PMHNP Pre clinical Diagnostic Exam Chamberlain University
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Free PMHNP Pre clinical Diagnostic Exam Chamberlain University Questions
Patients with COPD should avoid high-flow oxygen therapy due to which mechanism?
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Overproduction of Gamma Amino Butyric Acid (GABA) saturation from nasal cannula oxygen.
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Reliance on monoamine oxidization for respirations.
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Reliance on the hypoxic drive for respirations.
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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.
Which one of the following cranial nerves is assessed by having a patient say "ahhh" and assessing the gag reflex?
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Glossopharyngeal.
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Trigeminal.
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Abducens.
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Hypoglossal.
Explanation
Correct Answer: A) Glossopharyngeal.
Cranial Nerve IX (Glossopharyngeal) along with CN X (Vagus) are assessed together by asking the patient to say "ahhh" to observe uvula and soft palate movement, and by assessing the gag reflex. The Trigeminal nerve (CN V) controls facial sensation and jaw movement. The Abducens nerve (CN VI) controls lateral eye movement. The Hypoglossal nerve (CN XII) controls tongue movement.
An example of an olfactory hallucination involves which of the following senses?
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Hearing.
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Smell.
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Vision.
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Taste.
Explanation
Correct Answer: B) Smell.
An olfactory hallucination is a false sensory perception involving the sense of smell — the person perceives odors that are not actually present. Auditory hallucinations involve hearing, visual hallucinations involve vision, and gustatory hallucinations involve taste. Each type of hallucination is classified according to the specific sensory modality affected.
A 40 year old, female, African American patient presents for history and physical. Upon your initial assessment, you notice she has severe exophthalmos (bulging of the eyes). Which other exam features would you anticipate to find on physical examination?
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Central obesity.
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Thyromegaly or goiter.
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Bilateral conjunctivitis.
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Poor visual acuity.
Explanation
Correct Answer: B) Thyromegaly or goiter.
Exophthalmos (proptosis) is a hallmark feature of Graves' disease, an autoimmune form of hyperthyroidism. In Graves' disease, TSH receptor antibodies stimulate the thyroid gland to overproduce thyroid hormone, leading to diffuse thyroid enlargement — thyromegaly or goiter. The combination of exophthalmos and goiter is classically associated with Graves' disease. Central obesity is associated with Cushing's syndrome or hypothyroidism, not hyperthyroidism. Bilateral conjunctivitis is an eye infection unrelated to this presentation. Poor visual acuity may occur in severe exophthalmos due to optic nerve compression but is not a primary expected examination finding alongside exophthalmos.
A large goiter on the neck is most likely related to which of the following diagnoses?
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Myxedema Coma.
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Hashimoto's Thyroiditis.
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Hypothyroidism
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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.
Treatment of a community-acquired pneumonia (CAP) is most likely which of the following bacteria?
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Escherichia Coli.
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Methicillin Resistant Staph Aureus (MRSA).
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Haemophilus Influenzae.
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Streptococcus Pneumoniae.
Explanation
Correct Answer: D) Streptococcus Pneumoniae.
Streptococcus pneumoniae (pneumococcus) is the most common bacterial cause of community-acquired pneumonia across all age groups. It is a gram-positive diplococcus that colonizes the upper respiratory tract and can descend to cause lobar pneumonia, presenting with productive cough, fever, pleuritic chest pain, and consolidation on imaging. E. coli is primarily a cause of urinary tract and intra-abdominal infections. MRSA pneumonia is typically hospital-acquired or associated with post-influenza superinfection. Haemophilus influenzae can cause CAP, particularly in patients with COPD, but is not the most common causative organism overall.
Patients who complain of gnawing abdominal pain with a history of orthopedic overuse injuries and over-the-counter treatment should be questioned for the use of which class of medication which is at risk for causing peptic ulcer disease?
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Oral corticosteroids.
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Acetaminophen.
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Ibuprofen.
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Proton pump inhibitors.
Explanation
Correct Answer: C) Ibuprofen.
Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug) commonly used for orthopedic pain and overuse injuries. NSAIDs inhibit COX-1 and COX-2 enzymes, reducing prostaglandin synthesis that normally protects the gastric mucosa. Chronic use leads to mucosal breakdown, gastric irritation, and peptic ulcer disease — presenting classically as gnawing or burning epigastric pain. Acetaminophen works via a different mechanism and does not damage the gastric mucosa, making it the safer OTC analgesic for GI-sensitive patients. Oral corticosteroids can contribute to ulcers but are not typically self-administered OTC for orthopedic injuries. Proton pump inhibitors are actually used to treat and prevent peptic ulcers, not cause them.
Inappropriate iron supplementation of a presumed iron deficiency anemia that is actually thalassemia may cause which of the following complications?
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Leptospirosis.
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Hemachromatosis.
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Vitamin D excess.
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Vitamin A excess.
Explanation
Correct Answer: B) Hemachromatosis.
Thalassemia is a genetic hemoglobin synthesis disorder that can mimic iron deficiency anemia on basic labs. If iron is incorrectly supplemented in a thalassemia patient who does not have true iron deficiency, excess iron accumulates in organs such as the liver, heart, and endocrine glands — a condition known as hemochromatosis (iron overload). This can lead to organ damage, cirrhosis, cardiomyopathy, and diabetes. Leptospirosis is a bacterial infection unrelated to iron supplementation. Vitamins D and A are fat-soluble vitamins with no connection to iron metabolism or its excess.
Aqueous humor, the transparent mass of clear liquid is normally found in which chamber(s) of the eye?
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Both but greater in the anterior chamber
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) Anterior only
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Posterior only
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None of the above; it's only seen as an abnormal finding with malignancy
Explanation
Correct Answer: A) Both but greater in the anterior chamber
Aqueous humor is a clear, watery fluid produced by the ciliary body that fills both the anterior and posterior chambers of the eye. It is present in greater volume in the anterior chamber — the space between the cornea and the iris — where it maintains intraocular pressure, provides nutrients to the avascular cornea and lens, and removes metabolic waste. The posterior chamber, located between the iris and the lens, also contains aqueous humor but in a smaller volume as it flows from there into the anterior chamber through the pupil.
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?
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Lactate Dehydrogenase (LDH).
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Red cell distribution width (RDW).
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Potassium.
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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.
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