Midterm Exam ANP 652

Question 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

1. pylori ulcer

Barrett’s ulcer

 

Question 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 3 Complications of giant cell arteritis include:

Uveitis

Arthritis

Blindness

Hemiparesis

Question 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

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

True  False

 

Question 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 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 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 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

 

Question10 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 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

 

Question12  The classic triad of Parkinson’s includes all of the following except:

Resting tremor

Rigidity arms, legs, and neck stiffness

Bradykinesia

Severe cognitive deficits

 

Question 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 14 Loss of central vision is a hallmark of:

Macular degeneration

Glaucoma

Retinal detachment

Cataracts

 

Question 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 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 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 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

 

Question19 Areas of occult infection include:

Sinuses, teeth, central nervous system

Lung, ear, throat

Skin, joints, lymph nodes

Pelvis, abdomen, and chest

 

Question 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 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 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 23Parasitic 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 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 25 Which of the following lists of medications is generally contraindicated in geriatric patients?

Beers list

Anticholinergic list

Universal list

Alzheimer’s list

 

Question 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 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 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 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

 

Question30 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.

 

Question31 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 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 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 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 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 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 37 Which of the following medications would be most appropriate for the patient who is suffering from neuropathic pain?

NSAID

Acetaminophen

Gabapentin

Morphine

 

Question 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 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 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

1. influenzae

Candida albicans

Pseudomonas aeruginosa

 

Question 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

 

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

Hispanic

Caucasian

African American

Native American

 

 

 

Question 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

 

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

Neuropathy

Retinopathy

Gastroparesis

Alopecia

 

Question 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 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 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.

 

Question 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 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

 

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Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource