Midterm Exam ANP 652

Midterm Exam ANP 652

1 Patients with central nervous system injury may commonly have a specific type of gastric ulcer known as (select the best answer):

Curling’s ulcer

 

 

Duodenal ulcer

 

 

H. pylori ulcer

 

 

Barrett’s ulcer

 

 

 

Question Points: 1.0 / 1.0

 

 

2 How do you differentiate a cholinergic crisis from a myasthenia crisis? Select the best answer.

Perform a Tensilon (edrophonium) test.

 

 

Order a stat plasmapheresis trial.

 

 

Obtain a stat cortisol stimulation test.

 

 

Administer rapid immunomodulating therapies (IVIG).

 

 

 

Question Points: 1.0 / 1.0

 

 

3 Complications of giant cell arteritis include:

Uveitis

 

 

Arthritis

 

 

Blindness

 

 

Hemiparesis

 

 

 

Question Points: 1.0 / 1.0

 

 

4 On the Folstein Mini-Mental State Exam, the maximum score is 30, but a score of 23 or less indicates _____.

Cognitive impairment

 

 

Mental retardation

 

 

Alzheimer’s dementia

 

 

Parkinson’s dementia

 

 

 

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5 Atypical antipsychotics like Seroquel, Zyprexa, and Risperdol are the preferred treatments for dementia-related aggression.

True  False

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6 A 67-year-old male with a past medical history significant for lung cancer is admitted with sepsis. On assessment, you notice petechiae and bruising. Which of the following statements about DIC is not true?

Results from activation of the clotting cascade and results in clotting factor consumption.

 

 

Diffuse clothing occurs simultaneously with bleeding.

 

 

Heparin may improve lab parameters, but may aggravate bleeding.

 

 

Lab results indicate increased platelet, increased fibrinogen, and prolonged PT/INR.

 

 

 

Question Points: 0.0 / 1.0

 

 

7 Rickettsial infections include which of the following:

Rocky Mountain spotted fever and Q fever

 

 

Malaria and toxoplasmosis

 

 

Histoplasmosis and cryptococcosis

 

 

Epstein-Barr virus and cytomegalovirus

 

 

 

Question Points: 1.0 / 1.0

 

 

8 A 20-year-old female has periodic episodes that begin with decreased vision that lasts for about 30 minutes and is followed by a throbbing occipital headache. Which of the following is the most likely diagnosis?

Migraine

 

 

Vertebral-basilar insufficiency

 

 

Tension headache

 

 

Panic attack

 

 

 

Question Points: 1.0 / 1.0

 

 

9 Conductive hearing loss and sensorineural hearing loss are common in the elderly. What are three differential diagnoses for sensorineural hearing loss to include the most common pattern?

Barotraumas, viral cochleitis, osteoma

 

 

Acoustic neuroma, ototoxic drugs, presbycusis

 

 

Exostosis, meningioma, vascular disease

 

 

Presbycusis, trauma, Paget’s disease

 

 

 

Question Points: 1.0 / 1.0

 

 

10 Fever of unknown origin, by definition, is a fever of 101 Fahrenheit or greater rectally persisting over at least how many weeks?

2 weeks

 

 

3 weeks

 

 

1 week

 

 

6 weeks

 

 

 

Question Points: 1.0 / 1.0

 

 

11 Brain death criteria vary from state to state and involve the absence of breathing, absence of spontaneous movement, and several other neurological findings. Ancillary tests to prove brain death include all of the following except:

Transcranial Doppler

 

 

Electroencephalography

 

 

Cerebral blood flow study

 

 

Nerve conduction studies

 

 

 

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12 The classic triad of Parkinson’s includes all of the following except:

Resting tremor

 

 

Rigidity arms, legs, and neck stiffness

 

 

Bradykinesia

 

 

Severe cognitive deficits

 

 

 

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13 Focal seizures are often accompanied by automatisms, which are behaviors that include all of the following except:

Lip smacking

 

 

Picking at clothes

 

 

Chewing

 

 

Scratching

 

 

 

Question Points: 1.0 / 1.0

 

 

14 Loss of central vision is a hallmark of:

Macular degeneration

 

 

Glaucoma

 

 

Retinal detachment

 

 

Cataracts

 

 

 

Question Points: 1.0 / 1.0

 

 

15 Which of the following diseases cause degeneration or loss of nerve cells in the brain?

Alzheimer’s, Parkinson’s, and Huntington’s

 

 

Sepsis, chronic kidney disease, and scleroderma

 

 

Rheumatoid Arthritis, Alzheimer’s, and Scleroderma

 

 

Parkinson’s, B12 deficiency, and Myasthenia Gravis

 

 

 

Question Points: 1.0 / 1.0

 

 

16 Immunologic mediators that play a role in the pathophysiology of fever include all of the following except:

Interleukin 1 – primary

 

 

Interleukin 2

 

 

Interleukin 6

 

 

Tumor necrosis factor

 

 

 

Question Points: 1.0 / 1.0

 

 

17 The most common causes of fever in a geriatric patient include all of the following except:

Malignancies

 

 

Medication effect

 

 

Connective tissue disorders (rheumatoid arthritis, sarcoidosis, temporal arteritis)

 

 

Sexually transmitted infections (chlamydia, herpes)

 

 

 

Question Points: 1.0 / 1.0

 

 

18 Anemia is the reduction of one or more of the following major red blood cell measurements:

Hemoglobin, hematocrit, RBC count

 

 

B12, folic acid, hemoglobin

 

 

Hemoglobin, folic acid, fibrinogen

 

 

Hemoglobin, RBC, and B12

 

 

 

Question Points: 1.0 / 1.0

 

 

19 Areas of occult infection include:

Sinuses, teeth, central nervous system

 

 

Lung, ear, throat

 

 

Skin, joints, lymph nodes

 

 

Pelvis, abdomen, and chest

 

 

 

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20 A 62-year-old African American male with a past medical history significant for diabetes presents with sudden onset of headache on the right side and blurred vision in his right eye. Fundoscopic exam reveals a deeply cupped optic disc. Which of the following disorders is this patient likely experiencing?

Acute angle-closure glaucoma

 

 

Strabismus

 

 

Bacterial conjunctivitis

 

 

Cataracts

 

 

 

Question Points: 1.0 / 1.0

 

 

21 Dementia is characterized by many things, except:

General decrease in level of cognition

 

 

Behavioral disturbance

 

 

Interference with daily function and independence

 

 

Focused attention to detail and obsession with dates and numbers

 

 

 

Question Points: 1.0 / 1.0

 

 

22 Although the etiology of Guillain-Barre syndrome is largely unknown, which of the following possible triggers for this disease are most likely:

Campylobacter jejuni enteritis, cytomegalovirus, Epstein-Barr, HIV, or mycoplasma infection

 

 

Streptococcus pneumonia, Staph aureus, and E. coli

 

 

Cytomegalovirus, Epstein Barr, strep throat, or thrush

 

 

Any bacterial pneumonia or herpes zoster

 

 

 

Question Points: 1.0 / 1.0

 

 

23 Parasitic infections include which of the following:

Rocky Mountain spotted fever and Q fever

 

 

Malaria and toxoplasmosis

 

 

Histoplasmosis and cryptococcosis

 

 

Epstein-Barr virus and cytomegalovirus

 

 

 

Question Points: 1.0 / 1.0

 

 

24 A 65-year-old patient complains of recurrent temporal headaches, malaise, muscle aches, and low grade fever. The headache is described as superficial tenderness rather than deep pain. Temporal arteritis is suspected. Appropriate treatment is:

Aspirin or acetaminophen every 4 hours as needed for pain and fever

 

 

Refer for a temporal artery biopsy and initiation of oral prednisone

 

 

CT scan of the head and lumbar puncture for CSF evaluation

 

 

A daily three-blocker such as propranolol

 

 

 

Question Points: 1.0 / 1.0

 

 

25 Which of the following lists of medications is generally contraindicated in geriatric patients?

Beers list

 

 

Anticholinergic list

 

 

Universal list

 

 

Alzheimer’s list

 

 

 

Question Points: 1.0 / 1.0

 

 

26 Myasthenia gravis is a disorder of the neuromuscular junction, a pure motor syndrome, caused by an autoimmune attack on the acetylcholine receptor complex at the postsynaptic membrane of the neuromuscular junction. All of the following are true about this disease except (select the best answer):

Ptosis occurs in up to 40% of these patients initially, and eventually in 80% of these patients with disease progression.

 

 

Dysphagia

 

 

Proximal limb weakness with upper limbs more noticeable than lower

 

 

Loss of sensation with weakened or absent reflexes

 

 

 

Question Points: 1.0 / 1.0

 

 

27 The most common causes of fever in a geriatric patient include all of the following except:

Malignancies

 

 

Medication effect

 

 

Connective tissue disorders (rheumatoid arthritis , sarcoidosis, temporal arteritis)

 

 

Sexually transmitted infections (chlamydia, herpes)

 

 

 

Question Points: 1.0 / 1.0

 

 

28 Epidural hematomas are most often associated with the following findings (select the best answer):

Seen in the frontal/temporal region, with an initial loss of consciousness followed by a brief lucid period.

 

 

Seen mostly in occipital area, with complete loss of consciousness, and coma-like presentation.

 

 

Seen mostly in frontal region with no loss of consciousness and subtle, stable neurologic deficits.

 

 

None of the above

 

 

 

Question Points: 1.0 / 1.0

 

 

29 Robert is a 72-year-old male with a past medical history significant for CHF, hypertension, and diabetes, who presents to the ER with a family member who states that Robert has been acting strange lately. Which of the following is an assessment tool most commonly used to screen for dementia?

MMSE

 

 

Tinetti

 

 

Romberg

 

 

GDS

 

 

 

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30 All of the following are correct except:

It is acceptable to treat mild to moderate dementia with Aricept (donepezil) and Exelon (rivastigmine).

 

 

It is acceptable to treat moderate to severe dementia with Namenda.

 

 

It is acceptable to treat mild dementia with Razadyne (galantamine hydrobromide)

 

 

It is acceptable to treat severe dementia with Exelon.

 

 

 

Question Points: 1.0 / 1.0

 

 

31 A 27-year-old female presents with facial congestion, left-side facial pressure, and purulent nasal discharge for 11 days. Fever began 2 days ago. She has been trying OTC medications, but does not seem to be able to get any better. Which of the following is the best treatment option?

Amoxicillin/Clavulanate

 

 

Ciprofloxacin

 

 

Erythromycin

 

 

Doxycycline

 

 

 

Question Points: 1.0 / 1.0

 

 

32 Viral infections include which of the following:

Rocky Mountain spotted fever and Q fever

 

 

Malaria and toxoplasmosis

 

 

Histoplasmosis and cryptococcosis

 

 

Epstein-Barr virus and cytomegalovirus

 

 

 

Question Points: 1.0 / 1.0

 

 

33 A 32-year-old man presents with a 3-day history of fever, headache, and skin rash. Exam reveals positive Kernig and Brudzinski signs, as well as diffuse, erythematous, maculopapular rash. This presentation is most consistent with:

Subarachnoid hemorrhage

 

 

Viral encephalitis

 

 

Epidural hematoma

 

 

Bacterial meningitis

 

 

 

Question Points: 1.0 / 1.0

 

 

34 A spinal injury involving C2-C3 usually results in the following (select the best answer):

Respiratory paralysis and loss of sensation below the mandible

 

 

Quadriplegia and priapism

 

 

Paralysis from the nipple line down with sparing of ventilation and reflexes

 

 

None of the above

 

 

 

Question Points: 1.0 / 1.0

 

 

35 John is a 55-year-old male with a past medical history significant for IBS who presented to ER with knee pain after trauma. He is now POD #2 for knee replacement. His labs this morning indicated a platelet count of 15,000, but CMP and anticoagulation labs are within defined limits. What is the most likely diagnosis?

DIC

 

 

ITP

 

 

TTP

 

 

Cancer

 

 

 

Question Points: 1.0 / 1.0

 

 

36 Tamara is a 68-year-old female with a past medical history significant for CHF and recently found to have DIC in the intensive care unit. Which one of the following is not a therapeutic option?

Heparin

 

 

Amicar or EACA

 

 

Vitamin K

 

 

Platelet transfusion

 

 

 

Question Points: 1.0 / 1.0

 

 

37 Which of the following medications would be most appropriate for the patient who is suffering from neuropathic pain?

NSAID

 

 

Acetaminophen

 

 

Gabapentin

 

 

Morphine

 

 

 

Question Points: 1.0 / 1.0

 

 

38 Patients with central nervous system injuries and paralysis suffer from venous pooling in the legs and orthostatic hypotension. Which of the following represent etiologies for this hypotension?

Increased of skeletal muscle pump

 

 

Impaired sympathetic nervous system

 

 

Impaired parasympathetic nervous system

 

 

Impaired absorption of antihypertensive medications

 

 

 

Question Points: 1.0 / 1.0

 

 

39 Sarah is a 25-year-old female with no significant past medical history who presented to the ER with headache and loss of consciousness. Sarah was playing on a co-ed soccer team. She was doing a diving header to score a goal and accidentally hit her head on the goal post. What is the first diagnostic test to perform on the patient?

Skull x-ray

 

 

EEG

 

 

CBC, PT/INR

 

 

CT head

 

 

 

Question Points: 1.0 / 1.0

 

 

40 A 22-year-old female presents with left ear pain that increases with external ear palpation. She also noticed discharge on her pillow this morning. On physical exam, patient is afebrile and mildly ill-appearing. Otoscopic examination reveals an erythematous and edematous left ear canal with purulent exudates. Which of the following is not the likely causative organism for the patient’s ear pain?

Staphylococcus aureus

 

 

H. influenzae

 

 

Candida albicans

 

 

Pseudomonas aeruginosa

 

 

 

Question Points: 1.0 / 1.0

 

 

41 The diagnostic approach to fever of unknown origin includes a thorough history of all of the following except:

Travel

 

 

Diet

 

 

Animal or insect bites

 

 

Type of birth control, if any

 

 

 

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42 A differential diagnosis for a patient who presents with a severe headache of recent onset, neck stiffness, and fever is:

Subdural hematoma

 

 

Migraines

 

 

Tension headaches

 

 

Meningitis

 

 

 

Question Points: 1.0 / 1.0

 

 

43 Which of the following ethnic groups is at particularly high risk for diabetes?

Hispanic

 

 

Caucasian

 

 

African American

 

 

Native American

 

 

 

Question Points: 1.0 / 1.0

 

 

44 Which of the following has an association with AIDS dementia complex?

“Wet, Wobbly, Whacky”

 

 

CD4 count less than 200

 

 

Exaggerated response to neuroleptics

 

 

Multiple lacunar infarcts

 

 

 

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45 Chronic complications of diabetes include all of the following except:

Neuropathy

 

 

Retinopathy

 

 

Gastroparesis

 

 

Alopecia

 

 

 

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46 To assess the cerebellar functioning in the geriatric patient related to fall risk, the family nurse practitioner would evaluate:

Close eyes and distinguish common odors

 

 

Range of motion of all extremities

 

 

Ability to recall name, year, and place

 

 

Ability to balance on one foot, then the other

 

 

 

Question Points: 1.0 / 1.0

 

 

47 A 60-year-old female patient complains of sudden onset unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding, and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal. Which of the following is the most likely diagnosis?

Bell’s palsy

 

 

Parotiditis

 

 

Trigeminal neuralgia

 

 

Temporal arteritis

 

 

 

Question Points: 1.0 / 1.0

 

 

48 A transient ischemic attack is:

A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 24 hours.

 

 

A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 48 hours.

 

 

A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 72 hours.

 

 

Any stroke-type symptoms that resolve within 1 hour.

 

 

 

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49 Jugular venous oxygen saturation is one way of monitoring brain oxygenation for traumatic brain injuries. The normal values for jugular venous saturation is (select the best answer):

55-70%

 

 

80-100%

 

 

80-90%

 

 

35-55%

 

 

 

Question Points: 1.0 / 1.0

 

 

50 Bone resorption of postmenopausal women can be a key cause in a higher incidence of fractures. A primary cause could be due to:

Prolactin deficiency

 

 

Progesterone deficiency

 

 

Estrogen deficiency

 

 

Dental extractions

 

 

 

Question Points: 1.0 / 1.0