NRSADVN 3117 RN PRACTICE IN PRIMARY CARE EXAM Q & A 2024, Exams of Nursing

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NRSADVN 3117

RN Practice in Primary

Care

Q & A w/ Rationales

1. Which of the following actions is a primary care RN responsible for when providing care to a patient with a chronic illness? a) Prescribing medication for symptom management b) Collaborating with other healthcare professionals for coordination of care c) Performing complex surgical procedures d) Providing specialized care in an acute care setting Answer: b) Collaborating with other healthcare professionals for coordination of care Rationale: Primary care RNs are responsible for coordinating care for patients with chronic illnesses, which involves collaborating with other healthcare professionals such as physicians, pharmacists, and social workers.
2. When conducting an initial assessment of a patient in a primary care setting, which of the following is the nurse's priority action? a) Assessing the patient's vital signs b) Reviewing the patient's medical history c) Conducting a physical examination d) Establishing a therapeutic relationship with the patient Answer: d) Establishing a therapeutic relationship with the patient Rationale: Building a therapeutic relationship is the foundation of providing comprehensive primary care. It helps in gaining the patient's trust, understanding their concerns, and promoting effective communication.

in a primary care setting, which intervention is most appropriate? a) Administering insulin injections as prescribed b) Referring the patient to an endocrinologist for all diabetes-related care c) Instructing the patient in self-monitoring blood glucose levels d) Providing information on surgical treatment options Answer: c) Instructing the patient in self-monitoring blood glucose levels Rationale: Instructing the patient in self-monitoring blood glucose levels is a comprehensive and appropriate intervention for a primary care RN. It empowers the patient in managing their condition and enables early identification of any fluctuations.

6. A primary care RN is performing a comprehensive mental health assessment for a patient. Which of the following questions is most appropriate? a) "Have you had any surgeries in the past?" b) "Do you have a family history of heart disease?" c) "Do you have difficulty sleeping or changes in appetite?" d) "When was your last tetanus vaccination?" Answer: c) "Do you have difficulty sleeping or changes in appetite?" Rationale: Asking about difficulty sleeping or changes in appetite is important in assessing the patient's mental health. These symptoms can indicate possible underlying

mental health disorders such as depression or anxiety.

7. Which of the following age groups is most commonly served by primary care RNs? a) Neonates b) Adolescents c) Middle-aged adults d) Older adults Answer: d) Older adults Rationale: As the population ages, primary care RNs are increasingly serving older adults who often require comprehensive and specialized care to address age-related health conditions and promote healthy aging.
8. A primary care RN is educating a patient on the importance of exercise. Which statement by the patient demonstrates understanding? a) "I will exercise vigorously every day for at least an hour." b) "I will try to exercise for 30 minutes most days of the week." c) "I will only exercise if I have a lot of free time." d) "I don't need to exercise since I eat a healthy diet." Answer: b) "I will try to exercise for 30 minutes most days of the week." Rationale: The American Heart Association recommends at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise spread throughout

Rationale: Home visits provide primary care RNs with a unique opportunity to assess patients in their own environment, helping to gain insight into their living conditions, social support systems, and potential barriers to optimal healthcare.

11. Which of the following is an essential element of a patient-centered medical home model in primary care? a) A single healthcare provider responsible for all aspects of the patient's care b) Limited access to specialized care and services c) Fragmented and uncoordinated care delivery d) Emphasis on patient engagement and shared decision- making Answer: d) Emphasis on patient engagement and shared decision-making Rationale: Patient-centered medical homes focus on actively involving patients in their healthcare decisions, promoting self-management, and establishing partnerships between patients and healthcare providers.
12. A primary care RN is providing education to a patient on medication adherence. Which intervention is most effective? a) Providing written medication instructions only b) Using visuals and illustrations to explain proper medication use c) Sending medication reminders via email or text messages

d) Informing the patient to rely solely on their memory for medication schedules Answer: b) Using visuals and illustrations to explain proper medication use Rationale: Using visuals and illustrations enhances patient understanding and retention of educational materials, which can significantly improve medication adherence and patient outcomes.

13. Which of the following is a key difference between primary care and specialty care? a) Primary care focuses on preventing and managing chronic illnesses, while specialty care focuses on acute conditions. b) Primary care is provided by physicians, while specialty care is provided by nurses. c) Primary care requires specialized training in a specific area of medicine, while specialty care does not. d) Primary care is more expensive and less accessible than specialty care. Answer: a) Primary care focuses on preventing and managing chronic illnesses, while specialty care focuses on acute conditions. Rationale: Primary care aims to prevent, manage, and coordinate care for chronic illnesses, while specialty care typically involves providing specialized expertise and interventions for acute, complex medical conditions.

B:

Question 1: A 45-year-old patient presents with symptoms of persistent cough, weight loss, and night sweats. The nurse should suspect: A. Common cold B. Tuberculosis C. Allergic rhinitis D. Pneumonia Answer: B. Tuberculosis Rationale: The symptoms described are classic signs of tuberculosis, including a persistent cough, unintentional weight loss, and night sweats. This condition is a significant concern in primary care, particularly in patients with risk factors such as homelessness or HIV/AIDS. Question 2: When assessing a patient for cardiovascular risk factors, which of the following should the nurse prioritize? A. Family history B. Dietary habits C. Exercise routine D. Blood pressure Answer: A. Family history Rationale: Family history is a crucial indicator of genetic predisposition to cardiovascular diseases. It provides valuable information for risk assessment and the development of preventive care plans for the patient.

Question 3: A 65-year-old patient with diabetes presents with a foot ulcer. The nurse identifies signs of infection and should prioritize: A. Initiating antibiotic therapy B. Assessing blood glucose levels C. Referring to a podiatrist D. Educating the patient on foot care Answer: A. Initiating antibiotic therapy Rationale: In the presence of an infected foot ulcer, prompt initiation of antibiotic therapy is essential to prevent further complications, including sepsis. Assessing blood glucose levels and patient education are important but should follow the immediate management of the infection. Question 4: During a routine well-child visit, the nurse observes a 4- year-old displaying developmental delays and difficulty with speech. The nurse should: A. Schedule a hearing test B. Refer the child to a speech therapist C. Educate the parents on developmental milestones D. Perform a comprehensive neurological assessment Answer: B. Refer the child to a speech therapist Rationale: Speech delays in a 4-year-old should prompt a referral to a speech therapist for further evaluation and intervention. While educating the parents on developmental milestones is important, the priority is to address the specific concern identified during the visit.

Question 7: When assessing a patient's medication adherence, which of the following strategies should the nurse employ? A. Reviewing refill records B. Asking the patient about their adherence C. Conducting pill counts D. All of the above Answer: D. All of the above Rationale: Comprehensive assessment of medication adherence involves a combination of strategies, including reviewing refill records, direct inquiry with the patient, and conducting pill counts. Employing all these methods provides a more accurate understanding of the patient's adherence behaviors. Question 8: A 70-year-old patient presents with confusion and dehydration. The nurse should prioritize assessment for: A. Urinary tract infection B. Hypoglycemia C. Delirium D. Dehydration Answer: A. Urinary tract infection Rationale: In an older adult presenting with confusion and dehydration, urinary tract infection should be a primary consideration due to its prevalence and potential to cause acute cognitive changes. While hypoglycemia and delirium are important differentials, the focus should initially be on identifying a common cause such as a urinary tract infection.

Question 9: A 25-year-old patient presents with symptoms of anxiety and panic attacks. The nurse should initiate: A. Referral to a psychiatrist B. Cognitive-behavioral therapy C. Assessment for substance use D. Prescribing anxiolytic medication Answer: C. Assessment for substance use Rationale: Before initiating specific treatments for anxiety and panic attacks, it is important to assess for potential substance use, which can contribute to or exacerbate these symptoms. Referral to a psychiatrist and cognitive- behavioral therapy may be appropriate after a comprehensive assessment. Question 10: A 55-year-old patient with chronic obstructive pulmonary disease (COPD) experiences worsening dyspnea and productive cough. The nurse should assess for: A. Pneumonia B. Pulmonary embolism C. COPD exacerbation D. Asthma exacerbation Answer: A. Pneumonia Rationale: Worsening dyspnea and productive cough in a patient with COPD raise concerns for concurrent pneumonia, which is a common complication in this population. Assessing for pneumonia is critical to guide appropriate management and prevent further respiratory

intervention and management. Question 13: During a prenatal visit, a pregnant patient reports persistent vomiting and weight loss. The nurse should consider: A. Hyperemesis gravidarum B. Gestational diabetes C. Iron-deficiency anemia D. Gastroenteritis Answer: A. Hyperemesis gravidarum Rationale: Persistent vomiting and weight loss in pregnancy are indicative of hyperemesis gravidarum, a severe form of morning sickness. Considering this diagnosis is important for appropriate management and support for the pregnant patient. Question 14: A 40-year-old patient presents with symptoms of polyuria, polydipsia, and unexplained weight loss. The nurse should assess for: A. Type 1 diabetes B. Type 2 diabetes C. Diabetes insipidus D. Hyperthyroidism Answer: A. Type 1 diabetes Rationale: The classic symptoms described are consistent with type 1 diabetes, particularly in the absence of risk factors for type 2 diabetes. Assessing for type 1 diabetes is crucial for timely diagnosis and management.

Question 15: A 20-year-old patient presents with a history of unprotected sexual intercourse and requests emergency contraception. The nurse should: A. Provide emergency contraception without further assessment B. Assess for pregnancy and discuss contraceptive options C. Refer the patient to a gynecologist D. Educate the patient on safe sex practices Answer: B. Assess for pregnancy and discuss contraceptive options Rationale: Before providing emergency contraception, it is important to assess for pregnancy and discuss long-term contraceptive options with the patient. This approach ensures comprehensive care for the patient's reproductive health needs. C:

1. A 45-year-old male patient presents to the primary care clinic with complaints of fatigue, weight loss, polyuria, and polydipsia for the past two months. He has a family history of type 2 diabetes mellitus and hypertension. His vital signs are: blood pressure 160/90 mmHg, pulse 88 beats per minute, respiratory rate 18 breaths per minute, temperature 36.8°C, and oxygen saturation 98% on room air. His body mass index (BMI) is 28 kg/m2. The RN orders a fasting plasma glucose (FPG) test and a hemoglobin A1c (HbA1c)

years should have a Pap smear and an HPV test every five years (co-testing). The other options are either too frequent or too infrequent for this patient's age group.

3. A 60-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) comes to the primary care clinic for a follow-up visit after being discharged from the hospital for an acute exacerbation of COPD. He reports that he has been taking his medications as prescribed, but he still experiences shortness of breath, wheezes, and chest pain on exertion. His vital signs are: blood pressure 150/90 mmHg, pulse 100 beats per minute, respiratory rate 24 breaths per minute, temperature 37°C, and oxygen saturation 92% on room air. His current medications are: salbutamol inhaler, tiotropium inhaler, fluticasone/salmeterol inhaler, aspirin, metoprolol, and atorvastatin. What is the most appropriate nursing intervention for this patient? a) Administer supplemental oxygen via nasal cannula * b) Increase the dose of salbutamol inhaler c) Discontinue the fluticasone/salmeterol inhaler d) Refer the patient to a cardiologist Rationale: The most appropriate nursing intervention for this patient is to administer supplemental oxygen via nasal cannula to improve his oxygen saturation and relieve his dyspnea and chest pain. Increasing the dose of salbutamol inhaler may cause tachycardia and worsen his CAD. Discontinuing the fluticasone/salmeterol inhaler may increase the risk of COPD exacerbation. Referring the patient to a cardiologist may be indicated, but it is not an

immediate priority.

4. A 50-year-old female patient with a history of rheumatoid arthritis (RA) and osteoporosis visits the primary care clinic for a medication review. She reports that she has been taking methotrexate, prednisone, ibuprofen, calcium, and vitamin D as prescribed, but she still experiences joint pain, stiffness, and swelling in her hands, wrists, and knees. She also complains of frequent heartburn, nausea, and constipation. She has no allergies or other medications. Her vital signs are: blood pressure 130/80 mmHg, pulse 72 beats per minute, respiratory rate 16 breaths per minute, temperature 36.5°C, and oxygen saturation 97% on room air. Her body mass index (BMI) is 24 kg/m2. What are the potential adverse effects of the medications that this patient is taking? a) Methotrexate: hepatotoxicity, bone marrow suppression, infection b) Prednisone: osteoporosis, hyperglycemia, immunosuppression c) Ibuprofen: gastrointestinal bleeding, renal impairment, hypertension d) All of the above * Rationale: All of the medications that this patient is taking have potential adverse effects that need to be monitored and managed. Methotrexate can cause hepatotoxicity, bone marrow suppression, and infection; prednisone can cause osteoporosis, hyperglycemia, and immunosuppression; and ibuprofen can cause gastrointestinal bleeding, renal impairment, and hypertension. Calcium and vitamin D are