NR602 week 8 final exam

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NR602 week 8 final exam

A 27-year-old primiparous patient presents 3 weeks postpartum with complaints that her infant frequently chokes, pulls away from the breast during feeding, and appears distressed. She also reports excessive milk leakage between feedings. The infant’s growth is appropriate. Which is the MOST appropriate initial management?

1. Discontinue breastfeeding and transition to formula
2. Encourage feeding from both breasts during each feeding
3. Initiate metoclopramide therapy
4. Recommend expressing milk prior to feeding and using one breast per feeding session ✓

A 19-year-old patient presents with a painless breast mass. Physical examination reveals a discrete, firm, smooth, mobile mass. What is the MOST likely diagnosis?

1. Lipoma
2. Breast cyst
3. Phyllodes tumor
4. Fibroadenoma ✓

A 4-year-old child presents with recurrent abdominal pain and fever without an obvious source. The child has no respiratory symptoms, and the abdominal exam is nonspecific. Based on this presentation, which condition should be specifically evaluated as part of the differential diagnosis?

1. Acute appendicitis
2. Viral cystitis
3. Urinary tract infection ✓
4. Pelvic inflammatory disease

A 12-year-old girl presents for a routine health visit 8 months after menarche. Her mother reports that the adolescent’s menstrual cycles are irregular, sometimes occurring every 40–50 days, with variable flow. The patient has no other symptoms and is otherwise healthy. Which explanation is MOST appropriate?

1. The irregular cycles indicate abnormal uterine bleeding requiring immediate diagnostic evaluation
2. The irregular cycles are expected due to immaturity of the hypothalamic–pituitary–ovarian axis ✓
3. The menstrual pattern suggests ovulatory dysfunction related to an underlying endocrine disorder
4. The findings are inconsistent with normal development and suggest early onset menopause

A 14-year-old adolescent with a history of Attention Deficit/Hyperactivity Disorder (ADHD) presents with sudden worsening irritability, decreased need for sleep, grandiose statements, racing thoughts, and risky behaviors. The symptoms began abruptly and are significantly different from the child’s baseline behavior. Which interpretation is MOST appropriate?

1. The presentation reflects typical ADHD symptoms that fluctuate during adolescence
2. The findings suggest a possible manic episode requiring evaluation for bipolar disorder ✓
3. The symptoms are best explained by a depressive episode with irritability
4. The behaviors are consistent with adjustment disorder following a stressor

The NP wants to implement trauma-informed care principles during routine examinations. Which approach BEST reflects trauma-informed care?

1. Assuming trauma exposure is possible and providing autonomy-focused care to all patients ✓
2. Avoiding physical examinations unless trauma is disclosed
3. Referring patients with trauma histories to behavioral health prior to examination
4. Screening only patients with known trauma histories

A patient arrives with two small children and is the only adult present. She appears distracted and rushed but needs evaluation for abnormal uterine bleeding. Which clinician strategy BEST balances care quality and feasibility?

1. Proceed with accommodations and ask what parts of the visit feel manageable today ✓
2. Limit history to chief concern and skip sensitive topics
3. Require the patient to return without children to complete the history
4. Ask the oldest child to help answer questions to save time

A 37-year-old patient with limited English proficiency presents with pelvic pain. Her adult daughter offers to interpret because “it’s faster.” The clinic has access to certified medical interpreters. What is the BEST next step?

1. Proceed in English and document limited understanding
2. Use a certified medical interpreter and ask if the patient prefers phone or video ✓
3. Ask the daughter to interpret only the chief concern questions
4. Use the daughter to interpret since the patient requested it

A 26-year-old woman presents with complaints of increased vaginal discharge but denies vulvar irritation or pain. On speculum examination, the vaginal walls appear pink without inflammation, and a thin, gray-white, milky discharge is noted. Which microscopic finding would BEST support a diagnosis of bacterial vaginosis (BV)?

1. Vaginal epithelial cells coated with bacteria that obscure cell borders on a saline wet mount ✓
2. Numerous white blood cells and budding yeast forms on saline microscopy
3. Motile, flagellated organisms visible on a wet mount
4. Mucopurulent cervical discharge with cervical friability

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