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NUR 682 FINAL EXAM 2025-2026|NURS 682 CLINICAL
PHARMACOLOGY FOR PRESCRIBING ADVANCED
PRACTICE FINAL EXAM|300Qs&As|GRADED A+:-
Pace University
You see a 59-year-old man with poorly controlled hypertension. On physical examination, you note grade 1 hypertensive retinopathy. You anticipate all of the following will be present except: Patient report of acute visual change. You see a 38-year-old African American male with hypertension who is currently being treated with thiazide-type diuretic. His current blood pressure reading is 156/94 mm Hg and he has no history of diabetes mellitus or chronic kidney disease. Following current best evidence, you consider adding which of the following medications? Calcium channel blocker Mr. G is a 63 year old patient with a long history of hypertension, previously controlled on Lisinopril and HCTZ. His BP has been rising, to 170/104 at the last visit. He insisted he is adherent with his medications. The clinician added amlodipine, which dropped the BP to 160/96, but it is 180/110 today. He is asymptomatic with an essentially negative ROS. The patient has sleep apnea, which is effectively treated with CPAP. His GFR was 64 last month. According to figure 10 (page e193) in the 2017 ACC/AHA hypertension treatment guidelines, what other causes of secondary hypertension would be most likely to be causing Mr. G's new onset resistant hypertension?
Primary Aldosteronism A 68-year-old woman presents with hypertension and BP of 152-158/92-96 mm Hg documented over 2 months on three different occasions. Electrocardiogram (ECG) and creatinine are normal, and she has no proteinuria. Clinical findings include the following: BMI 26.4 kg/m2; no S3, S4, or murmur; and point of maximal impulse at fifth intercostal space, mid-clavicular line. Which of the following represents the best intervention? Initiate therapy with hydrochlorothiazide. When a heart valve fails to close properly, it is said to be: Incompetent. The S3 heart sound has all of the following characteristics except: A presystolic sound You are treating a healthy a 52 year old African American well woman never- smoker whose BP has been averaging 135 systolic and 84 diastolic for several years. She is on no regular medications. What additional information do you need in order to determine whether she should be treated with medication, in addition to lifestyle changes, according to the 2018 ACC/AHA hypertension guidelines? Avoid disease-related target organ damage.
You are evaluating a patient who has rheumatic heart disease. When assessing her for mitral stenosis, you auscultate the heart, anticipating finding the following murmur: localized diastolic with little radiation. Additional findings in MVP include: a mid-systolic click. Of the following patients, who is in greatest need of endocarditis prophylaxis when planning dental work? a 54-year-old woman with a prosthetic aortic valve When compared with Caucasians, African Americans tend to have a reduced effect with monotherapy with all of the following blood pressure medications except: CCB
You see a 68-year-old woman as a patient who is transferring care into your practice. She has a 10-year history of hypertension, diabetes mellitus, and hyperlipidemia. Current medications include hydrochlorothiazide (HCTZ), glipizide, metformin, simvastatin, and daily low-dose aspirin. Today's BP reading is 158/92 mm Hg, and the rest of her history and examination are unremarkable. Documentation from her former healthcare provider indicates that her BP has been in the range for the past 12 months. Your next best action is to: prescribe an angiotensin-converting enzyme inhibitor (ACEI). Mary is a 68 year old white female. She is a never smoker, not a diabetic, does not have kidney disease, and her only medications are two ES Tylenol prn (takes 2- 3 times per week), Prilosec 20 mg prn (takes daily), and Claritin 10 mg per day. Her blood pressure has been an average of 152/92 for several months now, which has not changed with efforts to decrease her BP through non-pharmacologic means. What additional information do you need in order to determine whether she should be treated with medication, according to the 2018 ACC/AHA hypertension guidelines? None of the above; she should be treated with medication based on BP alone What is the correct drug class of pindolol? beta-adrenergic receptor antagonist Of the following individuals, who is most likely to have a physiological split S heart sound? A 19-year-old healthy athlete
You examine a 24-year-old woman with mitral valve prolapse (MVP). Her physical examination findings may also include: pectus excavatum. The S4 heart sound has which of the following characteristics? It is noted in the presence of poorly controlled hypertension. According to the 2017 ACC/AHA hypertension guidelines, a 52 year old well woman with a healthy BMI whose BP is consistently 135 systolic and 84 diastolic is considered to have: Stage 1 hypertension For a patient with atrial fibrillation and hypertension, the level IIa recommendation is that the antihypertensive regimen include which of the following classes ARB When a heart valve fails to open to its normal orifice size, it is said to be: stenotic.
A physiological murmur has which of the following characteristics? becomes softer when the patient moves from supine to standing You are examining an 85-year-old woman and find a grade 3/6 crescendo- decrescendo systolic murmur with radiation to the neck. This is most likely caused by: aortic stenosis. What is the correct drug class of trandolapril? ACEI In evaluating mitral valve incompetency, you expect to find the following murmur: systolic with radiation to the axilla. You examine a 38-year-old woman who has presented for an initial examination and Papanicolaou test. She has no complaint. Her blood pressure (BP) is 154/ mm Hg bilaterally and her body mass index (BMI) is 31 kg/m2. The rest of her physical examination is unremarkable. Your next best action is to: arrange for at least two additional BP measurements during the next 2 weeks.
Which of the following is the most common serious complication of cholecystitis? pancreatitis A 63 year old woman presents with abdominal pain of approximately 12 hours duration. The pain was originally generalized throughout the abdomen but now is located in the right lower quadrant. The patient has had three episodes of dry heaves without vomiting. The pain is worse with motion. She has had no diarrhea or blood in the stool. On physical examination, her abdomen is soft but she has right lower quadrant tenderness with rebound tenderness. Her temperature is 98.4. Her white count is 16,700 with 85% neutrophils. Her urinalysis shows 2+ RBCs with 10-15 cells per high powered field. compound tomography of the abdomen and pelvis The obturator sign can be best described as abdominal pain elicited by: passive flexion and internal rotation of the hip. Lower GI hemorrhage associated with diverticular disease usually manifests as: a painless event.
You see a woman who has been sexually involved without condom use with a man newly diagnosed with acute hepatitis B. She has not received hepatitis B immunization. You advise her to: receive hepatitis B immune globulin and start hepatitis B immunization series. A 36-year-old man complains of nausea, fever, malaise, and abdominal pain. He shows signs of jaundice and reports darkly colored urine. Diagnostic results show elevated serum aminotransferase less than 10 times the upper limit of normal (ULN). His most likely diagnosis is: viral hepatitis The psoas sign can be best described as abdominal pain elicited by: passive extension of the hip. The preferred method to identify the location of small renal stones is: CT scan with kidney stone protocol (spiral or helical CT). Which of the following is the most likely patient report with anal fissure? "I have anal pain for up to 1 to 2 hours after I have a bowel movement."
Patients with urge incontinence often report urine loss: associated with a strong sensation of needing to void. Rectal bleeding associated with hemorrhoids is usually described as: streaks of bright red blood on the stool. Rectal bleeding associated with anal fissure is usually described by the patient as: drops of blood noticed when wiping. Diagnostic testing in inflammatory bowel disease (IBD) often reveals: evidence of underlying inflammation. Which of the following is most likely to be found in a person with acute cholecystitis? vomiting The most likely causative organism in community-acquired UTI in women during the reproductive years is:
Escherichia coli. Which of the following would be an acceptable food choice, using standard products, for a person with celiac disease? steak with mashed potatoes Struvite stones are typically found in people: with a history of kidney infections A 62-year-old woman who reports frequent constipation is diagnosed with an anal fissure. First-line therapy includes all of the following except: intra-anal corticosteroids. The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen? left lower quadrant Cyclooxygenase-2 (COX-2) contributes to: the inflammatory response.
To avoid rebound gastric hyperacidity following discontinuation of long-term PPI use, all of the following methods can be used except: empiric H. pylori therapy. Which of the following best describes colonic diverticulosis? bulging pockets in the intestinal wall The most common renal stones are composed of: calcium. A 62-year-old man presents with a 2-month history of noting a "bit of dark blood mixed in with my stool most days." Physical examination reveals external hemorrhoids, no rectal mass, and a small amount of dark brown stool on the examining digit. In-office fecal occult blood test is positive, and hemogram reveals amicrocytic hypochromic anemia. The next best step in his care is to: refer to gastroenterology practice for colonoscopy. Which of the following is found early in the development of chronic renal failure? persistent proteinuria
The HBV vaccine should not be offered to individuals who have a history of anaphylactic reaction to: baker's yeast. A 53 year old man comes to the clinic with persistent abdominal pain for approximately eight weeks, which he describes as so severe at times that he chooses not to get out of bed for the day. He has little appetite, and despite being thin to start with, has gone from 130 lbs to 122 lbs. He had persistent nausea with occasional vomiting. The patient has mild epigastric tenderness to palpation without any rebound tenderness, guarding, or a positive Murphy's sign. There are no palpable masses. The patient states that he drinks at most three or four beers, once per week. The patient has a normal CBC and white count. compound tomography of the abdomen and pelvis Peptic ulcer disease can occur in any of the following locations except: large intestine. A 43-year-old woman has a 12-hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is: acute cholecystitis.
Children should exercise, according to the American Academy of Pediatrics (quoted in Burns Chapter 10), at least: 60 minutes per day of moderate to vigorous activity When working on weight reduction with a middle-aged man with a body mass index of 33 kg/m2, an NP considers that one of the first actions should be to: ask the patient about what he believes contributes to his weight issues. Obesity in children is a serious problem, and all providers caring for children need to be knowledgeable about prevention and treatment of childhood obesity. Which of the following statements is true, according to Burns chapter 10? Obese children should not be put on a diet. Instead, the entire family's eating habits should be gradually modified. Although states vary by whether a disease is reported by the laboratory or the individual provider, reporting of communicable diseases is a mainstay of public health prevention efforts. Which of the following STDs is NOT reportable in all states, according to the 2015 CDC STD treatment guidelines? Genital Herpes (HSV-II)
Sam quit smoking 3 weeks ago after his 2 year old was diagnosed with asthma and he was told that parental smoking was likely making it worse. "I quit cold turkey, and so far so good. The hardest time is after meals when I used to have a cigarette and drink coffee, or when I am watching a football game and used to smoke and drink beer; now I just drink coffee or drink beer." Sam's statement would suggest to the clinician practicing using the Trans-theortical Model (as discussed in Burns chapter 9) that Sam would benefit from restructuring the environment and avoidance techniques You see a 48-year-old patient who started taking varenicline (Chantix®) 4 weeks ago to aid in smoking cessation. Which of the following is the most important question to ask during today's visit? "Have you noticed any changes in your mood?" Which of the following statements are guiding statements. (Select all that apply.) A) "You think expanding the physical therapies is something you should explore." B) "We discussed increasing your activity. Tell me what is working and what you would like to try next." C) Your current dosage causes me concern. Can we discuss some other options?"
