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NR511 Week 8 Final Exam

A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and diarrhea. The symptoms usually occur after eating, and the pain is frequently relieved with bowel movement. She is on a “celiac diet,” yet the episodic symptoms persist. Physical examination and diagnostic tests are negative, and colonoscopy shows no abnormalities. The nurse practitioner recognizes that this patient’s history and physical examination are consistent with which of the following?

Answers: A – D

Functional dyspepsia
B. Inflammatory bowel disease (IBD)
C. Irritable bowel syndrome (IBS) ✅
D. Lactose intolerance

A 28-year-old female presents for her annual physical exam and reports lifelong heavy menstrual bleeding. She denies other symptoms. A complete blood count (CBC) shows hemoglobin of 11.0 g/dL, a mean corpuscular volume (MCV) of 75 fL, low serum ferritin, and elevated total iron-binding capacity (TIBC). Which of the following is the most likely cause of her anemia?

Answers: A – D

Lead poisoning
B. Anemia of chronic disease
C. Beta-thalassemia trait
D. Iron deficiency anemia ✅

A patient presents to the clinic after feeling a sudden “pop” in his right ankle while playing basketball. On physical examination, the nurse practitioner performs the Thompson test and notes that it is positive as squeezing the calf does not produce plantar flexion of the ankle. What is the best initial management for this condition?

Answers: A – D

Immediate surgical repair with light weight-bearing in 24 hours
B. Non-weight-bearing with crutches and a course of NSAIDS for 1 week
C. Application of a short leg cast with the foot in plantar flexion for several weeks ✅
D. Immediate weight-bearing and physical therapy for two weeks

A 62-year-old female patient presents with fatigue, pallor, and shortness of breath on exertion. Laboratory tests reveal a hemoglobin level of 10 g/dL, serum ferritin of 15 ng/mL, and total iron-binding capacity (TIBC) of 500 µg/dL. Which of the following findings would most likely differentiate iron-deficiency anemia from anemia of chronic disease in this patient?

Answers: A – D

Increased mean corpuscular volume (MCV)
B. Elevated serum ferritin
C. High total iron-binding capacity (TIBC) ✅
D. Decreased serum iron

A 52-year-old patient presents with chronic diarrhea and rectal bleeding. The patient has a family history of inflammatory bowel disease (IBD). Which of the following diagnoses requires the most urgent evaluation?

Answers: A – D

Lactose intolerance
B. Hemorrhoids
C. Crohn’s disease ✅
D. Irritable bowel syndrome (IBS)

Which of the following antibacterial drug classes work by affecting the cell wall?

Answers: A – D

Aminoglycosides
B. Tetracyclines
C. Penicillins ✅
D. Macrolides

A patient presents with shoulder pain and suspected rotator cuff impingement. The NP performs the Neer’s test and notes that it is positive. A subacromial anesthetic injection is also administered. After the injection, the client reports decreased pain and improved strength. What can the NP infer from this response?

Answers: A – D

The patient does not have a rotator cuff-related issue and requires further imaging
B. The injection has permanently resolved the underlying shoulder pathology
C. The patient has a complete rotator cuff tear requiring surgical repair
D. The patient’s symptoms are due to inflammation and fibrosis rather than a full rupture ✅

Which of the following differential diagnoses should be considered when a nurse practitioner is evaluating a patient with dysuria, urgency, and hematuria who denies fever and flank pain?

Answers: A – D

Urethritis
B. Nephrolithiasis
C. Pyelonephritis
D. Cystitis ✅

A 36-year-old female presents with unintentional urinary leakage that has been progressively worsening over the past few months. She reports that leakage occurs with activities such as coughing, laughing, and exercising. Due to embarrassment, she has stopped going to the gym. Her medical history includes four vaginal deliveries. She denies experiencing sudden urges to urinate or difficulty reaching the bathroom in time. Based on this history, which type of urinary incontinence is the most likely diagnosis?

Answers: A – D

Functional incontinence
B. Overflow incontinence
C. Stress incontinence ✅
D. Urge incontinence

A 45-year-old male with poorly controlled diabetes presents to the emergency department with a jagged laceration on his foot sustained 15 hours ago. Examination reveals mild swelling but no obvious signs of infection. Which of the following is the most appropriate next step in wound management?

Answers: A – D

Delay antibiotic treatment unless signs of infection develop
B. Prescribe topical antibiotic ointment and advise the patient to monitor for signs of infection
C. Clean the wound thoroughly but do not prescribe prophylactic antibiotics
D. Initiate prophylactic antibiotic therapy with amoxicillin/clavulanate ✅

A 17-year-old male presents with acute ankle pain and swelling after twisting his ankle during a basketball game. Physical examination reveals moderate swelling, ecchymosis, and limited range of motion. What is the most likely diagnosis?

Answers: A – D

Achilles tendon rupture
B. Third-degree ankle sprain
C. Second-degree ankle sprain ✅
D. First-degree ankle sprain

A 55-year-old male presents with neck pain and stiffness. Physical examination reveals significant decreased range of motion of the cervical spine, 5/5 strength and normal sensation of the upper extremities, as well as normal upper extremity reflexes. What is the most appropriate initial diagnostic test?

Answers: A – D

Electromyogram/nerve conduction velocity (ECM/NCV) study
B. Computed tomography (CT) scan of the cervical spine
C. Anterior-posterior and lateral radiographs of the cervical spine ✅
D. Magnetic resonance imaging (MRI) of the cervical spine

A 52-year-old male patient presents to the clinic with a right leg wound sustained from a fall. He is to receive antibiotic prophylaxis to prevent infection. During the assessment, he reported a history of allergies to both penicillin and cephalosporins, which has been documented in his medical record. Given the patient’s allergies to penicillin and cephalosporins, which of the following antibiotics should the nurse practitioner prescribe for prophylaxis in this case?

Answers: A – D