PMHNP Pre clinical Diagnostic Exam Chamberlain University
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Free PMHNP Pre clinical Diagnostic Exam Chamberlain University Questions
- Allopurinol (Zyloprim).
- N-acetylcysteine (NAC).
- Furosemide (Lasix).
- Colchicine (Colcrys).
Explanation
Correct Answer: A) Allopurinol (Zyloprim).
Tumor lysis syndrome (TLS) occurs when massive cancer cell death releases large amounts of intracellular contents, leading to hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Allopurinol is a xanthine oxidase inhibitor that blocks uric acid production, preventing uric acid nephropathy — one of the most dangerous complications of TLS. It is given prophylactically and therapeutically in high-risk patients. NAC is used for acetaminophen toxicity and as a mucolytic. Furosemide may be used for fluid management but does not address uric acid levels. Colchicine is used for gout and pericarditis, not TLS.
A patient with a suspected diagnosis of systemic lupus erythematosus (SLE) should be evaluated for which of the following?
- Rheumatoid factor lab
- Spectrophotometric assay
- Gel electrophoresis
- Antinuclear antibody
Explanation
Correct Answer: D) Antinuclear antibody
The antinuclear antibody (ANA) test is the cornerstone screening tool for systemic lupus erythematosus. SLE is a systemic autoimmune disease in which the immune system produces autoantibodies against the body's own nuclear components — including DNA, histones, and ribonucleoproteins. A positive ANA test is present in over 95% of SLE patients, making it highly sensitive for the disease. Further confirmatory testing with anti-dsDNA and anti-Smith antibodies is performed when ANA is positive, as these are more specific to SLE.
Rheumatoid factor is the primary serological marker for rheumatoid arthritis, not SLE, though it can be weakly positive in some lupus patients. Spectrophotometric assay and gel electrophoresis are laboratory techniques used in other contexts such as protein analysis and are not standard diagnostic tools for SLE evaluation.
Which one of the following patients would you most anticipate to complain of a low forced expiratory volume over the first second (FEV1)?
- Strep pharyngitis.
- Lung cancer.
- Severe asthmatic.
- Congestive heart failure with bilateral pleural effusions.
Explanation
Correct Answer: C) Severe asthmatic.
FEV1 (Forced Expiratory Volume in 1 second) is a key spirometry measurement that is characteristically reduced in obstructive lung diseases. Severe asthma causes significant bronchospasm, airway inflammation, and narrowing that obstructs airflow, resulting in a markedly reduced FEV1 and a low FEV1/FVC ratio — the hallmark of obstructive disease. Strep pharyngitis is an upper respiratory infection that does not significantly affect FEV1. Lung cancer may reduce lung volumes depending on location but is not the most classic cause of low FEV1. Congestive heart failure with pleural effusions causes a restrictive pattern — reduced total lung volumes but relatively preserved FEV1/FVC ratio.
Patients with end-stage renal disease (ESRD) on dialysis experiencing anemia of chronic disease may benefit from the administration of erythropoeitin (Epocrit). Immediate evidence that this is working as desired would be evident by elevation in which level?
- Lactate Dehydrogenase (LDH).
- Red cell distribution width (RDW).
- Potassium.
- Total iron binding capacity (TIBC).
Explanation
Correct Answer: B) Red cell distribution width (RDW).
Erythropoietin (EPO) stimulates the bone marrow to produce new red blood cells. When EPO begins working, newly produced RBCs (reticulocytes) entering the circulation are larger than the older, smaller cells already present — causing an increase in the variation of RBC sizes, reflected as an elevated RDW. This is one of the earliest laboratory signs that erythropoiesis has been stimulated. LDH elevation suggests cell lysis or tissue damage, not effective erythropoiesis. Potassium is unrelated to EPO's mechanism of action. TIBC reflects iron-binding capacity and would be relevant to iron deficiency, not directly to EPO response.
An "S" or "C" side-to-side curvature of the spine would be associated with which one of the following spinal abnormalities?
- Scoliosis.
- Rheumatoid Arthritis (RA).
- Lordosis.
- Kyphosis.
Explanation
Correct Answer: A) Scoliosis.
Scoliosis is defined as an abnormal lateral (side-to-side) curvature of the spine, which appears as an "S" or "C" shape when viewed from behind. Rheumatoid arthritis is an inflammatory joint condition, not a spinal curvature abnormality. Lordosis refers to an exaggerated inward curve of the lower back (swayback). Kyphosis refers to an exaggerated outward curve of the upper back (hunchback). Both lordosis and kyphosis are anterior-posterior curvatures, not lateral.
The use of ceftriaxone (Rocephin) should be considered for which of the following?
- Anaerobic bacteria.
- Gram positive cocci.
- Gram negative rods.
- Ova and parasites.
Explanation
Correct Answer: C) Gram negative rods.
Ceftriaxone is a third-generation cephalosporin with excellent coverage against gram-negative rods (e.g., E. coli, Klebsiella, H. influenzae, Neisseria). It is widely used for community-acquired pneumonia, meningitis, gonorrhea, and sepsis due to its broad gram-negative activity and long half-life allowing once-daily dosing. Ceftriaxone has limited anaerobic coverage — metronidazole or carbapenems are preferred for anaerobes. While it has some gram-positive activity, it is not the drug of choice for gram-positive cocci such as MRSA or enterococci. Ova and parasites require antiparasitic agents entirely outside the antibiotic class.
Patients with COPD should avoid high-flow oxygen therapy due to which mechanism?
- Overproduction of Gamma Amino Butyric Acid (GABA) saturation from nasal cannula oxygen.
- Reliance on monoamine oxidization for respirations.
- Reliance on the hypoxic drive for respirations.
- Reliance on the carbon dioxide drive for respirations.
Explanation
Correct Answer: C) Reliance on the hypoxic drive for respirations.
In healthy individuals, the primary drive to breathe is triggered by rising CO2 levels. However, in patients with chronic COPD, chronically elevated CO2 levels cause the body to become desensitized to the CO2 drive. These patients instead rely on low oxygen levels — the hypoxic drive — as their primary stimulus to breathe. Administering high-flow oxygen eliminates this hypoxic stimulus, which can suppress the respiratory drive, reduce respiratory effort, and lead to hypercapnic respiratory failure. This is why oxygen must be administered cautiously and at controlled low flow rates in COPD patients. The other options described do not represent real physiological respiratory drive mechanisms.
A patient with erythema on the face surrounding the nasolabial folds as well as very fine dandruff is least likely to respond to which of the following treatments?
- Ketoconazole shampoo.
- Ultraviolet light therapy.
- Hydrocortisone cream.
- Fluorouracil (5-FU) cream.
Explanation
Correct Answer: D) Fluorouracil (5-FU) cream.
The clinical presentation — erythema around the nasolabial folds with fine dandruff-like scaling — is classic for seborrheic dermatitis, a chronic inflammatory skin condition associated with Malassezia yeast overgrowth. Standard treatments include antifungal agents such as ketoconazole shampoo (targets the yeast), low-potency topical corticosteroids such as hydrocortisone cream (reduces inflammation), and ultraviolet light therapy (has immunomodulatory effects on seborrheic dermatitis). Fluorouracil (5-FU) is a topical chemotherapy agent used to treat actinic keratosis and superficial skin cancers — it has no role in the treatment of seborrheic dermatitis and would therefore be least likely to produce a response.
A large goiter on the neck is most likely related to which of the following diagnoses?
- Myxedema Coma.
- Hashimoto's Thyroiditis.
- Hypothyroidism
- Hyperthyroidism.
Explanation
Correct Answer: D) Hyperthyroidism.
A large, visible goiter (enlarged thyroid gland) is most classically associated with hyperthyroidism, particularly Graves' disease, where TSH receptor stimulation leads to diffuse thyroid enlargement. The overstimulated thyroid grows significantly in size, producing a prominent goiter. While Hashimoto's thyroiditis can also cause a goiter early in the disease, it eventually leads to thyroid destruction and hypothyroidism. Myxedema coma is a severe, late-stage complication of hypothyroidism and does not typically present with a large goiter. Hypothyroidism, particularly in its later stages, is associated with a shrunken or fibrotic thyroid rather than a prominent goiter.
Based on current diabetes mellitus management guidelines, at which Hgb A1C is type 2 diabetes mellitus considered at goal on medication?
- Hgb A1c of 7.5.
- Hgb A1c of 8.0.
- Hgb A1c of 6.5.
- Hgb A1c of 7.0.
Explanation
Correct Answer: D) Hgb A1c of 7.0.
Per current ADA (American Diabetes Association) guidelines, the general target HbA1c for most non-pregnant adults with type 2 diabetes on medication is less than 7.0%. This threshold balances adequate glycemic control with minimizing the risk of hypoglycemia and medication side effects. An HbA1c of 7.5 or 8.0 would indicate suboptimal control and may warrant medication adjustment. An HbA1c of 6.5 is the diagnostic threshold for diabetes but is considered too aggressive as a treatment target for most patients due to increased hypoglycemia risk, particularly in older adults.
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