NURS 6550N FINAL EXAM (3 VERSIONS) & NURS 6550N MIDTERM EXAM (100 CORRECT Q & A IN EACH VERSION, TOTAL: 400 Q & A)
NURS 6550 Final Exam / NURS6550 Final Exam (Latest): Walden University
Walden University NURS 6550 Final Exam / Walden University NURS6550 Final Exam
A 21-year-old woman requests hormonal emergency contraception after a condom break during intercourse approximately 16 hours ago. Today is day 14 of her normally 27–29 day menstrual cycle. You advise her that:
Likelihood of conception is minimal and emergency contraception use is not advised
Hormonal emergency contraception can be effective up to 5 days after intercourse
When taken as advised, hormonal emergency contraception use reduces the risk of pregnancy by up to 65%
The most likely mechanism of action of hormonal emergency contraceptive is as an abortifacient
A 36-year-old man is hospitalized for alcohol poisoning. During follow-up evaluation the next day, he denies that he has a drinking problem. The best approach to assess for possible alcoholism is conducting which of the following questionnaires?
A quality improvement plan characterized by limiting variability and removing defects in a process best describes:
Continuous Quality Improvement.
Total Quality Management.
A 38-year-old woman comes to the emergency department complaining of a rapid heartbeat, tremors, and chest tightness. She reports earlier in the day she was feeling a migraine starting so she took a pill given to her by her friend who also experiences migraines. Her medical history reveals that she is currently taking a monoamine oxidase inhibitor for depression. Which migraine medication did she most likely take?
Acetaminophen and caffeine (Excedrin ® Migraine)
Naproxen sodium (Aleve ® )
Almotriptan (Axert ® )
Butalbital, acetaminophen and caffeine (Fioricet ® )
All of the following are elements of malpractice except:
A duty of care to the patient.
A fee is charged for the healthcare services related to the malpractice claim.
Breach of the standard of care.
You are seeing a 68-year-old woman for treatment of an uncomplicated urinary tract infection (UTI). She has well-controlled hypertension, type 2 diabetes mellitus, and dyslipidemia and takes an angiotensin-converting enzyme inhibitor (ACEI), statin, biguanide, and low-dose aspirin (ASA). She worked in a dry cleaning facility until approximately 8 years ago. During her evaluation, she mentions that she sometimes has difficulty understanding conversation, especially in noisy environments. This is likely a:
Consequence of occupational chemical exposure.
Early sign of dementia.
Normal age-related change in hearing
While evaluating a 33-year-old female with a 2-day history of dysuria, which of the following findings in urinalysis is most suggestive of urinary tract infection (UTI) caused by a Gram-negative organism?
30 mg/dL protein
All of the following are examples of primary prevention strategies except:
Counseling an elderly patient prior to discharge about fall risk at home and how to prevent falls through adequate illumination.
Performing a hemoglobin A1C for all patients admitted to the hospital.
Conducting a study to identify the leading cause of mortality in teenagers and how to reduce risk.
Immunizing all adults ≥60 years with zoster vaccine.
A 23-year-old woman is being evaluated for an upper respiratory tract infection. As you prepare for auscultation, the patient states “I have a benign murmur that has been with me my whole life”. Anticipating a physiologic murmur, you would expect which of the following characteristics?
Usually obliterates S2.
Becomes softer when going from a supine to standing position.
Occurs late in systole.
Has localized area of auscultation
When evaluating the value of a test, the proportion of negative results that are truly negative best describes:
Positive predictive value.
Negative predictive value.
A 16-year-old male presents for evaluation after a syncopal episode at school. He reports that he has recently been experiencing bouts of lightheadedness. His blood pressure is 126/76 mm Hg and his BMI=33 kg/m 2 . You notice velvet-like plaques at the nape of the neck. Laboratory assessment should include which of the following tests?
The NP is called to treat a 43-year-old woman for multiple contusions following a domestic violence attack. The NP realizes that one of the best predictors of a subsequent homicide of victims of domestic violence is:
History of alcohol/drug abuse by perpetrator.
Access to kitchen knives by the perpetrator.
History of perpetrator attempting to strangle the victim.
Issuance of a restraining order by the victim.
A 48-year-old woman is being evaluated with chief complaints of fatigue, weakness, lethargy, and decreased concentration. She also mentions a notable increase in facial hair over the past 6 months as well as unexplained weight gain (about 25 lbs [11.3 kg]) over the past 2 months. Her past medical history is notable for moderate persistent asthma with multiple exacerbations over the past 8 months requiring treatment with prednisone. The most likely diagnosis is:
Type 2 diabetes mellitus.
You see a 73-year-old woman with a 40 pack-year smoking history, chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) who presents with an ulcer on the sole of her left foot. The ulcer has an irregular edge and pale base and a punched out appearance, with the surrounding skin white and shiny. The patient states that the pain is worse at night in bed and when the legs are elevated. The most likely diagnosis is:
In evaluating a 62-year-old male with ischemic heart disease and mitral incompetency, you expect to find the murmur that is:
Diastolic with radiation to the neck.
Diastolic with little radiation.
Systolic with radiation to the axillae.
21-year-old camp counselor presents for evaluation with a chief complaint of generalized itchiness. He has just returned after a week of summer camp. Physical examination reveals excoriated papules along his axillary folds and at the belt line. The NP suspects scabies and prescribes permethrin (Elimite ® ) lotion. In counseling the patient on the use of permethrin, the NP mentions that:
Its use is associated with neurotoxicity risk.
Itch often persists for a few weeks after successful treatment.
A marked reduction in lesions is noted within 48 hours.
The medication should be rinsed off within 2 hours of application.
You see a 76-year-old woman living at home who is accompanied by her home care provider. She has COPD and type 2 diabetes mellitus. An example of a secondary prevention strategy is:
Administering the seasonal influenza vaccine.
Screening for physical or financial abuse/Checking her blood glucose level.
Checking her blood pressure.
Adjusting her insulin dosing regimen.
A 43-year-old woman is being evaluated in the emergency department with a complaint of a severe headache. She describes a unilateral, pulsing headache that was preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm. The patient stated she noticed a “funny smell” prior to the symptoms starting. This description is most typical of:
Migraine with aura.
Transient ischemic attack.
A 20-year-old college student living in a campus dormitory has been diagnosed with meningococcal meningitis. The NP decides to speak with the university health officials and inform them that:
There is little to no risk of spread of the disease to other individuals.
Only intimate partners are at risk for infection.
Individuals with household-type or more intimate contact are at risk for infection.
All individuals on campus can be considered to be at risk for infection.
You see a 54-year-old man living in subsidized housing with a history of hypertension. He states that he stopped taking his blood pressure medication about 4 months ago because of costs. He is concerned because his blood pressure is high whenever he checks it, though he does not report any symptoms. His BP at this visit is 196/104 mm Hg. Upon examination of this patient, you would expect to detect an S 4 sound heard during:
32-year-old man requires evaluation for hepatitis infection prior to taking a job as a restaurant cook. He presents with the following laboratory results:
Hepatitis A Panel Hepatitis B Panel Hepatitis C Panel Anti-HAV Negative HBsAg Negative Anti-HCV Positive IgM Negative Anti-HBc Negative HCV RNA Negative IgM Negative Anti-HBs Positive You recognize the patient is susceptible to:
Hepatitis A and B
Hepatitis B and C
Hepatitis B only
Hepatitis A only
When evaluating illness symptoms in older patients, the disease will often present differently from younger adults due to:
The likelihood of polypharmacy.
Decreased compensatory mechanisms in the elderly.
An increased physiologic response to illness in the elderly.
Presence of comorbid conditions.
When prioritizing risk factors for bacterial endocarditis, the nurse practitioner knows who among the following patients has the highest risk.
A 55-year-old man with 3-vessel coronary artery bypass grafts with stents.
A 23-year-old woman with mitral valve prolapse without tissue redundancy.
A 65-year-old man with nonobstructive cardiomyopathy.
A 75-year-old woman with a nonorganic prosthetic aortic valve.
The legal authority for NPs to perform healthcare services as defined by state law is called:
Duty of care.
Scope of practice.
A patient who was seen for an upper respiratory tract infection has an abnormal blood test result and requires a follow-up visit. The patient repeatedly fails to show up for the follow-up visit. Which of the following is the best approach to inform the patient of the need and urgency for a repeat test?
A voicemail or text message.
A visit to her home.
An e-mail message marked as “urgent”.
A certified letter.
A 26-year-old male presents with a chief complaint of bilateral, intermittent itchy eyes accompanied by rope-like discharge. This is most consistent with conjunctivitis caused by:
Over-exposure to smoke.
When developing a management plan for patients with genitourinary infections, which of the following would you most likely recommend for follow-up imaging following resolution of their infection?
A 27-year-old nonpregnant woman with acute, uncomplicated urinary tract infection (UTI).
A 38-year-old nonpregnant woman with 2 acute, uncomplicated UTIs in the past 9 months.
A 57-year-old man with acute bacterial prostatitis.
A 43-year-old man with type 2 diabetes mellitus and recurrent pyelonephritis.
s. Wang is a 56-year-old female who was seen 2 weeks ago for evaluation of ongoing abdominal discomfort and nausea. Laboratory assessment revealed H. pylori and she was treated for peptic ulcer disease with an appropriate antibiotic/proton-pump inhibitor combination. She returns today and admits to no real change in her symptoms. This suggests that:
Treatment was inadequate and a salvage regimen should be used.
It is too soon to expect a response and the patient should be reevaluated in four weeks.
The patient could have complicated peptic ulcer disease and should be referred for endoscopy.
Peptic ulcer disease is likely not the correct diagnosis.
The NP is called to evaluate Jane, a 43-year-old woman, who presents with a diffuse maculopapular rash that began on the trunk but now covers the entire body, including the palms and soles. The rash is not itchy but wart-like sores are present in the mouth and genital area as well as skin folds. Initial evaluation reveals generalized lymphadenopathy and a low-grade fever, and she complains of lethargy and headache. The patient reports that she had a painless genital ulcer that healed on its own about 3 weeks earlier. Which of the following is the most likely diagnosis?
A 27-year-old man presents with a chief concern of an abnormal mass within his left scrotum. He describes it as feeling like a “bag of worms” and is present when he is standing but disappears when he lies down. His past medical history is unremarkable and his BMI is 29 kg/m 2 . He has been in a monogamous relationship for the past 4months. The most likely diagnosis is:
An 18-year-old man is being evaluated for a severe exacerbation of asthma. He is currently taking an inhaled corticosteroid, a long-acting beta-agonist, and a short-acting beta-agonist on an as needed basis. The most important component of the initial assessment includes a(n):
Continuous pulse oximetry reading
Peak expiratory flow reading
Arterial Blood Gas
A 67-year-old man is being evaluated for shortness of breath. His medical history reveals that he experienced a myocardial infarction about 2 years ago and a history of hypertension, which is well controlled by diet.. Otherwise, his medical history is unremarkable. Which of the following would you expect to find on electrocardiogram (ECG)?
T wave inversion.
Pathologic Q wave.
ST segment elevation.
Tall R wave.
A 46-year-old man is rushed to the emergency department while experiencing an acute adrenal crisis that presents with abdominal pain, severe vomiting, and low blood pressure. He appears cyanotic and confused. The most appropriate treatment for this patient is an injection of:
A 74-year-old male with asymptomatic atrial fibrillation underwent electrical cardioversion that successfully restored the heart’s rhythm. Which of the following medications can be considered for the purpose of maintaining the heart’s rhythm?
Sotalol (Betapace ® )
Digoxin (Lanoxin ® )
Dabigatran (Pradaxa ® )
Enalapril (Vasotec ® )
In considering the use of an inhaled anticholinergic, such as tiotropium bromide (Spiriva ® ), for the treatment of chronic obstructive pulmonary disease (COPD), the NP recognizes which of the following is the desired therapeutic action?
Increases mucociliary clearance.
A 14-year-old male is brought in for evaluation after he reportedly collapsed during a tennis match, though he quickly regained consciousness. His medical history is otherwise unremarkable. You suspect hypertrophic cardiomyopathy. Which of the following heart murmur characteristics would support the diagnosis?
Occurs late in systole.
Widely split S₂.
Becomes louder when going from a supine to standing position.
Murmur follows mid-systolic click.
You see a 64-year-old man with an area of erythema concentrated on the left side of his neck with clusters of vesicles forming a line. He reported pain in the area a couple of days before the eruption of the lesions. He states that he recently initiated biologic therapy for rheumatoid arthritis. Which of the following is the most likely diagnosis?
Drug-related adverse reaction.
Gary is a 63-year-old African American male who has been treated for hypertension with ACE inhibitor monotherapy for the past 6 weeks. Despite Gary’s insistence that he is taking his medication as directed, his blood pressure continues to be elevated. Gary mentions that he prefers not having to take multiple medications each day due to cost and convenience. Which of the following is the most appropriate course of action?
Continue with the current regimen as the full effects are not observed until about 8 weeks of treatment.
Add an angiotensin receptor blocker (ARB) to the regimen.
Switch to a beta blocker.
Switch to a calcium channel blocker.
An NP’s duty of care can be established:
Only in the setting of a healthcare institution (e.g., hospital, clinic, etc.).
When the NP gives professional advice or treatment in any setting.