NR547 PMHNP Pre-clinical Diagnostic Exam Chamberlain University.
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Free NR547 PMHNP Pre-clinical Diagnostic Exam Chamberlain University. Questions
Which of the following is not associated with an elevated WBC?
- Acute myeloid leukemia.
- Congestive heart failure.
- Poorly-controlled rheumatoid arthritis.
- Recent oral corticosteroid therapy.
Explanation
Explanation:
Correct Answer: (B) Congestive heart failure
Congestive heart failure (CHF) is primarily a cardiac condition involving the heart's inability to pump blood efficiently. It does not directly cause leukocytosis (elevated WBC). Elevated WBC is typically associated with infection, inflammation, malignancy, or steroid use.
Why Other Options are Incorrect:
A. Acute myeloid leukemia is a blood cancer that directly causes a massive overproduction of white blood cells, leading to elevated WBC.
C. Poorly-controlled rheumatoid arthritis is a chronic inflammatory condition that can stimulate the immune system, leading to leukocytosis.
D. Recent oral corticosteroid therapy is well known to cause leukocytosis by demarginating neutrophils from blood vessel walls into circulation.
Your patient has been diagnosed with a darkened, round, raised, benign lesion that appears "stuck on" to the skin. Which of the following diagnoses best fits this description?
- Achrocordon.
- Hemangioma.
- Basal cell carcinoma.
- Seborrheic Keratosis.
Explanation
Explanation:
Correct Answer: (D) Seborrheic Keratosis
Seborrheic keratosis is a benign skin growth that classically presents as a darkened, round, raised lesion with a waxy, warty, "stuck on" appearance. It is one of the most common benign skin tumors, typically seen in older adults, and requires no treatment unless bothersome.
Why Other Options are Incorrect:
A. Acrochordon (skin tag) is a soft, flesh-colored, pedunculated growth that hangs off the skin and does not have the darkened, "stuck on" appearance described.
B. Hemangioma is a benign vascular tumor that appears as a bright red or bluish lesion caused by an overgrowth of blood vessels, not a darkened, "stuck on" lesion.
C. Basal cell carcinoma is a malignant skin cancer, not a benign lesion. It typically presents as a pearly or translucent bump with visible blood vessels, not the waxy "stuck on" appearance described.
Heartburn, or rising retrosternal burning pain or discomfort, is aggravated by all of the following except which one?
- Foods, such as citrus, onions and coffee.
- Alcohol.
- Gastric dumping, or increased emptying into the small intestines.
- Activities including lifting or bending over.
Explanation
Explanation:
Correct Answer: (C) Gastric dumping, or increased emptying into the small intestines.
Heartburn (gastroesophageal reflux) occurs when stomach acid refluxes back into the esophagus. Gastric dumping refers to rapid emptying of stomach contents into the small intestine, which actually reduces the amount of acidic content remaining in the stomach available to reflux into the esophagus. Therefore, gastric dumping does not aggravate heartburn and is the exception among the listed options.
Why Other Options are Incorrect:
A. Citrus fruits, onions, and coffee are well-established dietary triggers for heartburn. They either relax the lower esophageal sphincter, increase acid production, or are directly irritating to the esophageal mucosa.
B. Alcohol relaxes the lower esophageal sphincter (LES), reducing its barrier function and allowing gastric acid to reflux into the esophagus more easily, aggravating heartburn symptoms.
D. Activities that increase intra-abdominal pressure such as lifting heavy objects or bending over compress the stomach and push acidic contents upward through the lower esophageal sphincter into the esophagus, worsening reflux and heartburn.
Patients diagnosed with seborrheic dermatitis may be successfully treated with which of the following medications?
- Isotretinoin (Accutane).
- Fluorouracil (5-FU).
- Salycilic Acid.
- Ketoconazole shampoo.
Explanation
Explanation:
Correct Answer: (D) Ketoconazole shampoo
Seborrheic dermatitis is a chronic inflammatory skin condition closely associated with overgrowth of Malassezia yeast on the scalp and face. Ketoconazole is an antifungal agent that targets this yeast, reducing fungal colonization and the resulting inflammatory response. Ketoconazole shampoo is a well-established and highly effective first-line treatment for seborrheic dermatitis.
Why Other Options are Incorrect:
A. Isotretinoin (Accutane) is a retinoid used for severe, nodular, or treatment-resistant acne vulgaris. It is not indicated for seborrheic dermatitis and carries a significant side effect profile that would not be appropriate for this condition.
B. Fluorouracil (5-FU) is a topical chemotherapy agent used for actinic keratosis and certain superficial skin cancers. It has no role in the treatment of seborrheic dermatitis.
C. Salicylic acid has keratolytic properties and can help remove scale in seborrheic dermatitis as an adjunct treatment, but it does not address the underlying Malassezia yeast colonization, making it less effective as a standalone treatment compared to ketoconazole.
Which of the following are functions of the liver?
- Erythrocyte formation
- Clotting factor formation
- Platelet formation
- Thrombocyte formation
Explanation
Explanation:
Correct Answer: (B) Clotting factor formation
The liver is responsible for synthesizing the majority of clotting factors, including fibrinogen, prothrombin, and factors V, VII, IX, and X. This is why patients with severe liver disease such as cirrhosis develop coagulopathy and are at increased risk for bleeding.
Why Other Options are Incorrect:
A. Erythrocyte (red blood cell) formation occurs in the red bone marrow, not the liver. In fetal life, the liver does participate in hematopoiesis, but this function ceases after birth.
C. Platelet formation occurs in the bone marrow through the differentiation of megakaryocytes, not in the liver.
D. Thrombocytes are simply another name for platelets, and like option C, their formation takes place in the bone marrow, not the liver.
Which statement is true regarding enuresis?
- Episodes awaken clients after a deep sleep
- Clients typically sleep through episodes
- Typically caused by a physiologic abnormality
- More common in females
Explanation
Explanation:
Correct Answer: (B) Clients typically sleep through episodes
Enuresis, particularly nocturnal enuresis (bedwetting), is characterized by involuntary urination during sleep. Clients typically do not awaken during or after the episode, which is a distinguishing feature of this disorder. The child or adult remains asleep throughout the episode.
Why Other Options are Incorrect:
A. Episodes do not awaken clients. Unlike parasomnias such as sleep terrors where partial arousal occurs, enuresis happens during sleep without causing awakening, making this statement false.
C. Enuresis is most commonly functional rather than caused by a physiologic abnormality. In the majority of cases, no underlying anatomical or physiological pathology is identified as the cause.
D. Enuresis is actually more common in males than females. Boys have a higher prevalence of nocturnal enuresis compared to girls across all age groups.
The psychiatric mental health nurse practitioner is seeing a client for an initial diagnostic assessment. Which factor is most critical in determining whether a physical exam is necessary as part of the assessment?
- The number of medications the client takes
- The nature of the client's complaints
- The amount of time that has elapsed since the client's last complete physical exam
- The complexity of the client's past medical history
Explanation
Explanation:
Correct Answer: (B) The nature of the client's complaints
The nature of the client's presenting complaints is the most critical factor in determining whether a physical exam is necessary. Complaints that may have an organic or medical basis, such as sudden behavioral changes, cognitive decline, physical symptoms, or new onset psychosis, necessitate a physical examination to rule out medical etiologies before making a psychiatric diagnosis.
Why Other Options are Incorrect:
A. While the number of medications is relevant to pharmacological management and medication reconciliation, it does not in itself determine the need for a physical exam as critically as the nature of the presenting complaints.
C. The time elapsed since the last physical exam may prompt referral for routine preventive care but is not the most critical determinant of whether a physical exam is needed during a psychiatric assessment.
D. Past medical history complexity provides important background information but does not singularly determine the need for a current physical examination as directly as the client's present complaints and symptoms.
A 72-year-old presents to the emergency department with psychotic symptoms including hallucinations and disorganized thought. Which medical condition could also present with these symptoms?
- Lead poisoning
- Alzheimer's disease
- Hypoglycemia
- COPD
Explanation
Explanation:
Correct Answer: (B) Alzheimer's disease
Alzheimer's disease is a neurodegenerative condition that commonly presents with psychotic symptoms including hallucinations, delusions, and disorganized thinking, particularly in moderate to severe stages. In a 72-year-old presenting with these symptoms, Alzheimer's disease is a highly relevant medical condition to consider as a primary or contributing cause.
Why Other Options are Incorrect:
A. Lead poisoning can cause neurological symptoms and cognitive impairment but is far less commonly associated with frank hallucinations and disorganized thought in elderly patients compared to neurodegenerative conditions like Alzheimer's disease.
C. Hypoglycemia can cause altered mental status, confusion, and agitation but typically presents with diaphoresis, tremors, and rapid onset changes in consciousness rather than a sustained psychotic presentation with hallucinations and disorganized thought.
D. COPD can cause hypoxia-related confusion and altered mental status in severe cases, but it is not a primary cause of hallucinations and disorganized thought in the way that Alzheimer's disease is in an elderly patient.
Your patient has presented with dysfunctional uterine bleeding (DUB). Which of the following evaluations is most useful to perform first to find the leading cause of DUB?
- Pregnancy test.
- BMP.
- CBC.
- Vitamin K.
Explanation
Explanation:
Correct Answer: (A) Pregnancy test.
A pregnancy test is the most critical first step in evaluating dysfunctional uterine bleeding because pregnancy-related conditions such as ectopic pregnancy, spontaneous abortion, and gestational trophoblastic disease are potentially life-threatening causes of abnormal uterine bleeding that must be ruled out immediately before any other workup proceeds.
Why Other Options are Incorrect:
B. A basic metabolic panel (BMP) assesses electrolytes, kidney function, and blood glucose. While useful in a general workup, it does not identify the most common or immediately dangerous causes of DUB and should not be the first evaluation performed.
C. A complete blood count (CBC) is important for assessing the degree of blood loss and evaluating for anemia but does not identify the underlying cause of DUB. It should be obtained but is not the most useful first-line test.
D. Vitamin K levels are evaluated when coagulopathy is suspected as a cause of bleeding. While clotting disorders can contribute to DUB, vitamin K testing is not the first-line evaluation and does not address the most immediately dangerous cause.
Dabigatran etexilate (Pradaxa) works as an anticoagulant by its affect of directly inhibiting which of the following?
- Thrombin.
- Factor X.
- Prothrombin.
- Plasminogen.
Explanation
Explanation:
Correct Answer: (A) Thrombin
Dabigatran (Pradaxa) is a direct thrombin inhibitor (DTI). It works by directly and reversibly binding to thrombin (Factor IIa), the enzyme responsible for converting fibrinogen to fibrin and activating platelets, thereby preventing clot formation. This targeted mechanism distinguishes it from other anticoagulant classes.
Why Other Options are Incorrect:
B. Factor X (Factor Xa) is the target of a different class of DOACs known as Factor Xa inhibitors, which include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Dabigatran does not inhibit Factor Xa.
C. Prothrombin (Factor II) is the precursor to thrombin. While dabigatran inhibits thrombin (the active form), it does not directly inhibit prothrombin itself. Warfarin indirectly affects prothrombin by inhibiting its vitamin K-dependent synthesis.
D. Plasminogen is part of the fibrinolytic system and is converted to plasmin to break down clots. It is not involved in the coagulation cascade targeted by dabigatran and is not relevant to its mechanism of action.
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