NURSING MISC 3P EXAM QUESTIONS AND ANSWERS

Questions 1

When  performing a visual acuity test,  the nurse practitioner notes 20/30  in the left eye and 20/60  in the right eye.  The next step  is to

A- Have the patient  return  in 2 weeks for a follow-up vision screen

B- Dilate the eyes and  retest

C- Refer the patient  to an ophthalmologist

D- Document this as a normal finding.

Question 2

The American  Psychiatric Association’s Diagnostic and  Statistical Manual Disorder  fifth edition (DMS-5) describes Munchausen Syndrome by proxy as A- A self-inflicted injury to gain attention

B- A caregiver making  up or causing an illness or injury in a person under his or her care

C- An abusive behavior that does not involve the caregiver

D- A situation  in which the abuser is often inattentive and  uncaring toward the victim

Question 3

Symptoms of depression are a side effect of which neurotransmitter medication? [There are 3 categories of neurotransmitters in the brain: small molecules for fast action/excitatory transmission = glutamate & GABA; small molecules for slower modulation of activity = dopamine & serotonin; Peptides = endorphins, cannabindoids, oxytocin)

A- Dopamine

B- B- Gabapentin

C- C- Mu

D- Cortisol

Question 4

The right lymphatic  ducts  drain into what part of the circulatory system? (There are two lymph ducts, the right lymphatic duct and the thoracic duct. The right

drains lymph from the right upper  limb, the right side of thorax,  and the right

halves of head and neck.  The thoracic  duct drains lymph into the circulatory system between the left subclavian and  the left internal jugular veins)

A- Arterial

B- Venous

C- Arteriovenous system

D- Capillary bed

Question 5

Which lesion is dark, raised and  asymmetric with irregular  borders?

A- Nevus (the medical term for a mole. Nevi are  very common. Most people have between 10 and  40. Common nevi are  harmless collections of colored  cells. They

typically appear as small brown, tan, or pink spots)

B- Actinic (a rough,  scaly patch  on your skin that develops from years of exposure to the sun.  It's most commonly  found on your face,  lips, ears, back of your hands, forearms, scalp  or neck)

C- Keratoacanthoma (a dome-shaped lump or tumor that grows  on your skin)

D- Melanoma (the most serious type of skin cancer, develops in the cells (melanocytes) that produce melanin — the pigment that gives your skin its color.  Melanoma is asymmetric, irregular border,  change in color,  change in diameter, and evolved over  time [ABCDE])

Question 6

A pediatric patient  has areas of scaling  on the scalp, with round  patches of alopecia. This clinical finding is consistent with

A- Tinea capitis (Ringworm of the scalp is not really a worm, but a fungal infection. It gets the name  ringworm  because the fungus makes circular

marks on the skin, often  with flat centers and raised borders. Also  called

Tinea capitis, this infection affects your scalp and hair shafts, causing small patches of itchy,  scaly skin)

B- Seborrheic dermatitis (a common skin condition that mainly affects your scalp.

It causes scaly patches, red skin and  stubborn dandruff. Seborrheic dermatitis can  also affect oily areas of the body, such  as the face,  sides of the nose, eyebrows, ears, eyelids and  chest. For infants,  the condition is known as cradle cap  and causes crusty,  scaly  patches on the scalp.)

C- Trichotillomania  (hair-pulling disorder, is a mental disorder that involves recurrent, irresistible  urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop)

D - Alopecia areata (a condition that causes hair to fall out in small patches, which can  be unnoticeable. These patches may connect, however, and  then

become noticeable. The condition develops when the immune  system attacks the

hair follicles, resulting  in hair loss)

Question 7

A patient  with an acute presentation of acute aortic regurgitation (AR) typically presents with sudden severe shortness of breath, lower extremity edema, a rapid

heartbeat, and

A- Dry mouth

B- Chest pain

C- Decreased blood pressure

E - Systolic murmur

Question 8

Which of the following conditions is associated with chronic bloody diarrhea?

A- Irritable bowel syndrome (a common disorder that affects the large  intestine. Signs and  symptoms include cramping, abdominal pain, bloating,  gas, and diarrhea or constipation, or both. IBS is a chronic condition that you'll need to manage long term)

B- Crohn’s disease (an inflammatory bowel disease (IBD). It causes inflammation of your digestive tract, which  can lead to abdominal pain, severe diarrhea,  blood in stool, fatigue, weight loss and malnutrition)

C- Hepatitis A (Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. You're most likely to get hepatitis A from contaminated food or

water or from close contact with a person or object  that's infected.  signs and

symptoms can include: Fatigue, Sudden nausea and  vomiting, Abdominal pain or discomfort,  especially on the upper  right side beneath your lower ribs (by your liver), Clay-colored bowel movements, Loss of appetite, Low-grade fever, Dark urine, Joint pain, Yellowing of the skin and  the whites of your eyes (jaundice), Intense itching)

D- Celiac disease (an immune  reaction to eating  gluten, a protein found in wheat, barley  and  rye. Over time, this reaction damages your small intestine's lining and

prevents it from absorbing some nutrients (malabsorption). The intestinal

damage often causes diarrhea, fatigue,  weight loss,  bloating  and  anemia, and can  lead  to serious complications)

Question 9

Which condition is caused by an insufficient production of intrinsic factor by the gastric mucosa and  vitamin B insufficiency?

A- Diarrhea

B- Pernicious anemia (When your body  can’t make enough healthy red blood cells because it lacks vitamin B-12)

C- Osteoporosis

D- Muscle weakness

Question 10

A 32-year old woman  presents with dull puffiness of the eyes with pronounced non-pitting periorbital edema. This finding is suggestive of what condition?

A- Nephrotic  syndrome (a kidney disorder that causes your body to pass too

much protein in your urine. Nephrotic  syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys  that filter waste and  excess water from your blood. The condition causes swelling, particularly in your feet and ankles, and  increases the risk of other health  problems)

B- Myxedema (severely advanced hypothyroidism. This is a condition that occurs when  your body  doesn’t produce enough thyroid hormone. The

classic skin changes are: swelling of your face, which  can include your

lips, eyelids, and tongue, swelling and thickening of skin anywhere on your body,  especially in your lower legs)

C- Cushing’s syndrome (when your body is exposed to high levels of the hormone cortisol for a long time. Cushing syndrome, sometimes called

hypercortisolism, may be caused by the use of oral corticosteroid medication. The condition can  also occur  when your body makes too much cortisol on its

own. Too much cortisol can produce some of the hallmark signs of Cushing syndrome — a fatty hump  between your shoulders, a rounded face,  and pink or

purple  stretch marks  on your skin. Cushing syndrome can  also result in high blood pressure, bone  loss and,  on occasion, type 2 diabetes)

E-Sinusitis (You may feel pressure around your eyes, cheeks and  forehead. Perhaps your head throbs.  Sinusitis  usually occurs after a viral upper  respiratory

infection or cold and includes thick, discolored nasal mucus, decreased sense of smell, and  pain in one cheek or upper  teeth)

Myxedematous coma,  which is manifested by coma,  hypothermia, severe fluid and electrolyte imbalances, and  cardiovascular collapse, is a life-threatening, end-stage expression of hypothyroidism.

■■ Hyperthyroidism has an effect opposite to that of hypothyroidism. It produces an increase in metabolic rate and  oxygen  consumption, increased use of metabolic fuels, and  increased sympathetic nervous system responsiveness. Manifestations include nervousness, irritability, a fine muscle tremor,  weight loss despite an increased appetite, excessive sweating, muscle cramps, and  heat intolerance. Graves’  disease is characterized by the triad of hyperthyroidism, goiter, and  ophthalmopathy (exophthalmos or protruding  eyeballs) or dermopathy (pretibial myxedema).

■■ Thyroid storm or crisis, which is manifested by a very high fever, extreme cardiovascular effects (tachycardia, congestive failure, and  angina), and  severe central nervous system effects (agitation,  restlessness, and  delirium), is an extreme and  life-threatening form of thyrotoxicosis.

Question 11

A 52-year-old woman  is inquiring about  estrogen replacement therapy for symptoms of menopause. Which of the following is a contraindication?

A - History of phlebitis

B- Prior or present migraine  headaches

C- Family history of lung cancer

D - Prior breast or uterine  carcinoma

Question 12

Patient with asthma have  a pathological finding of:

A -Necrosis of small airways

B- Absence of goblet cells

C- Absence of ciliary regeneration

D - Hypertrophy of smooth muscle (Epithelial  to mesenchymal transition plays an important  role in airway remodeling. These epithelial and mesenchymal cells cause persistence of the inflammatory infiltration and induce histological changes in the airway wall, increasing thickness of the basement membrane, collagen deposition and smooth muscle hypertrophy and hyperplasia. Resulting of airway inflammation, airway remodeling

leads to the airway wall thickening and induces increased airway smooth muscle mass, which  generate asthmatic symptoms)

Question 13

A 65-year-old patient  with a history of a deep vein thrombosis (DVT) is being treated for a dental abscess. Which antibiotics  is safe to use with warfarin (Coumadin). [Some  antibiotics,  such  as penicillins, quinolones, metronidazole and cephalosporins can  cause unwanted side effects in warfarin users or decrease warfarin's effectiveness]

A- Amoxicillin (Amoxil) ----[Penicillin abx]

B- Trimethoprim/  sulfamethoxazole (Bactrim)----[known  as a co-trimoxazole antibiotic used to treat a variety of bacterial infections]

C- Ciprofloxacin (Cipro) -----[a fluoroquinolone antibiotic used for bacterial infections]

D- Clarithromycin  (Biaxin) -----[a macrolide antibiotic that fights bacteria infections that affect the skin and respiratory system. Also used to treat  stomach ulcers

caused by H. pylori]

Question 14

Primary syphilis is characterized by what type of lesion [Primary syphilis: The first sign of syphilis is a small sore,  called a chancre (SHANG-kur). The sore

appears at the spot where  the bacteria entered your body. While most  people

infected  with syphilis develop only one  chancre, some people develop several of them.  The chancre usually develops about  three  weeks after exposure. Many people who have  syphilis don't notice the chancre because it's usually painless, and it may be hidden  within the vagina  or rectum. The chancre will heal on its own within three  to six weeks. Secondary syphilis: Within a few weeks of the original chancre healing,  you may experience a rash that begins on your trunk but eventually covers your entire body — even  the palms of your hands and the soles of your feet. This rash  is usually not itchy and may be accompanied by

wart-like sores in your mouth or genital area. Some people also experience hair loss,  muscle aches, a fever, a sore  throat and swollen lymph nodes. These signs and symptoms may disappear within a few weeks or repeatedly come  and  go for as long as a year. Latent syphilis: If you aren't  treated for syphilis, the disease moves from the secondary stage to the hidden  (latent)  stage, when you have  no symptoms. The latent  stage can  last for years. Signs and symptoms may never return,  or the disease may progress to the third (tertiary) stage. Tertiary syphilis: About 15% to 30% of people infected  with syphilis who don't get treatment will develop complications known as late (tertiary) syphilis. In the late stage, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur  many  years after the original, untreated infection. Neurosyphilis: At any stage, syphilis can  spread and,  among other damage, cause damage to the brain and nervous system (neurosyphilis) and the eye (ocular syphilis). Congenital syphilis: Babies born to women  who have syphilis can  become infected  through  the placenta or during birth. Most newborns with congenital syphilis have  no symptoms, although some experience a rash on the palms of their hands and  the soles of their feet. Later signs and symptoms may include deafness, teeth  deformities and saddle nose — where  the bridge  of the nose collapses. However,  babies born with syphilis can  also be born too

early, be born dead (stillborn) or die after birth. A- A cluster  of scattered vesicles