• February 5th, 2019

Week 5 Midterm NSG 6420

Paper, Order, or Assignment Requirements

 A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of
Digital rectal examination
      Endoscopy
      Pelvic examination
      UrinalysisDefinition
Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients?
A Clinical practice guideline
    b  Clinical decision rule
    c  Clinical algorithm
    d  Clinical recommendation
A common auscultatory finding in advanced CHF is
    S3 gallop rhythm
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.

The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point?
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?
Def Mono spot
      Strep test
      Throat culture
      All of the above
Which of the following is not a contributing factor to the development of esophagitis in older adults?
Essential parts of a health history include all of the following except:
What test is used to confirm the diagnosis of appendicitis?
The first assessment to complete related to the eyes is
      Eye lids
      Visual acuity
      Extraocular movements
      Peripheral vision
The best way to diagnose structural heart disease/dysfunction non-invasively is
Chest X-ray
              EKG
        CORRECT  Echocardiogram
              Heart catheterization
Which of the following is considered a “red flag” when diagnosing a patient with pneumonia
Fever of 102
    Infiltrates on chest X-ray
    Pleural effusion on chest X-ray
    Elevated white blood cell count
In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen?
Left upper quadrant
      Right upper quadrant
      Left lower quadrant
      Right lower quadrant
Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms
Acute MI
      GERD
      Pneumonia
      Angina
In autosomal recessive (AR) disorders, individuals need
Only one mutated gene on the sex chromosomes to acquire the disease
      Only one mutated gene to acquire the disease
      Two mutated genes to acquire the disease
      Two mutated genes to become carriers
Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process?
chronic bronichitis
The best evidence rating drugs to consider in a post myocardial infarction patient include:
ASA, ACE/ARB, beta-blocker, aldosterone blockade
      ACE, ARB, Calcium channel blocker, ASA
      Long-acting nitrates, warfarin, ACE, and ARB
      ASA, clopidogrel, nitrates
A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, 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:
Lung cancer
    Tuberculosis
    Pneumonia
    COPD
Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to
      Pneumothorax
      Pleural effusion
      Pneumonia
      Pulmonary embolism
A patient presents with eye redness, scant discharge, and a gritty sensation. Your examination reveals the palpable preauricular nodes, which are most likely with:
Bacterial conjunctivitis
B.  Allergic conjunctivitis
C.  Chemical conjunctivitis
D.  Viral conjunctivitis
Emphysematous changes in the lungs produce the following characteristic in COPD patients?
Asymmetric chest expansion
      Increased lateral diameter
      Increased anterior-posterior diameter
      Pectus excavatum
An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD?
A.  Identification of a fluid wave
B.  Positive Murphy’s sign
C.  Palpable spleen
D.  Midepigastric pain that is not reproducible with palpation
Which of the following details are NOT considered while staging asthma?
A.  Nighttime awakenings
B.  Long-acting beta agonist usage
C.  Frequency of symptoms
D.  Spirometry findings
The cytochrome p system involves enzymes that are generally Inhibited by drugs :
    Inhibited by drugs
    Induced by drugs
    Inhibited or induced by drugs
    Associated with decreased liver perfusion
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.

Of the following lab studies, which would provide little help in determining your differential diagnosis?
      Abdominal plain films
      Liver function tests
      Amylase/lipase
      Urinalysis
Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of:
Angina
      Pericarditis
      Mitral valve prolapse
      Congestive heart failur
Men have faster and more efficient biotransformation of drugs and this is thought to be due to:
    Less obesity rates than women
    Prostate enlargement
    Testosterone
    Less estrogen than women
An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is:
Mallory-Weiss tear
B.  Esophageal varices
C.  Gastric ulcer
D.  Colon cancer
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?
Ménière’s disease
            Benign paroxysmal positional vertigo
            Transient ischemic attack (TIA)
            MigraineDefinition
. Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient?
Checking the macula
      Estimating cup-to-disk ratio

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