Week 10 Final Exam
1. In AR disorders, carriers have:
A. Two mutated genes; two from one parent that cause disease
B. A mutation on a sex chromosome that causes a disease
C. A single gene mutation that causes the disease
D. One copy of a gene mutation but not the disease
Answer: D. One copy of a gene mutation but not the disease
2. A 76-year-old patient with a 200-pack year smoking history presents with complaints of
chronic cough, dyspnea, fatigue, haemoptysis, and weight loss over the past 2 months. The
physical exam reveals decreased breath sounds and dullness to percussion over the left lower
lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left.
These are classic signs of:
A. Lung cancer
B. Tuberculosis
C. Pneumonia COPD
Answer: A. Lung cancer
3. The nurse practitioner is discussing lifestyle changes with a patient diagnosed with
gastroesophageal reflux. What are the nonpharmacological management interventions that
should be included?
Answer: It will be helpful to keep the head of your bed elevated on blocks
4. In examining the mouth of an older adult with a history of smoking, the nurse practitioner
finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for
pathology. Which is the most common oral precancerous lesion?
Answer: leukoplakia
5. You have a patient complaining of vertigo and want to know what could be the cause.
Knowing there are many causes for vertigo, you question the length of time the sensation
lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss.
You suspect which of the following conditions?
A. Ménière’s disease
B. Benign paroxysmal positional vertigo
C. Transient ischemic attack (TIA)
D. Migraine Definition
Answer: A. Ménière’s disease
6. Age-related changes in the bladder, urethra, and ureters include all of the following in
older women except:
A. Increased estrogen production’s influence on the bladder and ureter
B. Decline in bladder outlet function
C. Decline in ureteral resistance pressure
D. Laxity of the pelvic muscle
Answer: A. Increased estrogen production’s influence on the bladder and ureter
7. Your patient has been using chewing tobacco for 10 years. On physical examination, you
observe a white ulceration surrounded by erythematous base on the side of his tongue. The
clinician should recognize that very often this is
A. Malignant melanoma
B. Squamous cell carcinoma
C. Aphthous ulceration
D. Behcet’s syndrome Definition
Answer: B. Squamous cell carcinoma
8. When interpreting laboratory data, you would expect to see the following in a patient with
Anaemia of Chronic Disease (ACD)
A. Haemoglobin 12 g/dl, MCV increased, MCH increased
C. Haemoglobin 12 g/dl, MCV decreased, MCH increased
Answer: C. Haemoglobin 55
C. There is low incidence of cellulitis in patients with diabetes
D. Cellulitis is only a disease of the lower extremities of patients with known arterial
insufficiency
Answer: B. Facial cellulitis is more common in people >55
69. When teaching a group of older adults regarding prevention of gastroesophageal reflux
disease symptoms, the nurse practitioner will include which of the following instructions?
A. Raise the head of the bed with pillows at night and chew peppermints when symptoms of
heartburn begins.
B. Raise the head of the bed on blocks and take the proton pump inhibitor medication at
bedtime.
C. Sit up for an hour after taking any medication and restrict fluid intake.
D. Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor
before a meal.
Answer: B. Raise the head of the bed on blocks and take the proton pump inhibitor
medication at bedtime.
70. Which of the following descriptions accurately documents cellulitis?
A. Cool, erythematous, shiny hairless extremity with decreased pulse
B. Scattered, erythematous ring-like lesions with clear centers
C. Clearly demarcated, raised erythematous area of face
D. Diffusely inflamed skin that is warm and tender to palpation
Answer: D. Diffusely inflamed skin that is warm and tender to palpation
71. Aortic regurgitation requires medical treatment for early signs of CHF with:
A. Beta blockers
B. ACE inhibitors
C. Surgery
D. Hospitalization
Answer: B. ACE inhibitors
72. Your 77-year-old patient complains of frequent urination, hesitation in getting the stream
started, and nocturnal frequency of urination that is bothersome. On DRE, there is an
enlarged, firm, non-tender, smooth prostate. The clinician should recognize these as
symptoms of:
A. Benign prostatic hyperplasia (BPH)
B. Prostate cancer
C. Acute prostatitis
D. Urinary tract infection (UTI)
Answer: A. Benign prostatic hyperplasia (BPH)
73. When evaluating the expected outcome for a hypothyroid elderly patient placed on
levothyroxine, the nurse practitioner will
A. Assess a weekly TSH
B. Assess the TSH in 4-6 weeks
C. Ask the patient if the symptoms have subsided and adjust dosage accordingly
D. Decrease the dosage should a cardiac event occur
Answer: B. Assess the TSH in 4-6 weeks
74. When a patient presents with a skin-related complaint, it is important to first:
A. Fully inspect all skin lesions before asking the patient how the lesion in question
developed
B. Obtain a full history about the development of the skin lesion prior to the physical
examination
C. Complete a full physical examination of the body prior to inspecting the skin lesion
D. Examine the skin lesion without hearing a health history in order to not prejudice the
diagnosis
Answer: B. Obtain a full history about the development of the skin lesion prior to the
physical examination
75. Your 70-year-old patient has gastroesophageal reflux disease (GERD). After a trial of
lifestyle modifications and antacids, the patient continues to have occasional mild heartburn
after occasional meals and at night. The most appropriate next action is:
A. Prokinetic agents
B. H2 antagonists
C. Proton pump inhibitors
Answer: C. Proton pump inhibitors
76. Patients who have an underlying tinea infection to the cellulitis should also be treated
with which one of the following?
A. An anti-fungal medication
B. Topical steroids
C. Oral steroids
D. Zinc oxide
Answer: A. An anti-fungal medication
77. Which of the following is considered a “red flag” when diagnosing a patient with
pneumonia?
A. Fever of 102
B. Infiltrates on chest x-ray
C. Pleural effusion on chest x-ray
D. Elevated white blood cell count
Answer: C. Pleural effusion on chest x-ray
78. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin
treatment with corticosteroids until the condition has resolved. You look over her records and
it has been 2 years since her last physical examination and any laboratory or diagnostic tests
as she relocated and had not yet identified a healthcare provider. In prioritizing your
management plan, your first orders should include:
A. Recommending she increase her dietary intake of Calcium and Vitamin D
B. Ordering once a year bisphosphonate and a proton pump inhibitor
C. Participate in a fall prevention program
D. Dual-energy X-ray (DEXA) scan and updating immunizations
Answer: D. Dual-energy X-ray (DEXA) scan and updating immunizations
79. The first assessment to complete related to the eyes is
A. Eye lids
B. Visual acuity
C. Extraocular movements
D. Peripheral vision
Answer: B. Visual acuity
80. The major impact of the physiological changes that occur with aging is :
A. Reduced physiological reserve
B. Reduced homeostatic mechanisms
C. Impaired immunological response
D. All of the above
Answer: D. All of the above
81. Which of the following describes the pathology of De Quervain’s tenosynovitis?
A. Irritation of a tendon located on the radial side of the wrist, near the thumb
B. Impingement of the median nerve, causing pain in the palm and fingers
C. Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist
D. Ulnar nerve compression at the olecranon process
Answer: A. Irritation of a tendon located on the radial side of the wrist, near the thumb
82. A patient complains of fever, fatigue, and pharyngitis. On physical examination there is
pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be
considered?
A. Mono spot
B. Strep test
C. Throat culture
D. All of the above
Answer: D. All of the above
83. On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but
asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis.
The patient’s PSA is within normal limits for the patient’s age. The clinician should
A. Defi Refer the patient for transrectal ultrasound guided prostate biopsy
B. Obtain an abdominal X-ray of kidneys, ureter, and bladder
C. Recognize this as a normal finding that requires periodic follow up
D. Obtain urine culture and sensitivity for prostatitisnition
Answer: C. Recognize this as a normal finding that requires periodic follow up
84. Your 35-year-old female patient complains of feeling palpitations on occasion. The
clinician should recognize that palpitations are often a sign of
A. Anaemia
B. Anxiety
C. Hyperthyroidism
D. All of the above
Answer: D. All of the above
85. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney
disease or elevated bleeding risk):
A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days
B. Doxycycline 100 mg BID for 5 days
C. Prednisolone 35 mg QD for 5 days
D. Ice therapy
Answer: A. Indomethacin 50 mg TID for 2 days; then 25 mg TID for 3 days
86. Mr. Andrews experienced a brief onset of right-sided weakness, slurred speech, and
confusion yesterday. The symptoms have resolved. What should the nurse practitioner do?
A. Assure the patient that he will not experience the symptoms again
B. Identify modifiable cardiovascular risk factors
C. Do a thorough medication review and a CT scan
D. Order a stat EEG and administer O2 by mask
Answer: C. Do a thorough medication review and a CT scan
87. Emphysematous changes in the lungs produce the following characteristic in COPD
patients?
A. Asymmetric chest expansion
B. Increased lateral diameter
C. Increased anterior-posterior diameter
D. Pectus excavatum
Answer: C. Increased anterior-posterior diameter
88. Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to
what intervals?
A. Every 6 months
B. Yearly
C. Every 2 years
D. Every 2 to 4 years
Answer: C. Every 2 years
89. A 43-year-old female was in a bicycling accident and complains of severe pain of the
right foot. The patient limps into the emergency room. On physical examination, there is no
point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except
at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an X-ray
of the feet be ordered?
A. Yes, there is tenderness over the fifth metatarsal
B. No, there is not tenderness over the navicular bone
C. Yes, the patient cannot bear weight on the foot
D. A and C
Answer: D. A and C
90. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her
hands that has gradually worsened over the last few weeks. She reports that pain, stiffness,
and swelling of her hands are most severe in the morning. On physical examination, you note
swelling of the metacarpophalangeal joints bilaterally. These are common signs of:
A. Osteoarthritis
B. Rheumatoid arthritis
C. Scleroderma
D. Sarcoidosis
Answer: B. Rheumatoid arthritis
91. A 65-year-old male complains of a headache that feels “like a knife is cutting into his
head.” He also reports feeling right-sided scalp and facial pain and “seeing double” at times.
He has a history of hypertension and hyperlipidaemia. His medications include beta blocker,
statin drug, and an ACE inhibitor. On physical examination, you note palpable tenderness
over the right side of the forehead. There are no neurological deficits. Vision is 20/20 with
lenses. No weakness of extremities. CN II to XII are intact. The history corresponds to which
of the following disorders?
A. Drug toxicity
B. Giant cell arteritis
C. Cluster headache
D. Migraine headache
Answer: B. Giant cell arteritis
92. A 62-year-old female complains of fatigue and lack of energy. Constipation has increased
and the patient has gained ten pounds in the past 3 months. Depression is denied although the
patient reports a lack of interest in usual hobbies. Vital signs are within normal limits and the
patient’s skin is dry and cool. Which of the following must be included in the differential?
A. Hyperthyroidism
B. Hypothyroidism
C. Hyperparathyroidism
D. Grave’s disease
Answer: B. Hypothyroidism
93. A 20-year-old male construction worker is experiencing new onset of knee pain. He
complains of right knee pain when kneeling, squatting, or walking up and down stairs. On
physical examination, there is swelling and crepitus of the right knee and obvious pain with
resisted range of motion of the knee. He is unable to squat due to pain. Which of the
following disorders should be considered in the differential diagnosis?
A. Joint infection
B. Chondromalacia patella
C. Prepatellar bursitis
D. All of the above
Answer: D. All of the above
94. Your 55-year-old male patient presents to your office with complaints of sudden
development of severe right sided, colicky lower abdominal pain. He cannot sit still on the
examining table. The patient has previously been in good health. On physical examination,
there are no signs of peritoneal inflammation. A urine sample reveals haematuria and
crystalluria. Which is the next diagnostic test that should be done immediately?
A. Ultrasound of the abdomen
B. Abdominal x-ray
C. Digital rectal examination
D. Spiral CT scan
Answer: D. Spiral CT scan
95. A 62-year-old woman presents with a recurrent urinary tract infection. She now has a
fever of 104°F and severe costovertebral tenderness with pyuria. What is the appropriate
diagnosis and intervention for this patient?
A. Septic arthritis and oral prednisolone is indicated
B. Pyelonephritis and hospitalization is required
C. Recurrent cystitis and 10 days of antibiotics are needed
D. Pelvic inflammatory disease and 7 days of antibiotics are indicated
Answer: B. Pyelonephritis and hospitalization is required
96. Which of the following is not a contributing factor to the development of esophagitis in
older adults?
A. Increased gastric emptying time
B. Regular ingestion of NSAIDs
C. Decreased salivation
D. Fungal infections such as Candida
Answer: A. Increased gastric emptying time
97. An older adult male presents with pain in his right chest wall for the past 48 hours. Upon
examination, the nurse practitioner notices a vesicular eruption along the dermatome and
identifies this as herpes zoster. The NP informs the gentleman that:
A. All symptoms should disappear within three days
B. Oral medications can dramatically reduce the duration and intensity of his symptoms
C. He has chickenpox and can be contagious to his grandchildren
D. He has a sexually transmitted disease
Answer: B. Oral medications can dramatically reduce the duration and intensity of his
symptoms
98. Which test is the clinical standard for the assessment of aortic stenosis?
A. Cardiac catheterization
B. Stress test
C. Chest X-ray
D. Echocardiography
Answer: D. Echocardiography
