PMHNP Pre clinical Diagnostic Exam Chamberlain University
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Free PMHNP Pre clinical Diagnostic Exam Chamberlain University Questions
Patients with peripheral edema may benefit from which of the following agents?
- Gabapentin (Neurontin).
- Methotrexate (Trexall).
- Cilostazol (Pletal).
- Furosemide (Lasix).
Explanation
Correct Answer: D) Furosemide (Lasix).
Furosemide is a loop diuretic that inhibits the Na-K-2Cl transporter in the thick ascending loop of Henle, promoting excretion of sodium and water. This reduces intravascular volume and effectively decreases peripheral edema caused by conditions such as heart failure, hepatic cirrhosis, and chronic kidney disease. Gabapentin is used for neuropathic pain and seizures and can actually cause or worsen peripheral edema as a side effect. Methotrexate is an immunosuppressant/DMARD with no diuretic properties. Cilostazol is a phosphodiesterase inhibitor used for intermittent claudication, not edema management.
Which of the following findings confirms a diagnosis of glomerulonephritis?
- RBC casts on urinalysis with microscopy.
- WBC casts on urinalysis with microscopy.
- Gram negative rods in bloodstream.
- Proteus Mirabilis in urine.
Explanation
Correct Answer: A) RBC casts on urinalysis with microscopy.
RBC (red blood cell) casts in the urine are the hallmark finding of glomerulonephritis, indicating glomerular inflammation and bleeding within the nephron. The presence of RBC casts confirms that hematuria is of glomerular origin rather than from lower urinary tract sources. WBC casts are characteristic of pyelonephritis, indicating renal tubular inflammation from infection. Gram negative rods and Proteus Mirabilis are findings associated with urinary tract infections, not glomerulonephritis.
When screening for melanoma, which one of the following findings would be considered a suspicious feature of a mole characteristic of a possible melanoma?
- Regular border
- Diameter of 1 cm
- Symmetry of the lesion, mirror-like image when divided in half
- Brown color
Explanation
Correct Answer: B) Diameter of 1 cm
When screening for melanoma, the ABCDE criteria are used: Asymmetry, Border irregularity, Color variation, Diameter greater than 6mm, and Evolution. A diameter of 1 cm (10 mm) significantly exceeds the 6 mm threshold — approximately the size of a pencil eraser — that raises concern for melanoma. Any mole larger than 6 mm warrants further evaluation and possible biopsy.
A regular border is a reassuring, benign characteristic — melanomas typically have irregular, notched, or poorly defined borders. Symmetry of a lesion, where both halves mirror each other, is also a benign feature — asymmetry is what raises concern in the ABCDE criteria. A uniform brown color alone is not suspicious — it is multi-colored lesions with varying shades of brown, black, red, or white that indicate possible malignancy.
You are about to perform a diaphragmatic excursion test on your healthy patient. Which one of the following results would you expect to see in a healthy patient with no abnormalities?
- Absent or no change in movement of the diaphragm noted between full inspiration and full expiration measurement.
- Ascension of 8-12 inches of the diaphragm noted bilaterally on expiration, though often much less on the right side due to the location of the heart and great vessels.
- Much greater descent of the diaphragm on the right side due to the liver present (two-three times larger).
- Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration.
Explanation
Correct Answer: D) Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration.
In a healthy patient, the diaphragm descends symmetrically and equally on both sides during maximal inspiration and rises equally on expiration. The normal diaphragmatic excursion is approximately 3–5 cm (about 1–2 inches) bilaterally. Option A is abnormal — absent movement suggests paralysis or severe pathology. Option B incorrectly states the measurement in inches and reverses the movement direction. Option C is incorrect — while the right hemidiaphragm sits slightly higher due to the liver, the excursion movement should still be approximately equal bilaterally in a healthy person.
Patients who have a suspected pelvic inflammatory disease (PID) diagnosis should be treated with which of the following agents?
- Ceftriaxone (Rocephin) IM plus Azithromycin (Zithromax) PO.
- Amoxicillin (Amoxil) plus Metronidazole (Flagyl).
- Cephalexin (Keflex) only.
- Doxycycline (Vibramycin) alone.
Explanation
Correct Answer: A) Ceftriaxone (Rocephin) IM plus Azithromycin (Zithromax) PO.
PID is a polymicrobial infection most commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis, often with concurrent anaerobic involvement. CDC guidelines recommend combination therapy: ceftriaxone IM (to cover gonorrhea) plus azithromycin or doxycycline PO (to cover chlamydia), sometimes with metronidazole added for anaerobic coverage. This dual-agent approach ensures adequate coverage of all likely pathogens. Amoxicillin lacks adequate coverage for gonorrhea and chlamydia. Cephalexin alone is insufficient for PID. Doxycycline monotherapy does not adequately treat gonorrhea and is never used alone for PID.
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?
- Hemangioma.
- Seborrheic Keratosis.
- Basal cell carcinoma.
- Achrocordon.
Explanation
Correct Answer: B) Seborrheic Keratosis.
Seborrheic keratosis is a very common benign skin growth classically described as a darkened, round, raised, waxy lesion that appears "stuck on" or pasted onto the skin surface. It typically has a rough, verrucous texture and ranges in color from tan to dark brown or black. It is most common in older adults and is entirely benign. Hemangiomas are vascular lesions that appear red or purple. Basal cell carcinoma is a malignant lesion, not benign, and typically presents as a pearly, translucent nodule with rolled borders. Acrochordons (skin tags) are small, soft, pedunculated growths that do not have the stuck-on appearance.
A patient of Mediterranean descent who presents with microcytic anemia with normal red cell distribution width should be evaluated for which of the following types of anemia?
- Lead poisoning
- B12 deficiency
- Iron deficiency
- Thalassemia
Explanation
Correct Answer: D) Thalassemia
Thalassemia is a genetic hemoglobin disorder particularly prevalent in populations from the Mediterranean, Middle East, and Southeast Asia. It presents with microcytic anemia — small red blood cells — but critically, the RDW (red cell distribution width) remains normal because all the red cells are uniformly small, a key distinguishing feature from iron deficiency anemia where the RDW is elevated due to mixed cell sizes. Mediterranean descent combined with microcytic anemia and normal RDW should immediately raise suspicion for thalassemia trait.
Iron deficiency also causes microcytic anemia but characteristically produces an elevated RDW due to anisocytosis. B12 deficiency causes macrocytic, not microcytic, anemia. Lead poisoning can cause microcytic anemia but is not associated with Mediterranean heritage and presents with additional systemic features such as neurological symptoms and basophilic stippling on blood smear.
Which of the following agents when given orally should include rinsing the mouth for risk of development of oral candidiasis (thrush)?
- Inhaled corticosteroids.
- Long acting beta agonists.
- Short acting beta agonists.
- Leukotriene inhibitors.
Explanation
Correct Answer: A) Inhaled corticosteroids.
Inhaled corticosteroids (ICS) deposit steroid particles in the oropharynx during inhalation, suppressing local immune defenses and promoting overgrowth of Candida albicans, leading to oral candidiasis (thrush). Patients must be instructed to rinse their mouth and gargle with water after every use to wash away residual particles and significantly reduce this risk. Long-acting and short-acting beta agonists do not suppress local immunity and are not associated with oral candidiasis. Leukotriene inhibitors are taken as oral tablets and do not deposit in the oropharynx in the same manner.
Your patient states they are experiencing lateral lower back pain and testing reveals bacteria in the urine. Which of the following are the most likely agent to cause an uncomplicated urinary tract infection in female patients?
- Escherichia Coli.
- Heliobacter.
- Campylobacter.
- Klebsiella Oxytoca.
Explanation
Correct Answer: A) Escherichia Coli.
Escherichia coli (E. coli) is responsible for approximately 80–85% of all uncomplicated urinary tract infections in female patients. Its prevalence is due to its normal residence in the gastrointestinal tract and the relatively short female urethra, which allows E. coli to ascend easily into the bladder. The lateral lower back pain described also suggests possible pyelonephritis — an upper UTI — where E. coli remains the predominant causative organism. Helicobacter pylori is associated with peptic ulcer disease. Campylobacter causes gastrointestinal infections. Klebsiella can cause UTIs but is far less common than E. coli, particularly in uncomplicated cases.
When using a sphygmomanometer, which one of the following would result in an inaccurate, falsely decreased blood pressure?
- Having the patient lying in Trendelenburg position
- Utilizing a blood pressure cuff that is too large for the patient's arm.
- Utilizing a cuff that is too small for a patient's arm.
- Having the patient's arm positioned below their heart
Explanation
Correct Answer: B) Utilizing a blood pressure cuff that is too large for the patient's arm.
When a blood pressure cuff is too large for the patient's arm, it over-compresses the artery at a lower pressure than what is actually needed, causing the reading to be falsely lower than the patient's true blood pressure. This is a well-established source of measurement error in clinical practice.
Using a cuff that is too small produces the opposite error — it requires more pressure to compress the artery, resulting in a falsely elevated reading. Having the patient's arm positioned below the heart increases hydrostatic pressure in the vessels, which also leads to a falsely elevated reading, not decreased. Trendelenburg positioning increases venous return and cardiac preload, which tends to elevate blood pressure rather than decrease it, and is not a recognized cause of falsely low BP readings with a sphygmomanometer.
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