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NR576 Week 8 Final Exam

Question 1

A 34-year-old patient presents with chronic diarrhea, weight loss, and bulky, foul-smelling, fatty stools. Physical examination is otherwise unremarkable. Which diagnostic test is most appropriate to evaluate the underlying cause of these symptoms?

✓  A. Stool fat analysis

1. Prothrombin time (INR)
2. Liver enzyme testing
3. Serum vitamin B12 level

Question 2

A 13-year-old boy presents with sudden onset of severe right scrotal pain accompanied by nausea and lower abdominal discomfort. His mother reports no history of trauma. On physical exam, the right testicle is swollen, exquisitely tender, and elevated compared to the left. Which diagnosis is most likely?

✓  A. Testicular torsion

1. Varicocele
2. Fournier’s disease
3. Testicular cancer

Question 3

A patient presents with burning epigastric pain that worsens after meals and when lying down at night. What is the most likely underlying cause?

1. Nonsteroidal anti-inflammatory drug gastritis

✓  B. Decreased lower esophageal sphincter tone

1. Helicobacter pylori infection
2. Diffuse esophageal spasm

Question 4

What type of pain is most frequently mistaken for cardiac chest pain?

1. Cholecystitis
2. All answers are incorrect

✓  C. Gastroesophageal reflux disease (GERD)

1. Peptic ulcer disease (PUD)

Question 5

A patient presents with acute low back pain after lifting a heavy object. Which question is most important when obtaining the history?

1. “Does anyone in your family have chronic back pain?”
2. “Can you describe how the injury occurred?”
3. “Have you experienced similar back injuries before?”

✓  D. “Do you have any chronic medical conditions?”

Question 6

Four patients present to the clinic for evaluation of animal bite wounds. Which patient has the highest risk for developing a wound infection?

1. A 45-year-old who smokes cigarettes with a dog-bite laceration to the cheek

✓  B. A 62-year-old with a deep cat-bite puncture wound to the hand

1. A 22-year-old with a large, open dog-bite laceration to the upper arm
2. A 35-year-old with a superficial rodent bite to the lower leg

Question 7

A 24-year-old sexually active male presents with epididymitis. Which pathogens should empiric therapy target?

✓  A. Neisseria gonorrhoeae and Chlamydia trachomatis

1. Mycoplasma genitalium and Ureaplasma urealyticum
2. Escherichia coli and Proteus mirabilis
3. Pseudomonas aeruginosa and Enterococcus faecalis

Question 8

A 57-year-old male with symptomatic benign prostatic hyperplasia is started on finasteride. He returns 1 month later and reports little improvement in his urinary symptoms. Which response by the AGPCNP is most appropriate?

✓  A. Explain that the maximum reduction in prostate size may take up to 6 months

1. Switch immediately to an antibiotic
2. Discontinue finasteride because the medication is ineffective
3. Increase the dose immediately.

Question 9

A 24-year-old female presents with dysuria, urinary frequency, and urgency. She reports recent sexual activity and uses a diaphragm for contraception. She denies vaginal discharge, fever, and flank pain. Which diagnosis is most consistent with this presentation?

1. Urethritis

✓  B. Acute cystitis

1. Acute pyelonephritis
2. Asymptomatic bacteriuria

Question 10

A 19-year-old male presents 2 hours after sustaining a 5-cm linear laceration to the cheek while playing outdoors. The wound is thoroughly irrigated and closed with 5-0 nylon sutures. When should the AGPCNP advise the patient to return for suture removal?

✓  A. 7 days

1. 10 days
2. 3 days
3. 5 days

Question 11

A 45-year-old patient presents with severe right upper quadrant abdominal pain that began after eating a high-fat meal. The pain has persisted for several hours and is accompanied by nausea, vomiting, low-grade fever, and right upper quadrant tenderness on examination. Which diagnosis is most likely?

1. Peptic ulcer disease

✓  B. Acute cholecystitis

1. Acute pancreatitis
2. Acute hepatitis

Question 12

A 50-year-old patient presents with jaundice, pruritus, dark urine, and light-colored stools. Which underlying process is most consistent with these findings?

✓  A. Cholestasis

1. Iron deficiency anemia
2. Hemolysis
3. Hepatocellular injury

Question 13

A 68-year-old male presents with fatigue, unintentional weight loss, intermittent lower abdominal pain, and a positive fecal occult blood test. Laboratory studies reveal iron deficiency anemia. Which diagnosis is most consistent with this presentation?

✓  A. Colon cancer

1. Irritable bowel syndrome
2. Diverticular disease
3. Crohn’s disease

Question 14

Nighttime extremity pain in adolescents that is deep but not present in the joints and that may be caused by inflammation of the muscle bodies in tight fascial sheaths and by periods of high activity is:

✓  A. Growing pains

1. Shin splints
2. Osgood-Schlatter disease
3. Patellofemoral stress syndrome

Question 15

A 35-year-old patient presents with acute low back pain after lifting a heavy object. The pain is localized to the lumbar region without radiation, weakness, numbness, or bowel or bladder dysfunction. Physical examination is otherwise unremarkable. Which recommendation is most appropriate for the initial management of this patient?

✓  A. Remain active as tolerated

1. Wear a lumbar support brace daily
2. Remain on bed rest for 3 to 5 days
3. Begin opioid therapy for persistent pain

Question 16

A 16-year-old high school football player twisted his knee and comes to the clinic complaining of knee pain. He also states that in the past few weeks his knee has “locked up a couple of times.” On examination, a positive McMurray test result is elicited. What diagnosis is consistent with his symptoms?

1. Dislocated patella
2. Chondromalacia patella
3. Anterior cruciate ligament tear

✓  D. Medial meniscus tear

Question 17

A 54-year-old patient presents with acute low back pain, new urinary retention, saddle anesthesia, and bilateral lower-extremity weakness. What is the most appropriate next step?

1. Obtain lumbar spine radiographs

✓  B. Arrange emergent surgical evaluation

1. Begin physical therapy
2. Prescribe nonsteroidal anti-inflammatory drugs

Question 18

A 72-year-old patient presents with low back pain radiating down the posterior aspect of the leg. During the examination, pain is reproduced when the affected leg is passively raised to 60 degrees while the patient is in the supine position. These findings are most consistent with which diagnosis?

✓  A. Lumbar disc herniation

1. Vertebral compression fracture
2. Lumbar muscle strain
3. Lumbar spinal stenosis

Question 19

A 50-year-old male presents with fever, chills, dysuria, urinary frequency, urgency, and nocturia. During the physical examination, the AGPCNP suspects acute bacterial prostatitis. Which approach is most appropriate during the digital rectal examination?

1. Perform a gentle examination to avoid symptoms.
2. Apply firm pressure to better assess prostate tenderness.
3. Perform a vigorous prostate massage to obtain secretions.

✓  D. Delay the examination until antibiotic therapy is completed.

Question 20

A patient with ulcerative colitis states, “I feel like this disease is controlling my life. I’m always worried about my symptoms.” What is the most appropriate therapeutic response by the AGPCNP?

1. “You need to take better control of your condition.”

✓  B. “Let’s talk about your symptoms and identify strategies to better manage flare-ups.”

1. “If you take your medications consistently, your symptoms should improve.”
2. “You should avoid eating before leaving the house.”

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Related: (Completed) NR576 Week 4 Midterm Exam