Synthesis in Advanced Nursing Practice of Patients in Primary Care Settings

Synthesis in Advanced Nursing Practice of Patients in Primary Care Settings

NRNP-6565-4-Synth Adv Nurs Prac Care

1. Comprehensive Practice
2. Begin: Quiz – Week 4 Comprehensive Practice

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Question 1

Jay is a 72 y/o male who comes to the clinic with the following chief complaint: “I have been feeling very tired recently and having trouble breathing when I go upstairs. I noticed that my ankles and feet are swollen and I have been putting on weight.” Treatment for Jay’s diagnosis could include which of the following?

		Diuretics
		Calcium channel blockers
		Beta blockers
		All of the above
		A & C only

D

Andrew is a 37 y/o male who comes to the clinic with the following symptoms: insomnia, feelings of worthlessness, and being easily fatigued. Given his symptoms the most likely diagnosis would be:

		Major depression
		Minor depression
		Suicidal ideation
		Anxiety

A

Mike is a 22 y/o male who comes to your clinic with a 5-day history of cough without sputum production. He states that his cough is worse in the morning and he has some hoarseness, post-nasal drip, and a low-grade fever. Mike has otherwise been healthy. Differentials for Mike might include which of the following?

		Pneumonia
		Sinusitis
		COPD
		All of the above
		A & B only

D

John is a 26 y/o Caucasian male who works as a landscaper for his father’s business. During the past couple of months, he has noticed a small dark popular lesion on his neck. He states that it sometimes bleeds and is a “sore that never heals.” The NP notes that he has a circumscribed 2mm lesion at the base of his neck just below the hairline. The NP’s diagnostic impression is that this is probably:

		Squamous cell carcinoma
		Basal cell carcinoma
		Melanoma
		Malar lupus

B

The typical ratio of basal to bolus insulin is:

		70:30 or 55:45
		50:50 or 60:40
		40:60 to 45:55
		None of the above

D

Andre is a 52 y/o construction worker who stayed home today because he was having severe chest pain. His wife calls the clinic and describes his symptoms as: squeezing chest tightness, with pain that radiates to the left side of his neck, jaw, and left arm. The NP’s immediate response should be to tell the wife:

		Begin CPR and then call 911.
		Call 911 immediately.
		Have the wife drive the patient to the ER.
		Call back if the intensity of the pain increases.

B

Joan is a 39 y/o female who presents to the clinic with a chief complaint of: 3-day history of fever (101 F degrees), chills, n & v, and flank pain. During the physical exam, the NP notices that Joan has CVA tenderness. In a urine check, the NP notes that she has many leukocytes, hematuria, WBC casts, and mild proteinuria. The most likely diagnosis is:

		Acute pyelonephritis
		Nephrolithiasis
		Simple UTI
		None of the above

A

Joan is a 39 y/o female who presents to the clinic with a chief complaint of: 3-day history of fever (101 F degrees), chills, n & v, and flank pain. During the physical exam, the NP notices that Joan has CVA tenderness. In a urine check, the NP notes that she has many leukocytes, hematuria, WBC casts, and mild proteinuria. Complications for Joan would include all the following except:

		Shock
		Renal failure
		Gram-positive septicemia
		None of the above

D

Once cervical cancer screening is initiated in women, the screening interval should be:

		Every 2 years
		Every 3 years
		Every 4 years
		Every 5 years

B

Andrew, a 41 y/o male resident of Oklahoma, presents to the clinic in July with the following symptoms: fever, chills, severe headache photophobia, and myalgia. He states that since his fever occurred 2 days ago, he now has this rash of petechiae on wrists, forearms, and ankles. The first line pharmacological treatment for Andrew would include:

		Chloramphenicol
		Doxycycline
		Ampicillin
		Penicillin

B

Dylan is a 22 y/o Type 1 diabetic. He eats 40 grams of carbohydrates for lunch. If he follows the 450 Rule, and wants to dose himself with Rapid Acting Insulin (RA) to compensate for the increased carbohydrates, then he would give himself how much RA insulin:

		1 unit
		2 units
		3 units
		4 units

D

John is a 26 y/o Caucasian male who works as a landscaper for his father’s business. During the past couple of months, he has noticed a small dark popular lesion on his neck. He states that it sometimes bleeds and is a “sore that never heals.” The NP notes that he has a circumscribed 2mm lesion at the base of his neck just below the hairline. The most appropriate treatment for John’s lesion would be:

		Apply Aldara Cream
		Electrocautery
		Mohs surgery
		“Watch and wait”

C

Mark is an alcoholic who is stopped for drunk driving. When the officers approach him he states that he wants to die. The officers decide that for his own protection they will Baker Act him. The Baker Act allows for involuntary detention for what period.

		Until the person sobers up
		48 hours
		72 hours
		96 hours

C

Vulvovaginitis in the vulva and vagina can be caused by which of the following organisms?

		Bacteria
		Fungi
		Protozoa
		All of the above
		None of the above

C

Andrew, a 41 y/o male resident of Oklahoma, presents to the clinic in July with the following symptoms: fever, chills, severe headache photophobia, and myalgia. He states that since his fever occurred 2 days ago, he now has this rash of petechiae on wrists, forearms, and ankles. The NP, based on these data, diagnoses Andrew with:

		Rocky Mountain Spotted Fever (RMSF)
		Atopic dermatitis
		Erythema migrans
		Brown recluse spider bite

A

Mike is a 22 y/o male who comes to your clinic with a 5-day history of cough without sputum production. He states that his cough is worse in the morning and he has some hoarseness, post-nasal drip, and a low-grade fever. Mike has otherwise been healthy. Based on these symptoms Mike’s likely diagnosis is:

		Acute bronchitis
		Chronic bronchitis
		Emphysema
		Flu

A

Martin is a 17y/o male who comes to the clinic with the following chief complaint: “I have pain around my belly button and have had no appetite for the past 24 hours. I have had some nausea and have vomited three times. I have had a low-grade fever also.” During the clinical exam, the NP notices that Martin has some guarding and rebound tenderness in the RLQ. The most likely diagnosis for this patient is:

		Acute appendicitis
		Cholecystitis
		Acute diverticulosis
		Acute pancreatitis

A

Joan is a 39 y/o female who presents to the clinic with a chief complaint of: 3-day history of fever (101 F degrees), chills, n & v, and flank pain. During the physical exam, the NP notices that Joan has CVA tenderness. In a urine check, the NP notes that she has many leukocytes, hematuria, WBC casts, and mild proteinuria. Follow-up for Joan would be needed in what period?

		6–12 hours
		12–24 hours
		24–36 hours
		48 hours

B

Bonnie is a 76 y/o female patient who resides in a nursing home. She is currently on a 10-day course of Clindamycin for a recurrent bacterial vaginal infection. She has started having 10–15 watery stools per day. The NP recognizes this as:

		Crohn’s disease
		Ulcerative colitis
		Clostridium difficile colitis
		None of the above

C

Martin is a 41 y/o male who comes to the clinic with the following symptoms: fever, chills, and malaise. On physical exam, the NP notes that he has a new murmur that was not present at his last visit and is aware that he has a prosthetic valve. He also has splinter hemorrhages on his nails, and petechiae on his palate. Based on these finding alone the NP arrives at the following presumed diagnosis:

		Congestive heart failure
		Infective endocarditis
		Dissecting abdominal aortic aneurysm (AAA)
		None of the above

B

Mike is a 22 y/o male who comes to your clinic with a 5-day history of cough without sputum production. He states that his cough is worse in the morning and he has some hoarseness, post-nasal drip, and a low-grade fever. Mike has otherwise been healthy. Treatment for Mike’s condition would include all the following except:

		Rest
		Mucolytics
		Antibiotics
		Increased fluid intake

C

Jane is a 57 y/o female whose husband of 35 years just passed away in the past 6 months. Jane comes to the clinic and says: “I cry all the time. I can’t sleep, I have no energy, I have lost 20 pounds in the past 2 months, and I get easily agitated. What’s wrong with me?”

		Anxiety
		Minor depression
		Major depression
		None of the above

C

Joan is a 39 y/o female who presents to the clinic with a chief complaint of: 3-day history of fever (101 F degrees), chills, n & v, and flank pain. During the physical exam, the NP notices that Joan has CVA tenderness. In a urine check, the NP notes that she has many leukocytes, hematuria, WBC casts, and mild proteinuria. Pharmacological treatment for Joan could include which of the following drugs:

		Fluoroquinolone
		Ceftriaxone
		Ciprofloxacin
		All of the above
		A & C only

C

Diagnostic studies for Type II diabetes mellitus would include which of the following:

		HbA1C (>6.5%)
		Fasting plasma glucose (= to or >126 mg/dL)
		Random plasma glucose (>200 mg/dL)
		All of the above
		None of the above

C

Risk factors for Alcohol Use Disorder include which of the following?

		Family history
		Stressful life events
		Low socioeconomic status
		All of the above
		A & B only

C

Adela is a 38 y/o overweight female who presents to the clinic with RUQ pain that occurs approximately 1 hour after eating a fatty meal. The most likely diagnosis for Adela is:

		Acute pancreatitis
		Acute cholecystitis
		Crohn’s disease
		Ulcerative colitis

B

According to the U.S. Preventive Task Force, screening for cervical cancer should not begin in women before the age of:

		30 y/o or younger
		35 y/o or younger
		20 y/o or younger
		40 y/o or younger

C

Martin is a 17 y/o male who comes to the clinic with the following chief complaint: “I have pain around my belly button and have had no appetite for the past 24 hours. I have had some nausea and have vomited three times. I have had a low-grade fever also.” During the clinical exam, the NP notices that Martin has some guarding and rebound tenderness in the RLQ. In the physical exam, the NP performs some abdominal maneuvers. What would be the most appropriate maneuvers for Martin’s symptomatology?

		Psoas sign
		Obturator sign
		Rovsing’s sign
		Murphy’s sign
		A & B only

D

Jay is a 72 y/o male who comes to the clinic with the following chief complaint: “I have been feeling very tired recently and having trouble breathing when I go upstairs. I noticed that my ankles and feet are swollen and I have been putting on weight.” The most likely diagnosis for this patient is:

		Acute myocardial infarction (AMI)
		Infective endocarditis
		Congestive heart failure (CHF)
		Dissecting abdominal aortic aneurysm (AAA)

C

Bobby is a 20 y/o African American male who comes to the clinic with the following presentation. His BMI is >85% for his age and sex. His PMH indicates hypertension, hyperlipidemia, and acanthosis nigricans. Based on his PMH and presenting symptoms, the NP would most likely be inclined to identify him as having:

		Pheochromocytoma
		Type 1 diabetes mellitus
		Type 2 diabetes
		None of the above

C