6531 280 QUESTIONS AND CORRECT ANSWERS

NURS 6531 ACTUAL Final REVIEW EXAM/NURS

6531 280 QUESTIONS AND CORRECT ANSWERS

LATEST VERSION - most tested questions covered

A small, rural hospital is part of an Accountable Care Organization (ACO) and is designated as a Level

• ACO. What is part of this designation? p. 2
• Bonuses based on achievement of benchmarks
• Care coordination for chronic diseases
• Standards for minimum cash reserves

d. Strict requirements for financial reporting - CORRECT ANSWER-ANS: A

A Level 1 ACO has the least amount of financial risk and requirements, but receives shared savings bonuses based on achievement of benchmarks for quality measures and expenditures. Care coordination and minimum cash reserves standards are part of Level 2 ACO requirements. Level 3 ACOs have strict requirements for financial reporting.

The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety.What is the initial action for this patient?

• Administer empirical intravenous antibiotics and steroids.
• Have the child lie down and administer high-flow, humidified oxygen.
• Obtain an immediate consultation with an otolaryngologist.

d. Perform a thorough examination of the oropharynx. - CORRECT ANSWER-ANS: C

Patients with suspected epiglottitis, with high fever, sore throat, stridor, drooling, and respiratory distress should be referred immediately to otolaryngology. Starting an IV or having the child lie down will increase distress and may precipitate laryngospasm. The throat should not be examined because it may cause laryngospasm.

An adult patient is seen in clinic with fever, sore throat, and dysphagia. Which diagnostic test will the provider order to confirm a diagnosis of epiglottitis?

• Blood cultures
• Complete blood count
• Fiberoptic nasopharyngoscopy 1 / 4

d. Lateral neck film - CORRECT ANSWER-ANS: C

Fiberoptic nasopharyngoscopy allows direct visualization of the epiglottis and is used increasingly with adult patients suspected of having epiglottitis. Blood cultures and a CBC may be drawn as part of the workup to help guide antimicrobial therapy but are not diagnostic. A lateral neck film is not always diagnostic with adults.

An adult patient is diagnosed with epiglottitis secondary to a chemical burn. Which medication will be given initially to prevent complications?

• Chloramphenicol
• Clindamycin
• Dexamethasone

d. Metronidazole - CORRECT ANSWER-ANS: C

This case of epiglottitis does not have an infectious cause, so antibiotics are not given unless there are symptoms of infection. A corticosteroid can decrease the need for intubation.

A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these symptoms?

• Bacterial infection
• Candida albicans
• Herpes simplex virus (HSV)

d. Human papilloma virus (HPV) - CORRECT ANSWER-ANS: C

HSV infections generally start with a prodrome of tingling, pain, and burning followed by vesicular and ulcerative lesions. Bacterial infection presents with inflammation of the gingiva, bleeding, and ulceration with or without purulent discharge. Candida albicans appear as white, cottage cheese-like lesions that may be removed, but may cause bleeding when removed. HPV manifests as white, verrucous lesions individually or in clusters.

A patient diagnosed with gingival inflammation presents with several areas of ulceration and a small amount of purulent discharge. What is required to diagnose this condition?

• Culture and sensitivity
• Microscopic exam of oral scrapings
• Physical examination

d. Tzanck smear - CORRECT ANSWER-ANS: C 2 / 4

This patient has symptoms consistent with gingivitis, which may be diagnosed by physical examination alone. Cultures are not necessary unless systemic disease is present. A microscopic exam of oral scrapings to look for hyphae may be performed to diagnose candida infections. A Tzanck smear is performed to confirm a diagnosis of herpes simplex.

A patient reports painful oral lesions and the provider notes several white, verrucous lesions in clusters throughout the mouth. What is the recommended treatment for this patient?

• Nystatin oral suspension
• Oral acyclovir
• Oral hygiene measures

d. Surgical excision - CORRECT ANSWER-ANS: D

White, verrucous lesions in clusters are diagnostic for human papilloma virus (HPV) infection which is treated with surgical excision. Nystatin suspension is given for candida infection. Oral acyclovir is used for herpes simplex virus (HSV) infection. Oral hygiene measures are used for gingivitis.

Which physical examination finding suggests viral rather than bacterial parotitis?

• Clear discharge from Stensen's duct
• Enlargement and pain of affected glands
• Gradual reduction in saliva production

d. Unilateral edema of parotid glands - CORRECT ANSWER-ANS: A

Viral parotitis generally produces clear discharge. Enlargement and pain of affected glands may be nonspecific or is associated with tuberculosis (TB) infection. A gradual reduction in saliva, resulting in xerostomia, is characteristic of human immunodeficiency virus (HIV) infection. Unilateral edema is more often bacterial.

A patient diagnosed with acute suppurative parotitis has been taking amoxicillin-clavulanate for 4 days without improvement in symptoms. The provider will order an antibiotic for Methicillin- resistant S. aureus. Which other measure may be helpful?

• Cool compresses
• Discouraging chewing gum
• Surgical drainage

d. Topical corticosteroids - CORRECT ANSWER-ANS: C

If improvement does not occur after 3 to 4 days of antibiotics, surgical drainage is appropriate.Warm compresses are recommended for comfort. Chewing gum and other methods to stimulate the 3 / 4

production of saliva are recommended. Steroids are questionable and topical steroids will have little effect.

What are factors associated with acute suppurative parotitis? (Select all that apply.)

• Allergies
• Anticholinergic medications
• Diabetes mellitus
• Hypervolemia

e. Radiotherapy - CORRECT ANSWER-ANS: B, C, E

Anticholinergic medications decrease salivary flow and increase the risk for parotitis. Chronic diseases, including diabetes mellitus, can increase the risk. Radiotherapy and other procedures may increase the risk. Allergies and hypervolemia do not increase the risk.

An adolescent presents with fever, chills, and a severe sore throat. On exam, the provider notes foul- smelling breath and a muffled voice with marked edema and erythema of the peritonsillar tissue.What will the primary care provider do?

• Evaluate for possible epiglottitis.
• Perform a rapid strep and throat culture.
• Prescribe empirical oral antibiotics.

d. Refer the patient to an otolaryngologist. - CORRECT ANSWER-ANS: D

This patient has clinical signs of peritonsillar abscess, which may be diagnosed on clinical signs alone.Patients with peritonsillar abscess should be referred to an otolaryngologist for possible I&D of the abscess and hospitalization for IV antibiotics. A rapid strep and culture are not indicated. Oral antibiotics generally do not work.

A patient is diagnoses with peritonsillar abscess and will be hospitalized for intravenous antibiotics.What additional treatment will be required?

• Intubation to protect the airway
• Needle aspiration of the abscess
• Systemic corticosteroid administration

d. Tonsillectomy and adenoidectomy - CORRECT ANSWER-ANS: B

Needle aspiration, antibiotics, pain medication, and hydration can effectively treat peritonsillar abscess. Intubation is not performed unless the airway is compromised. Systemic corticosteroid administration is useful, but not required in all cases. Tonsillectomy alone is sometimes performed if recurrent tonsillitis or peritonsillar abscess is present

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