D. MRI - CORRECT ANSWER: A.

NR 577 Final Exam Latest Update - Actual Exam 300 Questions and 100% Verified Correct Answers Guaranteed A+

• A 56-year-old patient comes in for a routine well visit. He has a history of a previous

stroke and Type 2 Diabetes. Which of the following orders would be appropriate for a patient with a previous stroke?

• Initiate statin therapy

B. EEG

• Warfarin therapy with an INR goal of 2-3

D. MRI - CORRECT ANSWER: A.

Patients with a history of an ASCVD should be started on statin therapy regardless of current LDL. The question did not mention any other symptoms that would warrant additional diagnostics. Warfarin therapy is only indicated if AFIB would be the primary indication for anticoagulation after a stroke.

• A 36-year-old female is being seen in your clinic for left sided facial weakness. In

your review of systems, the patient reports that "certain sounds really bother me and my taste buds seem off". She also reports temporal pain which has subsided. Your physical exam reveals no other neurological deficits. Which of the following interventions would be most appropriate?

• Call 911 to activate emergency stroke protocols
• Refer the patient to neurology
• Order an MRI

D. Prescribe a course of oral corticosteroids - CORRECT ANSWER: D.

Bell's Palsy commonly causes alterations in taste and hyperacusis. This contrasts with stroke. Corticosteroids increase the chances of recovery complete by 12-15% at nine to twelve months and are routinely prescribed. The complaint of pain also suggests a possible viral infection such as herpes simplex or varicella which has been implicated, in some cases, as a trigger for facial palsy.

• A 9-year-old female patient presents to your clinic with complaints of a headache.

The patients mother states the headache started two days ago and she has been giving her children's Tylenol. The child states the pain is bilateral and worsens when running or

standing. The nurse practitioner should:

• Treat her for migraine prevention and start topiramate
• Order a CT of her head
• Educate the parent that children need at least 9 hours of sleep
• Refer to a psychologist for cognitive behavioral therapy - CORRECT ANSWER: B.

Table 25-8 lists red flags for pediatric headaches. Headaches that worsen with postural changes may indicate additional intracranial pathology and should be further investigated. Depending on the urgency an MRI vs. CT should be considered. A, C, & D are preventative measures for established migraines or TTH.

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• You are educating the parents of a 16-year-old boy who has been newly diagnosed

with epileptic syndrome. Which statement is false?

• Most states will grant a driver's license if the patient has been deemed seizure free

for 6-12 months by his physician.

• Clinical seizures that last 15 minutes are considered medical emergencies
• Physical training such as weight training should be restricted due to safety concerns.

D. Depression is a common comorbidity of epilepsy. - CORRECT ANSWER: C.

Physical activity that promote age appropriate socialization and normalcy are highly recommended. The only activities that come with restrictions are scuba diving, contact sports (may or may not be allowed depending on the physician), and free climbing.Swimming is allowed, but preferably under supervision.

• A 25-year-old male presents to the clinic complaining of a severe, throbbing

headache for the past 2 days. The pain increases when exposed to bright lights and is accompanied by nausea. He states the headache started after working a 16-hour shift without resting. What type of headache is the patient suffering from and what medication is appropriate for immediate relief?

• Migraine headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours if no

relief

• Migraine headache - Topiramate 50mg BID
• Tension - Type Headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours

if no relief

D. Cluster headache - Sumatriptan 6mg SQ single dose - CORRECT ANSWER: A.

Migraine headaches can be unilateral and are often accompanied by nausea, vomiting, and photophobia. These headaches can be triggered by lack of sleep and stress.Zolmitriptan is often effective for immediate relief of migraines. Topiramate is used as a prophylaxis for migraines. The patient's symptoms are not characteristic of a tension type or cluster headache. Triptans are not recommended for tension type headaches.

• A 63-year old male presents to clinic with complaints of tremors and muscle spasms.

The patient has a history of Parkinson's disease and has been taking Levodopa 50mg TID. What is an appropriate treatment plan for this patient?

• Decrease the amount of levodopa the patient is taking per day.
• Inform the patient that these side effects are common as Parkinson's disease

progresses and start the patient on amantadine.

• Refer the patient to a neurologist for further evaluation.
• Continue to monitor the patient for increase in tremors. - CORRECT ANSWER: B.

Levodopa-induced dyskinesias are common in later Parkinson's disease. Dyskinesias can occur in the form of chorea, tremors, tics, and dystonia. According to Papadakis and McPhee (2018), although levodopa-induced dyskinesias are dose related, decreasing the dose can alter the therapeutic benefit of the medication. The patient can begin taking amantadine or levetiracetam to help decrease the dyskinesias.

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• An 11-year old presents to clinic with her mother complaining of severe headaches

and nausea when she wakes up in the morning. Headaches have worsened over the past week. The patient states the headaches are worse when she changes position and mostly towards the back of her head. As the nurse practitioner, what is best treatment option for this patient?

• Tell the mother to buy ibuprofen over the counter and follow-up if no relief.
• Prescribe topiramate 50mg BID.
• Refer the patient for a stat CT scan of her head.

D. Prescribe acetaminophen 15mg/kg. - CORRECT ANSWER: C.

Although ibuprofen 10mg/kg and acetaminophen 15mg/kg are first line treatment for acute headaches in children, this patient's symptoms are red flags and require further evaluation and workup. Topiramate is prescribed as a preventative medication for headaches in children.

• The NP is evaluating a 6-year old child for his annual check-up. After completing his

vision screening the results are 20/20 in the right eye and 20/30 in the left eye. What would be the next step the NP would take?

• This is a normal finding, no further steps to take.
• Repeat the vision screening in 6 months.
• Refer the child to an ophthalmologist.
• Advise the mother on importance of hydration and nutrition to improve vision. -

CORRECT ANSWER: C.

The results are within the normal limits but any two-line discrepancy during vision screening has to be referred to an ophthalmologist even if normal.

• A patient currently 4mo pregnant informs the NP that she will be travelling to Belize

with her husband in the following week. What is the best response by the NP to the patient?

• You may want to post pone your trip to Belize due to high prevalence of the Zika

Virus.

• You should walk around the plane often to prevent blood clots.
• Make sure you are up to date with the recommended vaccinations for travel to

Belize.

D) Enjoy your trip. - CORRECT ANSWER: A.

Pregnant women should take into consideration postponing travel to areas where Zika Virus is prevalent because infected women during pregnancy can led to fetal microcephaly and loss, in addition to infant and newborn blindness and neurologic problems.

• A 67-year-old female comes into your clinic stating that her daughter just gave birth

to her first grandchild and she if planning to fly to visit them next month. She reports her daughter told her to make sure her immunizations were up to date as her grandchild was 2 months premature. She wants to know what immunizations she needs as she 3 / 4

has not had any "since high school". You advise her to get which of the following immunizations?

• Influenza, MMR, PCV 13, Herpes Zoster, Tdap
• Influenza, PCV13, Herpes Zoster
• MMR, PCV13, Herpes Zoster

D. Influenza, Herpes Zoster - CORRECT ANSWER: A.

The CDC and The Advisory Committee on Immunization Practices (ACIP) recommend routine influenza vaccination for all persons aged 6 months and older. The ACIP recommend one dose of MMR for non-high-risk adults aged 18 years and older. PCV 13 is recommended for those 65 and older. Increasing reports of pertussis among US adolescents, adults, and their infant contacts have stimulated vaccine development for older age groups. The ACIP recommends Tdap for those age 65 years and older who are around at-risk infants such as those with prematurity. The ACIP also recommends Herpes Zoster vaccination at age 50.

• A 55-year-old male presents for a new patient visit. The patient reports he last saw a

provider 10 years ago when his wife made him see a doctor for a "pill to quit smoking," as he had tried to quit smoking many times since starting at age 18. He tells you that he has not smoked since that visit and wants to know if he should be screened for lung cancer. Which of the following statements should you make?

• "Since you have not smoked in a decade, you are no longer at risk for smoking

associated lung cancer".

• "Unless you are having issues with your breathing, there is no need to screen for

lung cancer."

• "Since you smoked for so long, I will send you for a CT of your chest to screen for

lung cancer"

• "Unfortunately, there is no screening available for lung cancer". - CORRECT

ANSWER: C.

USPSTF recommends low-dose CT in smokers aged 55-80 years old with a 30-pack year smoking history or prior smokers with this history who have quit in the last 15 years.

• When ordering outpatient imaging studies for a patient who has a medical history of

Stage IV renal failure, a nurse practitioner would be wise to avoid which study?

• 2 view chest XRAY
• CT angiography abdomen and pelvis
• MRI brain

d. CT c-spine - CORRECT ANSWER: B.

Radiographic contrast media is directly nephrotoxic and is one of the leading causes of acute kidney injury. Those with preexisting kidney disease pose the greatest risk of significant nephropathy if given this contrast media. Of the listed imaging options, only the CT angiography uses the contrast media and a patient with a history of renal failure should not receive this agent. (Papadakis & McPhee. Current Medical Diagnosis and Treatment, 2019. Pg. 932.)

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