APEA PRETEST Flashcards
A depressed patient has been treated and has had releif of symptoms while on medication for depression. Which patient statement indicates a correct understanding of depression?
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The process by which a professional association confers recognition that a licensed professional has demonstrated mastery of a specialized body of knowledge and skills is termed:
A. licensure.
B. quality assurance.
C. certification.
D. policy and procedure.
C
Which two diuretics would make a good combination for a patient who needed diuresis but not hypokalemia?
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A 19 yo sexually active female is being counseled by the NP about contraception. The NP is accurate when she tells the patient that a diaphragm:
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Which statement below about breastfeeding is NOT accurate?
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Which of the following diseases is NOT acquired transplacentally?
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- A 46 year old female has hypertension and is well managed with propanolol (Inderal). Which of the following is a beneficial secondary effect of this drug?
A. Improved glycemic control.
B. Improved lipid profile
C. Weight loss
D. Migraine prophylaxis
D
What is the recommended timing for gestational diabetes screening
A. 12-16 weeks gestation
B. 24-28 weeks gestation
C. 30-34 weeks gestation
D. 34-38 weeks gestation
B
- A patient is 26 weeks pregnant. She presents today with very tender vesicles on an erythematous base in the genital area. She complains of malaise and fever and states that she’s never felt anything like this before. How soon should the lesions and symptoms resolve
A. at delivery
B. in about 3 days
C. in about 14 to 21 days
D. in about 7 days
- Which of the following is NOT an appropriate suppression therapy for chronic bacterial prostatitis (CBP)
A. doxycycline 100 mg qd
B. nitrofurantoin (Macrobid) 100 mg qd
C. Bactrim DS (Sulfatrim) qd
D. erythromycin qd
.
A. shortness of breath.
B. nocturnal dyspnea.
C. weight gain.
D. anorexia.
- An 87 year old patient was placed on low dose amlodipine (Norvasc) for treatment of hypertension and angina. She takes an ASA daily, but, takes no other medications. What side effects might be expected from taking amolodipine?
A. diarrhea.
B. orthostatic hypotension.
C. decreased heart rate.
D. nocturnal cough.
B. orthostatic hypotension
This patient is 87 yo and could be expected to have more severe side effects than a 57 yo. Orthostatic hypotension is not only likely, but represents a huge safety concern. CCBs are associated with constipation. HR does not decrease with the “pines”. Cough is associated with ACEIs.
Six weeks gestation is confirmed in a 23 year old, moderately overweight, patient. She asks the nurse practitioner, “Should I diet so I won’t gain too much baby fat
“ The nurse practitioner appropriately responds:
A. “It is probably a good idea to lose a few pounds in the first trimester since it will be harder to control weight gain later.”
B. “A weight gain of approximately 25 pounds is ideal for mother and baby.”
C. “It doesn’t matter how much weight you gain or lose as long as you eat a well-balanced diet.”
D. “Just try to limit your weight gain as much as you comfortably are able.”
When, in childhood, do the frontal sinuses usually present
A. Birth
B. 2 to 3 years
C. 4 to 6 years
D. 10 to 11 years
A patient presents with sudden onset of “crushing chest pressure,” diaphoresis, pallor, and extreme weakness. Electrocardiogram and serum enzyme changes support a diagnosis of acute myocardial infarction (AMI). The nurse practitioner would expect:
A. widened QRS intervals, AV dissociation, elevated CPK-MP and LDH, and negative troponin.
B. ST changes, prominent Q wave, elevated CPK-MB and LDH, and cardiac troponin I.
C. prolonged PR interval, bradycardia, and increased CPK-MB and LDH.
D. peaked T waves, tachycardia, and elevated CPK-MB and LDH, and cardiac Troponin I.
B. ST changes, prominent Q wave, elevated CPK-MB and LDG, and cardiac Troponin I.
CPK begins to rise at 4-6 hours, peaks in 16-30 hours, and returns to normal in 3-4 days. CPK-MB is specific to heart tissue damage. LDH begins to rise within 24-48 hours, peaks in 3-6 days, and returns to normal in 7-10 days. AST/SGOT begins to rise in 12-18 hours, peaks in 24-48 hours, and returns to normal in 4-7 days. ST segment depression indicates heart ischemia and ST segment (early MI) depression indicates heart tissue death (AMI). Prominent Q waves reflect heart tissue damage (AMI). Cardiac troponin I elevates early and higher levels correlate with poor outcomes.
Untreated infection with human papilloma virus (HPV-16) increases the female’s risk for:
A. pelvic inflammatory disease.
B. ovarian cancer.
C. infertility
D. cervical cancer.
- Which APRN is the exception to the graduate level preparation requirement for certification for advanced practice registered nurses?
A. Advanced practice registered nurses who have completed an approved educational program prior to implementation of graduate level education are considered to have met the requirements for advanced practice registered nursing.
B. Advanced practice registered nurses who plan to practice in a hospital or other controlled setting are not required to have graduate education.
C. Advanced practice registered nurses who can pass both the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP) certification examinations are allowed to practice without graduate level education.
D. There are no exceptions to the rule requiring graduate education to practice as an advanced practice registered nurse
A. APRNs who have completed an approved educational program prior to implementation of graduate level education are considered to have met the requirements for APRN.
Strabismus is observed in a 13 month old child. The most appropriate action for the nurse practitioner to take is to
A. refer the patient to an ophthalmologist.
B. patch the child’s affected eye.
C. follow the child closely for 2 more months.
D. teach the patient and parent eye muscle exercises.
The Dubowitz Clinical Assessment is a
A. standardized scoring system for assessing gestational age of newborns.
B. scale developed for rating the newborn’s appearance, heart rate, reflexes, activity, and respirations.
C. system for identifying children who have been sexually or physically abused.
D. screening system to identify congenital anomalies.
- The nurse practitioner examines a 6 year old who has had sore throat and fever for less than 24 hours. Based on the most common cause of pharyngitis in this age group, the most appropriate action is to?
A. prescribe amoxicillin in a weight-appropriate dose.
B. ask if any other family members have the same symptoms.
C. encourage supportive and symptomatic care.
D. prescribe an antihistamine and decongestant.
C. Encourage supportive and symptomatic care.
The most common cause of pharyngitis in this age group is viral.
The nurse practitioner is counseling a young woman who desires pregnancy. She discontinued her oral ontraceptives four months ago. Her urine pregnancy test (UPT) is negative. She expresses concern that she might have an infertility problem. The nurse practitioner accurately tells her that a couple is not considered infertile until there has been unprotected intercourse without conception for what period of time?
A. 4 months
B. 8 months
C. 1 year
D. 1 ½ years
Licensure is:
A. another term for certification.
B. contingent on certification.
C. used to establish minimal competence.
D. necessary for reimbursement.
Which class of drugs increases a patient’s risk for developing rhabdomyolysis?
A. Anti-hypertensives
B. Thiazide diuretics
C. The “statins”
D. Anti-coagulants
statins?
Which of the following is the best response to a woman who has just admitted she is a victim of spousal abuse?
A. “What was it you did to make him angry?”
B. “You must seek refuge immediately.”
C. “I am concerned about your safety.”
D. “I am going to call a shelter for you.”
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An example of primary prevention is:
A. routine immunizations for healthy children or adults.
B. screening for high blood pressure.
C. cholesterol reduction in a patient with CAD.
D. a PAP smear to determine degree of cervical dysplasia.
A 30 yo woman has varicose veins. These are
A. due to congenital valve deformities.
B. usually diagnosed on clinical presentation.
C. not affected by pregnancy.
D. more symptomatic during ovulation.
Which of the following is NOT true about Carpal Tunnel Syndrome?
A. Symptoms present in the first 3 fingers of the affected hand.
B. Symptoms are absent in the 5th finger.
C. Median nerve compression can result in decreased strength and impaired fine motor coordination.
D. Phalen’s and Tinel’s signs are negative.
- The most common breast cancer risk factor is:
A. a family history of breast cancer.
B. a family history of breast and ovarian cancer.
C. nulliparity.
D. advancing age
Coarctation of the aorta should be suspected in newborns or infants who exhibit any of the following EXCEPT:
A. upper extremity hypertension.
B. lower extremity hypotension.
C. diminished lower extremity pulses.
D. diastolic murmurs.
- The most reliable diagnostic indicator of gout is:
A. monosodium urate (MSU) crystals in the synovial fluid.
B. tophi visible over joints or in connective tissue.
C. elevated serum uric acid level.
D. abrupt onset of single joint inflammation and pain.
A. MSU crystals in synovial fluid
MSU crystals in synovial fluid is the most reliable sign of gout. Uric acid levels are unreliable in diagnosis, but play a role in gout management.
Primary prevention of human papilloma virus (HPV) infection requires educational efforts directed toward
A. receiving annual screening examinations.
B. self-examination to detect the signs of infection.
C. receiving a vaccination on an annual basis.
D. delaying the onset of sexual activity and using barrier methods of contraception.
Which of the following is a secondary cause of hyperlipidemia?
A. Osteoporosis
B. Hypothyroidism
C. Recent dietary excess and weight gain
D. Lack of exercise
B. Hypothyroidism
In evaluation of a patient with hyperlipidemia, a TSH should always be checked and corrected before treating. Other possible causes are pregnancy, excessive weight or alcohol intake, IR or deficiency, liver disease, and uremia. Medications that cause this are: thiazides, BB, oral contraceptives, and corticosteroids.
Which of the following is NOT a risk factor for sudden infant death syndrome (SIDS)?
A. Maternal age < 19 years
B. Winter months
C. Low birth weight
D. Female gender
- Which of the following is NOT covered by Medicare Part B?
A. Out-patient services
B. Services in short-stay skilled nursing care facilities
C. Physician and/or APRN provider services
D. Lab and x-ray services
- A 15 year old male has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about?
A. testicular self-examination.
B. protection of the testes during sports activities.
C. risk of testicular torsion.
D. practicing safer sex.
- A 16 year old patient with Type 2 diabetes mellitus has sporadic blood glucose levels recorded in his glucose diary for the past 3 months. Every reading is between 100 and 140 mg/dL (5.6-7.8 mmol/L). A glycosylated hemoglobin of 14% for this patient would indicate:
A. good overall glucose control.
B. poor glucose control in the last 2 weeks.
C. adequate glucose control in the last month only.
D. poor glucose control for the last 1 to 3 months.
A 45 year old obese pre-menopausal female complains of indigestion, flatulence, RUQ and epigastric “crampy pain” that radiates to the right scapula. Symptoms are exacerbated by a high-fat meal. What is the most likely diagnosis?
A. Hepatitis
B. Chronic cholecystitis.
C. Acute pancreatitis
D. Myocarditis
A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several times per day (while at rest) which is relieved with nitroglycerin. What is the most appropriate initial action for the nurse practitioner?
A. Refer to a cardiologist as soon as possible.
B. Prescribe long-acting nitroglycerin.
C. Order a treadmill stress test.
D. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hour
A mother calls the office reporting that her child has burned his finger by touching a hot pot about 1 hour ago. She describes the burn as red, painful, dry, and without blistering. The child cried at the time of the accident and is complaining of pain now. The nurse practitioner should instruct the mother to?
A. apply cool water compresses and administer ibuprofen.
B. bring the child to the clinic for evaluation.
C. apply cooking oil.
D. apply moisturizing lotion
- An autosomal recessive disorder such as cystic fibrosis is expressed in the offspring when:
A. neither parent carry the gene.
B. both parents carry the gene.
C. 1 parent has the disease.
D. 1 parent carries the gene.
- Which symptom is NOT typical in a female during the peri-menopausal period?
A. Vasomotor instability
B. Paresthesias
C. Increased vaginal lubrication
D. Disturbed sleep patterns
A 6 year old patient presents to the nurse practitioner’s health clinic with a 1 x 1 inch (2.5 cm x 2.5 cm) honey-colored crust on his right shin. The nurse practitioner diagnoses impetigo. Following debridement with soap and water, the most appropriate pharmacological treatment is?
A. erythromycin 250 mg orally 4 times a day for 10 days.
B. mupirocin (Bactroban®) ointment applied to the lesion 4 times a day for 10 days.
C. ciprofloxacin (Cipro®) 500 mg 2 times a day for 10 days.
D. miconazole nitrate (Monistat®) ointment applied to the lesion 4 times a day for 10 days.
A 6 year old presents with complaints of sore throat and fever for 2 days. He has multiple vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. What is the most likely diagnosis?
A. Viral pharyngitis
B. Herpangina
C. Epiglottitis
D. Tonsillitis
The most appropriate first-line drug treatment for African American patients diagnosed with hypertension is:
A. a calcium channel blocker (CCB), demonstrated by research to be the most effective anti-hypertensive drug class for this population.
B. an angiotensin converting enzyme inhibitor (ACE-I), because African-Americans are typically high renin producers.
C. an angiotensin converting enzyme inhibitor (ACE-I), because African-Americans are typically low renin producers.
D. a beta-adrenergic blocker (beta-blocker), demonstrated by research to be the most effective first-line treatment for all ethnic populations.
A good sunscreen lotion or sunblock may contain all of the following components. Which provides the LEAST protection against the sun’s harmful rays?
A. Zinc oxide
B. Benzophenones
C. Para-aminobenzoic acid (PABA)
D. Lanolin
The parents of a 2 year old report that she is not saying any words, but makes sounds, babbles, and understands simple commands from her parents. The parents are not concerned. The nurse practitioner responds?
A. “Your child should be saying a few words by this time. She should be referred for further assessment.”
B. “Your child should be saying a few words by this time. We will wait another 3 to 6 months and observe her progress.”
C. “Your child’s language skills are not as developmentally advanced as we would expect. She will need speech therapy.”
D. “Your child should be referred to an ear, nose, and throat specialist to assess her hearing.”
Your child should be saying a few words by this time. She should be referred for further assessment.
By 2 yo, a child should have a 20+ word vocabulary and should refer to herself by name. She should be referred for a speech and hearing evaluation, but ENT is not needed.
- Which lymph node characteristics should raise concern if palpated by the examiner?
A. Enlarged and mobile
B. Tender and 0.5 cm in diameter
C. Firm and non-tender
D. Warm and 1.0 cm
Given appropriate patient education by the primary care provider, poor compliance with medical recommendations is most often due to?
A. willful disobedience.
B. vision and/or hearing deficits.
C. anxiety.
D. limited cognitive ability
A 74 year old widowed male, who lives alone, tells the nurse practitioner “I get enough to eat. I don’t need much.” He does not prepare food for himself at home, preferring to eat a noon meal at a neighborhood restaurant. He says he might have a bowl of cereal in the morning or in the evening if he is hungry at home. Which of the following is the most sensitive indicator of this patient’s nutritional status?
A. Absence of 3 well-rounded daily meals
B. Fatigue and weight loss
C. Serum pre-albumen level
D. Elevated serum BUN and RBCs
Why is it important that a post-menopausal woman with an intact uterus receive combined estrogen-progestin hormone replacement therapy rather than estrogen alone?
A. Taken without progestin, estrogen is less effective in relieving vulvovaginal atrophy.
B. The beneficial effect of estrogen on high-density lipoprotein cholesterol levels is increased with the addition of progestin.
C. Prolonged use of unopposed estrogens increases the risk of endometrial cancer.
D. Risk of breast cancer is increased for women using unopposed estrogen.
- The Patient Self-Determination Act of 1991 requires all health care agencies receiving Medicare or Medicaid funds to give patients written information about their rights to make decisions regarding their medical care. A document which declares in advance what type of medical care a person wants to be provided or withheld should he or she be unable to express his or her wishes is called?
A. an advanced directive.
B. a durable power of attorney.
C. informed consent.
D. a right to die statement.
.
- A patient complains of “an aggravating cough for the past 6 weeks.” Which medication is most likely to be causing the cough?
A. methyldopa (Aldomet®)
B. enalapril (Vasotec®)
C. amlodipine (Norvase®)
D. hydrochlorothiazide
.
- The obesity associated with Type 2 diabetes mellitus is?
A. a lower body (gynecoid) distribution.
B. defined as BMI 30% or greater.
C. defined as waist-to-hip ratio 0.5 or less.
D. a truncal (android) distribution.
.
- Which agent is most effective for the treatment of nodulocystic acne?
A. benzoyl peroxide (Benzac)
B. retinoic acid (Retin-A®)
C. Topical tetracycline
D. isotretinoin (Accutane®
.
- A 59 year old postmenopausal woman has atrophic vaginitis. She has a history of breast cancer at age 40 years. What is the appropriate initial treatment for this patient?
A. Oral conjugated estrogens
B. Oral medroxyprogesterone acetate
C. Topical medroxyprogesterone acetate
D. Topical conjugate estrogen cream
D. Topical conjugate estrogen cream
Topical or oral estrogen may be used for atrophic vaginitis. Given her history, topical is a safer choice.
An 83 year old man has a resting hand tremor. What disease process is this type of tremor is most commonly associated with
A. Multiple sclerosis (MS)
B. Parkinson’s disease
C. Diabetic neuropathy
D. Huntington’s chorea
Primary prevention of human papilloma virus (HPV) infection requires educational efforts directed toward
A. receiving annual screening examinations.
B. self-examination to detect the signs of infection.
C. receiving a vaccination on an annual basis.
D. delaying the onset of sexual activity and using barrier methods of contraception.
- What is the most frequent cause of death in patients with anorexia nervosa?
A. Renal failure
B. Suicide
C. Hepatic failure
D. Cardiac arrest
D. Cardiac arrest
The most frequent cause of death is cardiac arrest, followed by suicide.
Which of the following is NOT true regarding the diagnosis of scoliosis in children
A. Scoliosis is most apparent during the pre-adolescent growth spurt.
B. Scoliosis may be evidenced by unequal shoulder, scapula, or iliac crest height with the child standing.
C. Kyphosis in the adolescent indicates scoliosis.
D. Routine screening for scoliosis should begin at 10 to 12 years-of-age, with forward bending touching the toes, and unclothed examination of the spine.
Which of the following must be present for the diagnosis of bacterial vaginosis
A. Presence of clue cells
B. Vaginal pH < 4.0
C. Presence of pseudohyphae on HPF
D. Negative amine test
Which of the following is appropriate to teach a patient who is using a daily nitrate agent for treatment of chronic angina
A. Continuous 24-hour coverage is necessary for maximum protection.
B. A daily 12-hour nitrate-free period is important to prevent tolerance.
C. A daily 6-hour nitrate-free period is important to prevent tolerance.
D. Nitrate-free periods present a potential for developing nitrate intolerance.
Microscopic examination of expressed prostatic secretions (EPS) and post-prostate massage urine is positive for WBCs > 10 to 20/HPF and negative for bacteria. The most likely diagnosis is
A. chronic nonbacterial prostatitis.
B. benign prostatic hyperplasia (BPH).
C. acute bacterial prostatitis.
D. carcinoma of the prostate gland.
. The infant 1 to 6 months-of-age with a diagnosis of developmental hip dysplasia is correctly treated with
A. closed reduction of the hips.
B. surgical open reduction followed by pelvic and/or femoral osteotomy.
C. a variety of adduction orthoses.
D. the Pavlik harness.
In comparing sensitivity to specificity, sensitivity refers to a
A. true positive.
B. false positive.
C. false negative.
D. true negative.
Which of the following findings would raise the nurse practitioner’s suspicion of bulimia in a 17 year old female?
A. Hyperkalemia
B. Emaciation
C. Scars on her knuckles
D. Dental caries
C. Scars on her knuckles
Scars on the knuckles suggest induced vomiting and are often found in patients with bulimia. Hypokalemia may also be present. Patients with anorexia appear emaciated, bulimics are usually normal weight. Frequent vomiting causes dental erosion.
Healthy People 2010 published by the U.S. Department of Health and Human Service
A. is a set of national health objectives designed to improve the overall health of people and communities.
B. provides guidelines for adolescent preventive services.
C. reviews evidence for 169 interventions to prevent 60 illnesses across the life span.
D. removes barriers to prenatal and infant health care to narrow the gap between services provided to African-American and caucasian mothers and infants.
- A 25 year old overweight patient presents with a complaint of dull achiness in his groin and history of a palpable lump in his scrotum that “comes and goes.” On physical examination, the nurse practitioner does not detect a scrotal mass. There is no tenderness, edema, or erythema of the scrotum and the scrotum does not transilluminate. Considering these findings, what is the most likely diagnosis?
A. Testicular torsion
B. Epididymitis
C. Inguinal hernia
D. Varicocele
C. Inguinal hernia
Manfestations of an inguinal hernia are dull ache in the groin and a mass in the scrotum that may or may not be reducible. An inguinal hernia is not easily see and may be palpated with a finger inserted through the external inguinal canal as the patient coughs or bears down.
- The mechanism by which nurses are held accountable for practice, based on the quality of nursing care in a given situation in accordance with established standards of practice, is:
A. outcome criteria.
B. process criteria.
C. peer review.
D. quality assurance
C. Peer review
- The finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of a prostate gland that is:
A. enlarged, symmetrical, semi-firm, and non-tender.
B. enlarged, symmetrical, boggy, and exquisitely tender.
C. asymmetrical and nodular.
D. exquisitely tender with absence of median sulcus.
A. enlarged, symmetrical, semi-firm, and non-tender
BPH is characterized by an enlarged, symmetrical, semi-firm, and non-tender prostate. Pain and bogginess are associated with infection. Assymmetry, harness, and nodularity are associated with cancer.
- The correct treatment for ankle sprain during the first 4 hours after injury includes
A. alternating heat and ice, and ankle exercises.
B. resistive ankle exercises, ankle support, and pain relief.
C. rest, elevation, compression, ice, and pain relief.
D. referral to an orthopedist after x-rays to rule out fracture.
A 15 year old patient has a complaint of vaginal discharge. She is sexually active with multiple partners. Which of the following symptoms should lead the nurse practitioner to suspect pelvic inflammatory disease (PID)
A. Cervical motion tenderness (CMT)
B. A report of dyspareunia
C. A complaint of low back pain
D. A yellow vaginal discharge
- A 50 year old male is scheduled for his annual wellness visit. The nurse practitioner would appropriately recommend all of the following EXCEPT:
A. stool for occult blood annually .
B. annual digital rectal examination (DRE) and prostate specific antigen (PSA).
C. monthly self-testicular examination and annual clinical testicular examination.
D. annual lipid profile
C. monthly self-testicular examination and annual clinical testicular examination
There are no recommendations for this in this age group, testicular cancer is common in younger men 15-35.
. The nurse practitioner correctly diagnoses a 2nd degree burn injury which is described as
A. full thickness, waxy or leathery, without vesicles.
B. partial thickness, with erythema and edema but no vesicles.
C. partial thickness, with involvement of the dermis and epidermis, edema, and vesicles.
D. full thickness, with involvement of muscle and bone.
- The hallmark of neurofibromatosis (von Recklinghausen disease) present in almost 100% of patients is
A. acoustic neuroma.
B. astrocytoma of the retina.
C. distinctive osseous lesions.
D. cafe au lait spots.
. A child complains of “hurting a lot” with swallowing and states that his “throat feels full.” His sorethroat started 4 days ago. He is hyper-extending his neck. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis
A. Peritonsillar abscess
B. Thyroiditis
C. Mononucleosis
D. Epiglottitis
. An overweight male complains of low back pain after helping to move a refrigerator over 2 days ago. To avoid future problems, the nurse practitioner should teach him
A. exercises to strengthen his lower back.
B. to rest his back until he is pain free.
C. to seek early medical attention after a back injury.
D. to take his pain medication as prescribed.
. A 25 year old female patient presents for a routine well-woman exam. On physical examination, the nurse practitioner notes a scant nipple discharge, absence of a palpable mass, and absence of lymph node enlargement. Which of the following is the most likely diagnosis
A. Intraductal papilloma
B. Breast cancer
C. Chest wall syndrome
D. Fibrocystic breast disease
. A patient with active tuberculosis (TB) has a negative PPD skin test. This phenomenon may be explained by any of the following EXCEPT
A. oral steroid treatment.
B. frequent acute exacerbations of chronic asthma.
C. HIV infection.
D. malnourishment due to anorexia nervosa.
. What information would best help the parent who is concerned about a school-age child’s eating habits
A. A child who is allowed to eat whatever he wants will usually be well-nourished.
B. The school-age child’s nutritional requirements are the same as for adults.
C. The school-age child requires 10 kilocalories per pound daily.
D. Establish a consistent schedule for meals and allow the child to participate in meal planning.
A patient is diagnosed with primary hypertension. Blood pressure readings for the previous 3 months have been 154/100, 148/102, 158/104. This patient’s hypertension is categorized
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Antibiotic administration has been demonstrated to be of little benefit in the treatment of which of the following disease processes
A. Chronic sinusitis
B. Acute bronchitis
C. Bacterial pneumonia
D. Lobar pneumonia
- A 24 year old male patient diagnosed with Hodgkin’s lymphoma is concerned about long-term survival. The most accurate response by the nurse practitioner would be:
A. “The 5-year survival rate is about 80%
B. “Non-Hodgkin’s lymphoma has a better prognosis.”
C. “With radiation and chemotherapy, there is almost a 100% cure rate.”
D. “With surgical treatment, there is a 95% cure rate.”
A. The 5 year survival rate is about 80%.
Hodgkin’s carries a better prognosis than non-Hodgkin’s, the 5 yr survival rate is 52%. Surgical treatment is not indicated for Hodgkin’s.
A patient has developed a blood clot in his lower extremity and is receiving warfarin (Coumadin®) therapy. Which outpatient laboratory measurement best measures the therapeutic effect of warfarin
A. International normalized ratio
B. Activated clotting time
C. PT
D. PTT
A nurse practitioner performs an in office procedure that is considered outside his scope of practice. The patient suffers a bad outcome. This is an example of which of the following
A. Negligence
B. Malpractice
C. Incompetence
D. Beneficence
What is the law concerning informed consent and childhood vaccines?
81. A 12 year old has a fasting serum cholesterol of 190mg/dL (4.94 mmol/L). Her mother asks if this value is “ok.” The nurse practitioner responds?
A. Because childhood vaccines are required for school, a consent form is considered redundant.
B. All health care providers are required to use standard consent forms.
C. Public health department nurses are required to use consent forms but this is optional for practitioners in the private sector.
D. A standard general immunization consent is required for the first vaccine only.
- A 12 year old has a fasting serum cholesterol of 190mg/dL (4.94 mmol/L). Her mother asks if this value is “ok.” The nurse practitioner responds?
A. “This is acceptable for her age and gender, although less than 200mg/dL (5.2 mmol/L) is desirable.”
B. “This is acceptable, but she should increase her fruit and vegetable intake.”
C. “This is unacceptable. The desired level is < 170 mg/dL (4.42mmol/L).”
D. “This is unacceptable, but inappropriate to treat because of her age.”
- The obligatory criteria for diagnosis of muscular dystrophy are?
A. progressive, genetic myopathy with degeneration and death of muscle fibers.
B. asymmetric overgrowth of extremities, angiomas, thickening of bones, and excessive muscle growth.
C. hypotonia that persists into adulthood, and recurrent joint dislocation.
D. hypotonicity, developmental delays, and symmetric congenital absence of individual muscles.
- An urgent call is received from a patient’s wife who states that her husband is having chest pain unrelieved by three nitroglycerin tablets. The nearest hospital is forty minutes away. Besides having the patient reach the hospital as soon as possible, what intervention can the nurse practitioner suggest which might influence a positive outcome
A. Have the patient chew an aspirin on the way to the hospital.
B. Have the patient take nitroglycerin every five minutes until reaching the hospital.
C. Ask the patient’s wife, a nurse, to check his blood pressure and call you with the results.
D. Tell the patient not to take any more nitroglycerin for 15 minutes.
- A 73 year old patient presents with a very sore, glossy, smooth, beefy-red tongue. This clinical presentation most likely reflects
A. pernicious anemia, due to insufficient intrinsic factor.
B. secondary hypothyroidism.
C. cheilosis, a serious disease of the mouth and oropharynx.
D. a neurological disorder such as Parkinson’s disease.
- A 2 week old infant presents with projectile vomiting, weight loss, dehydration, constipation, and history of insatiable appetite. An olive-shaped mass is palpable to the right of the epigastrium. The nurse practitioner, suspecting pyloric stenosis, refers the infant for an upper GI series. The expected finding is
A. double bubble pattern, secondary to air in the stomach, and a distended duodenum.
B. dilated loops of bowel.
C. bowel loops of varying width, with a grainy appearance.
D. the “string sign,” indicating a narrow and elongated pyloric canal.
- A 7 year old male presents with a painless limp, antalgic gait, muscle spasm, mildly restricted hip abduction and internal rotation, proximal thigh atrophy, and slightly short stature. The most likely diagnosis is
A. transient monoarticular synovitis.
B. slipped capital femoral epiphysis.
C. congenital dysplasia of the hip.
D. Legg-Calve-Perthes disease.
D. Legg-Calve-Perthes disease
These are classic signs of LCP, a local, self-healing disorder. The mean age of presentation is 7 yo. Justification of treatment is prevention of secondary osteoarthritis and femoral head deformity.
- What is the recommendation of the U.S. Department of Health and Human Resources regarding nicotine replacement therapy
A. Encourage the use of nicotine replacement except in the presence of serious medical conditions.
B. Offer nicotine replacement only to those smokers who are unsuccessful after 3 attempts to stop smoking.
C. Discourage the use of nicotine replacement.
D. Offer nicotine replacement only to select populations of heavy smokers with a long history of smoking.
- A 66 year old patient exhibits sudden onset of fluctuating restlessness, agitation, confusion, and impaired attention. This is accompanied by visual hallucinations and sleep disturbance. What is the most likely cause of this behavior
A. Dementia
B. Delirium
C. Parkinson’s disease
D. Depression
- Most children who have been sexually abused have:
No detectable genital injury
- Among adolescents in the U.S., the greatest known risk factor for contracting hepatitis B is:
A. homosexual activity.
B. injecting drug use.
C. heterosexual activity.
D. alcohol and designer drug use.
C. heterosexual activity
Heterosexual activity 27%, homosexual activity 11%, injection drug use 14%. No risks associated with 30%.
- When counseling a woman who is breastfeeding her 6 month old infant, the nurse practitioner should recommend a caloric intake over her pre-pregnancy requirements of
A. 200 kcal per day.
B. 500 kcal per day.
C. 900 kcal per day.
D. 1000 kcal per day.
A professional liability insurance policy that provides coverage for injuries arising out of incidents occurring during the period the policy was in effect, even if the policy subsequently expires, or is not renewed by the policy-holder, is termed a(an)
A. claims-made policy.
B. individual policy.
C. occurrence-based policy.
D. suplemental policy.
A 38 year old penicillin allergic patient has folliculitis on a bearded part of his face. The nurse practitioner prescribes erythromycin and tells the patient
A. erythromycin may upset his stomach, so it should be taken with food.
B. taking erythromycin should clear the infection in 3 days.
C. the problem will recur unless the patient remains beardless.
D. a similar allergic reaction could occur with erythromycin because he is penicillin allergic.
The nurse practitioner correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals
A. an increased reticulocyte count.
B. a mean corpuscular volume (MCV) > 100 fl.
C. Hemoglobin (Hgb) 14.0
D. an increased total iron binding capacity (TIBC).
The mother of a 2 year old uncircumcised male patient is concerned that she cannot retract the foreskin over the glans penis. The appropriate response by the nurse practitioner is to
A. refer the patient to a urologist.
B. forcibly retract the foreskin.
C. treat the child for possible infection.
D. reassure the mother that this is normal.
- A 75 year old female complains that she awakens 3 to 4 times each night sensing bladder fullness, but is unable to “hold it” until she can get seated on the bathroom toilet. This type of urinary incontinence is termed:
A. overflow incontinence.
B. stress incontinence.
C. functional incontinence.
D. urge incontinence.
D. urge incontinence
Bladder fullness and urgency are characteristic of urge incontinence. Stress incontinence is characterized by incontinence with laughing and sneezing. Overflow is seen in paraplegics and diabetics who are unable to sense a full bladder.
Successful management of a patient with attention deficit hyperactivity disorder (ADHD) is best achieved with
A. stimulant medication along with behavioral and family interventions.
B. methylphenidate (Ritalin®) in conjunction with an antihistamine.
C. treatment by a pediatric psychiatrist.
D. firm discipline and removal of offending foods from the diet.
- Which of the following patients requires radiological evaluation of a first incidence of urinary tract infection?
A. A 9 year old female
B. An 11 year old male
C. A 13 year old female
D. An 18 year old female
B. An 11 yo male
Criteria for radiologic workup includes: infants, any child < 3 yo, any child < 8 yo with acute sx, males with a first infection, females with a secondary infection, any suspicious factors. adolescents with pyelonephritis or after a secondary UTI.
The treatment of choice for chronic bacterial prostatitis (CBP) is
A. erythromycin 4 times daily for 7 to 10 days.
B. doxycycline twice daily for 7 to 10 days.
C. a flouroquinolone twice daily for 3 weeks to 4 months.
D. Bactrim®-DS (Sulfatrim) daily for 4 to 16 weeks.
The nurse practitioner diagnoses eczema on the cheeks of a 2 year old female. The patient’s mother explains that she is embarrassed to take the child in public because her face is so red, dry, and crusted. She asks for a “strong” cortisone cream so the eczema will clear rapidly. The nurse practitioner knows that
A. a high potency cortisone preparation applied to the face will shorten the duration of the eczema flare-up.
B. a high potency cortisone cream on the face will only be helpful if used in conjunction with a hydrating lotion.
C. a high potency cortisone cream is not recommended for use on children under 3 years-of-age.
D. a high potency cortisone cream may cause atrophy, telangiectasia, purpura, or striae if used on the face.
A patient presents to the rural health clinic with severe chest pain. The nurse practitioner places the patient on a cardiac monitor and observes a normal sinus rhythm with elevated ST segments. His blood pressure is 130 75 mmHg. What is the likely cause of this patient’s chest pain
A. Anxiety
B. Dyspepsia
C. Cardiac ischemia
D. Costochondritis
Which of the following drugs is considered safe for use during pregnancy
A. miconazole (Monistat®) cream
B. isotretinoin (Accutane®)
C. trimethoprim-sulfamethoxazole (Bactrim®, Sulfatrim))
D. terconazole (Terazol®) vaginal cream
- A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms and hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take
A. Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
B. Perform a diet history and check CBC and FBS.
C. Provide nutritional guidance and have the patient return in one month.
D. Consult home health for intravenous administration of fluids and electrolytes.
- Which of the following laboratory tests is useful in the diagnosis of spontaneous abortion
A. Serial quantitative beta-human chorionic gonadotropin levels
B. Qualitative plasma estradiol levels
C. Plasma dehydroepiandrosterone sulfate (DHEA-S®) levels
D. Qualitative plasma human chorionic gonadotropin levels
- Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis
A. Pneumonia
B. Asthma
C. Sinusitis
D. Pertussis
- A young female reports onset of right flank pain 2 days ago that is now severe. Last night she discovered a “burning rash” in the same area. The nurse practitioner identifies papular fluid-filled lesions that are confluent and follow a linear distribution along the T-8 dermatome. The nurse practitioner would appropriately order
A. an oral antibiotic.
B. a topical anti-fungal.
C. an oral antiviral.
D. a topical steroid cream
- Which of the following should NOT be recommended to the parents of a child with asthma?
A. Eliminate air conditioning in the child’s room.
B. Encase the child’s mattress in a sealed vinyl cover.
C. Remove carpeting from the child’s bedroom.
D. Do not allow smoking in the home.
A. Eliminate air conditioning in the child’s room.
Air conditioning decreases outdoor irritants and allergens in the indoor air. It also decreases humidity, which reduces mold and mite growth.
- Which finding below would be unusual in a patient with diabetic retinopathy?
A. Papilledema
B. Dot and blot hemorrhages
C. Microaneurysms
D. Cotton wool spots
A. Papilledema
Papilledema represents swelling of the optic nerve and is associated with increased ICP.
- Which of the following patients most warrants screening for hypothyroidism
A. A young adult female with postpartum depression lasting 2 weeks
B. A patient taking a thyroid replacement preparation
C. A 40 year old male with unexplained tremors
D. An elderly female with recent onset of mental dysfunction
- A 19 year old pregnant patient, at 20 weeks gestation, complains of pain in the right lower quadrant. She is afebrile and denies nausea and vomiting. The most likely diagnosis is
A. appendicitis.
B. urinary tract infection.
C. muscle strain.
D. round ligament pain.
- The most reliable indicator(s)of neurological deficit when assessing a patient with acute low back pain is(are):
A. patient reports of bladder dysfunction, saddle anesthesia, and motor weakness of limbs.
B. history of significant trauma relative to the patient’s age.
C. decreased reflexes, strength, and sensation in the lower extremities.
D. patient report of pain with the crossed straight leg raise test.
C. decreased reflexes, strength, and sensation in the lower extremities
Although positive SLR is a significant indicator, compromised reflexes, sensation, and strength is more reliable. Choice A describes cauda equina and is emergent.
