of choice for gonorrhea?

Ceftriaxone

Doxycycline

Acyclovir

Metronidazole

NR511 Midterm Exam 2018

Question 71.Question : Which of the following statements is true regarding the

treatment of carpal tunnel syndrome?

The goal of treatment is to prevent flexion and extension

movements of the wrist.

Splints are used in carpal tunnel syndrome, because they

allow for free movement of the fingers and thumb while

maintaining the wrist in a neutral position.

Corticosteroid injections are discouraged in the treatment

of carpal tunnel syndrome because of the risks for median

nerve damage, scarring, and infection.

All of the above

Question 72.Question : Mr. S presents in the clinic with pain, tenderness, erythema,

and swelling of his left great toe. The clinician suspects

acute gout. Which of the following should the clinician

expect in the initial test results for this patient?

Elevated uric acid level

Elevated blood urea nitrogen

Decreased urine pH

Decreased C-reactive protein

Question 73.Question : Which of the following data is indicative of testicular torsion?

Absent cremasteric reflex

Pain relieved on testicular elevation

Testicle very low in the scrotum

Swollen scrotum with “red dot sign”

Question 74.Question : A patient with type 2 diabetes asks the clinician why she

needs to exercise. In order to answer her, the clinician must

understand that exercise has what effect on the patient with

type 2 diabetes?

Reduces postprandial blood glucose

Reduces triglycerides and increases high-density

lipoprotein (HDL)

Reduces total cholesterol

All of the above

Question 75.Question : A 26-year-old woman is seen with complaints of irregular

vaginal bleeding. Which of the following tests should be the

first priority?

Pregnancy test

Pelvic ultrasound

Endometrial biopsy

Platelet count

Question 76.Question : What is the most common cause of generalized

musculoskeletal pain in women ages 20 to 55?

Chronic fatigue syndrome (CFS)

Anemia

Fibromyalgia syndrome (FMS)

Sports-related injuries

Question 77.Question : If the international normalized ratio (INR) result is above the

therapeutic range in a patient with atrial fibrillation on

warfarin, what might the clinician do?

Stop the warfarin for 1 week, and then repeat the INR.

Withhold one or more days of anticoagulant therapy.

Restart therapy at a lower dose immediately.

The prothrombin time and INR should be reevaluated

within 1 month of the dosage adjustments.

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Question 78.Question : A 32-year-old woman is seen in the clinic because she has

been unable to get pregnant after 12 months of unprotected

sex. In order to determine the cause of the infertility, the

clinician should question her about which of these possible

causes?

Pelvic inflammatory disease

Oral contraceptive use for 15 years

Early menarche

Diet high in soy protein

Question 79.Question : Which of the following statements concerning the treatment

of fibromyalgia syndrome is true?

There is currently no cure for the disorder; however,

patients should be made aware that symptom relief is

possible.

Treatment is directed toward controlling discomfort,

improving sleep, and maintaining function.

Fibromyalgia syndrome can be difficult to manage,

requiring a variety of approaches and multiple medications.

All of the above

NR511 Midterm Exam 2018

Question 80.Question : The clinician should prescribe an antibiotic that covers

which of these organisms for a patient with acute

prostatitis?

Gram-positive cocci

Gram-negative cocci

Gram-positive bacillus

Gram-negative bacillus

Question 81.Question : Which household solution should be used to clean a

bathroom if sharing with a friend who has HIV?

100% bleach

50% bleach and 50% vinegar

Nine parts H2O to one part bleach

The friend must have his or her own bathroom.

Question 82.Question : Sandra is 42 years old and has just been diagnosed with

leukemia. She is complaining of bone and joint pain. Which

type of leukemia is most likely the culprit?

Acute lymphocytic leukemia

Acute myelogenous leukemia

Chronic myelogenous leukemia

Chronic lymphocytic leukemia

Question 83.Question : Which of the following is identified as an eating disorder in

which a person craves food substitutes, such as clay, ice

chips, and cotton, and is considered an objective finding

associated with severe iron deficiency?

Ferritin

Porter’s syndrome

Hypochromasia

Pica

Question 84.Question : The clinician suspects that a client seen in the office has

hyperthyroidism. Which of the following tests should the

clinician order on the initial visit?

High sensitivity thyroid-stimulating hormone (TSH) and

free T4

Free T4 and serum calcium

Free T3 and T4

TSH and thyroxin antibodies

Question 85.Question : The clinician has been doing diabetic teaching for a patient

with type 1 diabetes. Which of the following statements by

the patient would indicate that teaching has been effective?

“As long as I don’t need glasses, I don’t have to worry

about going blind.”

“I know I need to have my eyes checked every year.”

“My optometrist checks my eyes.”

“I will see my eye doctor when my vision gets blurry.”

Question 86.Question : Triggering factors for acute exacerbations of which of the

following conditions include exposure to ultraviolet (UV)-B

and UV-A rays?

Rheumatoid arthritis

Scleroderma

SLE

Sjögren’s syndrome

Question 87.Question : Which of the following characteristics separates anaphylaxis

from a vasovagal reaction?

Bradycardia

Extreme diaphoresis

Severe bronchoconstriction

Hypotension

Question 88.Question : Mr. Jackson is a 65-year-old man recently diagnosed with

osteoarthritis. The clinician has explained to Mr. Jackson

that the goals for managing osteoarthritis include controlling

pain, maximizing functional independence and mobility,

minimizing disability, and preserving quality of life. Mr.

Jackson explains to the clinician that his first choice would

be to use complementary therapies to control his condition

and asks what therapies are most effective in treating

osteoarthritis. What would be the most appropriate

response from the clinician?

“Complementary therapies should be considered only if

surgical interventions are not successful.”

“I am unfamiliar with the available complementary

therapies for osteoarthritis and prefer to discuss more

mainstream treatments, such as NSAIDs and physical

therapy, to manage your condition.”

“I would be happy to discuss all the treatment options

available to you. Complementary therapies, such as

acupuncture, acupressure, and tai-chi, are being studied for

use in the treatment of osteoarthritis and have shown

promise when used with standard medical therapy.”

“It would be crazy to use complementary therapies to

treat such a serious condition.”

Question 89.Question : One benefit of motivational interviewing (MI) is:

It assumes that ambivalence is a normal part of the

change process.

It can be utilized during routine office visits.

It is a therapeutic technique which is not necessarily time

intensive.

All are benefits of MI.

Question 90.Question : What percentage of burns is involved using the rule of nines

if both front legs are burned?

18%

24%

36%

NR511 Midterm Exam 2018

Question 91.Question : Women are at the highest risk for developing postpartum

depression for up to how long after childbirth?

2 weeks

1 month

3 months

6 months

Question 92.Question : Which statement about HIV postexposure prophylaxis (PEP)

for health-care workers is the most accurate?

PEP should be started within hours of exposure.

PEP should be started within 72 hours of exposure.

Renal and hepatic function tests should be done 6 weeks

after beginning PEP.

PEP will prevent potential hepatitis C infection if present.

Question 93.Question : The clinician is caring for Diane, a 22-year-old woman who

presents with an injured ankle. Diane asks the clinician if she

will need an x-ray. The clinician explains to Diane that an xray

is not always necessary for an injured ankle and that the

decision to obtain radiographs is dependent on the

examination and Diane’s description of her injury. Which of

the following clues in Diane’s examination or history would

alert the clinician to the need for obtaining radiographs?

Inability to bear weight immediately after the injury

Development of marked ankle swelling and discoloration

after the injury

Crepitation with palpation or movement of the ankle

All of the above

NR511 Midterm Exam 2018

Question 94.Question : A vegetarian patient with gout asks the clinician about food

he should avoid. The clinician should advise the patient to

avoid which of the following foods?

Rice

Carrots

Spinach

Potatoes

Question 95.Question : A patient with a basilar skull fracture may experience an

impaired downward gaze or diplopia from which affected

cranial nerve?

CN II

CN III

CN IV

CN V

Question 96.Question : A patient presents to the clinician after experiencing four

episodes in the last month of sweating, palpitations, chest

pain, nausea, and shaking. Each episode lasted about 10

minutes. The patient is now becoming very fearful of future

events and has been reluctant to leave the house. The

clinician suspects panic disorder but wants to rule out any

possible medical causes. Which of the following medical

conditions can mimic the symptoms of a panic attack?

Pheochromocytoma

Hyperthyroidism

Cardiac arrhythmias

All of the above

Question 97.Question : Which test is used to confirm a diagnosis of epididymitis?

Urinalysis

Gram stain of urethral discharge

Complete blood cell count with differential

Ultrasound of the scrotum

NR511 Midterm Exam 2018

Question 98.Question : BATHEing the patient refers to:

A technique used in primary care to get the patient to

accept the need for psychological or psychiatric referral

A technique used to facilitate cultural understanding

A technique used to perform psychotherapy

A technique that is a quick screen for psychiatric issues

and interventions for psychological problems

Question 99.Question : BATHEing the patient is an advanced practice nursing

intervention that allows the practitioner to:

Develop a therapeutic relationship without “owning” the

patient’s problem

Conduct psychological counseling within the context of

the primary care encounter

Focus on the “process” and not the assessment

Make the patient and family happier

Question 100.Question : A 45-year-old woman is seen in the clinic with abnormal

uterine bleeding and pain during intercourse. The clinician

should consider which of the following diagnoses?

Leiomyoma

Pregnancy

Ovarian cancer

All of the above

NR511 Midterm Exam 2018