Cogan NP Prep Flashcards
FNP Exam Study
1
Q
There are three general strategies when interviewing an adolescent. Which of the following is NOT one of those strategies?a) DRUGSS formatb) SAFETEENS formatc) PACES formatd) HEADSS format
A
Ans: A DRUGSS IS INVENTEDThese are strategies for interviewing teensHEADSS: Home environment, Employment and education, activities, drugs, social sexualityPACES: Parents and peers, accident: alcohol/drugs, Cigarettes, emotional issues, school/sexualitySAFETEENS: Sexuality, Accident/abuse, firearms/homicides,Emotions/toxins, environment, exercise, nutrition and shots/immuniz
2
Q
Cimetidine, and OTC agent that complicates polypharmacy, inhibits what enzyme in the liver, prolonging the effects of other drugs in the body?a) Glucose oxidaseb) Cytochrome P450c) Cox-1d) Lactate dehydrogenase
A
Ans: B Cytochrome P450
3
Q
You are performing a complete neuro exam on Adam, a 40 year old male patient. Which of the following should be performed and /or examined so as to locate abnormalities?a) Mental status, CN, motor function, sensory function, reflexesb) Mental status, motor function, sensory function, reflexes, CNc) Cranial nerves, mental status, sensory function, motor function, reflexesd) Mental status, sensory function, cranial nerves, motor function, reflexes
A
Answer: AAccording to the assessment book, Mental status comes first. Then CN. Then Motor/Cerebellar, then reflexes, sensory, finally station/gait.None of these match exactly but A was the closest.
4
Q
Shannon, 34, is in for diagnostic tests for Multiple sclerosis. Before you initiate assessment, you engage in a brief conversation concerning her disorder and the lab exams that surround it. Of the following statements, which is incorrect regarding lab diagnosis of MS?a) An edrophonium test can be administered as a differential diagnostic b) Lab diagnostics often find an increased number of lymphocytes in the circulating bloodc) Slightly elevated protein can be found in the CSFd) Lab diagnostics can never be definitive for MS.
A
Ans: A It is false that the edrophonium test can be administered as a differential diagnostic Edrophonium is used as a differential diagnostic between MG and a cholinergic crisis, and thus is irrelevant for MS. those with MG take anticholinesterase. In overdose, there is an abundance of anticholinergics in the system. These symptoms are similar to an exacerbation of MG symptoms.For MS labs, you find an increase in lymphs in the blood and elevated protein in the CSF however lab diagnostics can never be definitive for MS
5
Q
Which of the following components of Continuous Quality Improvement monitors the numbers of qualified staff, equipment, and resources?a) Appropriatenessb) Processesc) Establishmentsd) Structures
A
Ans: D In the system of Continuous Quality Improvement, structures include the resources, equipment, and the size and qualifications of staff.Processes of care include assessment, planning, performing treatments and management of complications.Establishments are the businesses or institutions where CQI are implemented
6
Q
A mom and her 13 year old daughter come to clinic reporting that the daughter complains of painful menstrual cramping and back pain requiring her to miss school several days per month. You suspect a diagnosis of Dysmenorrhea. Which of the following is NOT an example of supportive treatment of this diagnosis?a) Heat applicationb) High iron dietc) Psychological counselingd) Ibuprofen
A
Ans: B High iron dietSupport measures include psych support, heat, and OTC NSAIDs (for prostaglandin support)
7
Q
Gayle, 50, comes to clinic and complains of “twitches” that occur in her right shoulder. You administer an electromyography test and determine that these findings occur as a result of lower motor neuron dysfunction. Which of the following is the most likely diagnosis?a) Nystagmusb) Clonusc) Tremorsd) Fasciculations
A
Ans: D FasciculationsFasciculations are small, localized involuntary muscle twitches; a brief, spontaneous contraction affecting a small number of muscle fibers, often causing a flicker of movement under the skin. Nystagmus is the eyesClonus are continuous succession of seizure like twitchesTremors occur as rhythmic oscillations not twitches
8
Q
Which of the following is NOT considered by Native Americans to be an “Indian Problem” treatable with “Indian Medicine”?a) Mental illnessb) Cancerc) Paind) Alcoholism
A
Ans: B CancerCancer is considered to be a White Man’s disease. Mental health, alcoholism, and pain are all considered to be naturally indian disorders and are treatable with Indian MedicineOther white-man illnesses include DM and cholelithiasis
9
Q
Pervasive development disorders are a collection of disorders known as autism spectrum disorders. These are characterized by altered response to environmental stimuli and impaired social interactions. Which of the following is a true fact of PDD?a) PDD occur in approximately 1 in 100,000 childrenb) PDD are more common in boys than in girlsc) PDD are most severe in malesd) Neurological disorders are not a cause of PDD
A
Ans: BPDD are more common in boys than in girls.Autism is more common in boys than in girls, however, when it occurs in girls, It is not only more severe, but it can usually associated with Rett’s SyndromePDD presents in 2-5/10,000 childrenand Neuro disorders as a result of brain insult in utero have been known to cause PDD
10
Q
Max, age 2 months, is brought to clinic for a checkup. His mom tells the NP that she has noticed that Max has a seemingly permanent head tilt, and he seems cross eyed. You suspect the child may have strabismus. Which of the following, if present, would indicate another possible problem?a) Squintingb) Head shakingc) Face turningd) Decreased visual acuity
A
Ans: BHead shakingHead shaking is NOT a sign associated with strabismus. All the other choices are findings of patients with suspected strabismus. In addition, exotropia, hyper or hypotropia, and an unequal Hirschberg pupillary reflex also may present
11
Q
A college athlete comes to clinic complaining of malaise and a cough. His physical findings include a fever, and a chest film reveals lung consolidation. You note that he has no other previous health conditions. According to the latest guidelines of the IDSA and the ATS, which treatment is best for this patient?a) Cefotaximeb) Levofloxacinc) Moxifloxacind) Azithromycin
A
Ans: D Azithromycin (macrolide)Resp fluoros are not indicated in this case PLUS there are two of them listedCefotaxime is a third generation cephalosporin and works against S. pneumoniae but not against H. Flu and M. Catarrhalis
12
Q
Mary comes to your facility and asks for privacy. The 24 year old says that there is a fishy smelling gray discharge from her vagina. Of the following, which is the most likely diagnosis?a) Candidab) GCc) Trichd) BV
A
Ans: DBacterial Vaginosis presents with a grey discharge/fishy odor. Trich is “frothy” Yellow-green Candida is white curd-likeGC is green gook (can’t you just hear Tom’s voice saying that!) but does not present as fishy
13
Q
Which of the following genetic syndromes is associated with congenital cardiac defects?a) Tay-Sach’s Diseaseb) Klinefelter’s syndromec) Turner’s syndromed) DiGeorge Syndrome
A
Ans: D DiGeorge is listed first as having cardiac issues…..pretty gray area in this answerDiGeorge Syndrome: aortic arch anomaliesTurner Syndrome: Coarctation of the aorta and Bicuspid aortic valves
14
Q
Maggie, 2 months old, is due to receive the polio vaccine. Which of the following statements is true regarding polio vaccine administration to the patient?a) The oral polio vaccine should be given on the normal vaccination scheduleb) The final dose of the inactivated polio vaccine would typically be given when the patient is 6-10 years oldc) The oral vaccine should be given when Maggie is 6 years oldd) The inactivated polio vaccine must be given when Maggie is 6 years of age
A
Ans: DThe inactivated polio vaccine must be given when Maggie is 6 years oldThe inactivated Polio vac should be administered in a series of 4 doses at 2, 4, and 6 months with the final dose at 6 years. The oral dose is discouraged and is only an option for the 3rd and 4th doses.It is not recommended that Maggie receive her final polio at age 10
15
Q
Which of the following would not be true about a genetic disorder?a) Only 30-35% of genetic disorders are diagnosed in the neonatal periodb) Major malformations occur in approximately 2% of live birthsc) About 80% are identified before the age of 6 monthsd) Of the major malformations, 80% are associated with a genetic cause and an increased risk of recurrence
A
Ans: aFalse: That only 30-35% of genetic disorders are diagnosed in the neonatal period. In fact, genetic disorders are diagnosed at 40-45% in the neonatal period. All the other statements are true
16
Q
An 18 year old female comes to the office 2 weeks before leaving for college. She is anxious but also excited to live in the dorms. She however had an active TB infection and needs to begin treatment NOW. You tell her that if the condition proves susceptible to her medication regimen, the initial course of the medication could last for:a) 9 monthsb) 6 monthsc) 2 monthsd) 1 month
A
Ans: Cthe INITIAL part of the med regimen of RIPE lasts for 2 monthsAfter 2 months, the med regimen is reduced to only INH and rifampin for the next 4 months….this is the latter part of treatment.Patients with HIV should be treated for 9 months
17
Q
Alison, 25, checked into your hospital 2 weeks ago as an inpatient. When you make your rounds, she complains about a painful redness on her skin that seems to have spread overnight. She is shivering and states the she feels cold, although the infected skin is actually rather warm to the touch. You suspect cellulitis which you know may be caused by one of a few organisms. Which of the following is the leading cause of cellulitis in the inpatient setting?a) E. colib) S. aureusc) Staphylococcusd) S. pyogenes
A
Ans: AE. Coli: Inpatient cellulitis is most often a gram neg organism E. coli.S. aureus that can cause inpatient cellulitis though less common than E. coliS. pyogenes is the leading cause of OUTpatient cellulitisStaphlococcus is just too general a referenceBe careful with these questions….when there are 3 Staphs and one is so general, that is a hint!
18
Q
After giving birth to Sarah, 28 year old Samantha and her husband leave the hospital after one day. When should she come back so that Tabitha can have her first well-child check?a) 3-5 daysb) 4-6 daysc) 2-3 daysd) 1-2 days
A
Ans: A 3-5 daysBright futures states that if an infant is discharged from the hospital before 48 hours, he/she should be seen in clinic within 3-5 daysNewborn visits are: 2, 4, 6, 9, 12 months with no vacs due at 9 so the kid needs a Hct or a free pass on needle sticks that visit.
19
Q
A mom brings her infant son to you because he has been breathing rapidly and tires easily. You suspect the baby’s symptoms indicate a cardiac condition. Where are you most likely to feel a thrill if he has a VSD?a) LRSBb) Pulmonicc) Erb’s pointd) Mitral
A
Ans: C Erb’s pointA holosystolic thrill at the Erb’s point located at the LLSB is associated with VSD.
20
Q
You are a nurse practitioner assessing the neurological system of a patient. Which of the following is the best question to ask in order to test the patient’s declarative memory?a) What did you have for breakfast this morning?b) Can you repeat the words: rose, hose, nose, and clothes?c) Can you repeat the words: brown, chair, textbook, and tomato”d) How old were you when you got your first job?
A
Ans: CCan you repeat the words: brown, chair, textbook, and tomato”Declarative is the patient’s ability to use memory to learn new information.A and D deal with long and short term memory-episodic memoryB words rhyme so they are not diverse
21
Q
You have been treating Edwina, 68, for a long-term fever. Since this is a prolonged presentation, you screen for infection. All of the following would indicate infections except:a) 2 or more measurements of oral temperature equal or greater than 99F (37.2)b) Rectal Temp equal to 99F (37.5)c) Increase in temp of equal to or greater than 2F (1.1C) from baselined) Single measurement of temp equal or greater than 100F (37.8C)
A
Ans: BA rectal temp equal to or greater than 99.5 F (37.5C) NOT 99F (37.2 C) indicates infection.All of the other values are indicators of infection in the elder
22
Q
The NP examines Martin, a 3 month old in clinic who came because of poor weight gain. The NP conducts an exam and palpates an olive-shaped mass in the abdomen. Which of the following would the NP expect to find in Martin’s case?a) Choking and coughingb) Abdominal distentionc) Projectile vomitingd) Hematemesis
A
Ans: C Projective vomitingA condition noted on physical exam in the patient with PS is the presence of an olive-shaped mass in the abdomen. Though projectile vomiting is classic, there is no hematemesis, choking and coughing (as in GERD), and abdominal distention is characteristic of AGE
23
Q
You are approached by 47 year old Emma who is very concerned about osteoporosis. Her dad’s side of the family has women who have experienced serious cases of the condition. Her mom’s side has no notable history with this condition. Now that Emma is getting close to the age of menopause, she wants to know how likely it is that she will experience effects of osteoporosis. She is especially interested in how she compares to others her own age. Which dual-energy xray absorptiometry score is most relevant in this case?a) Z scoreb) T scorec) D scored) C score
A
Ans: Z scoreT scores compare the patient to the population meanWith Z scores, your bone mineral density is compared to that of a typical individual whose age is matched to yours.
24
Q
Your 32 year old patient reports that he has been having trouble interacting with customers at work. He recently got a job as a clerk, and now he feels frightened when he has to speak with customers. He says that he has been taking more breaks than allowed just to run to the bathroom to catch his breath. Which of the following disorders best matches his experience?a) Panic disorderb) OCDc) PTSDd) Generalized Anxiety Disorder
A
Ans: A Panic DisorderPanic disorder is dread of seemingly harmless objects or situationsGeneralized anx disorder is excessive worry about general life circumstancesOCD is OCDand PTSD is anxiety/flashbacks for at least 6 months after a traumatic event
25
James and Devin's first son is diagnosed with Down's Syndrome. Amongst their many concerns, they want to know if this could affect their son's heart. Which of the following is the most common heart defect associated with Down's Syndrome?a) Tetralogy of Fallotb) Transposition of the great arteriesc) Atrioventricular septal defectd) Patent ductus arteriosus
Ans: CAtrioventricular septal defect15-20% of newborns with down's have an AV septal defect.Tetralogy of Fallot is associated with Downs but is very uncommonPDA and Transposition are not associated with Downs'CoArc is associated with TurnersAR and MVP are associated with Marfan's
26
A patient with a history of migraine headaches is taking propranolol. However, it is noted that she does not have cardiac issues or anxiety. Given this information, which is the most likely reason that she is on Propranolol?a) To prevent macular degeneration as a result of chronic headachesb) To lessen the severity of migraine headachesc) To diminish the recurrence of migraine headachesd) To improve alertness during headache attacks
Ans: Bto lessen the severity of migraine HAsPropranolol is migraine prophylaxis: prevention. It's action is to lessen the severity of migraine symptoms. It does not improve alertness, prevent Macular degeneration, or diminish the recurrence of migraine headaches.
27
When diagnosing ADHD, the NP must be mindful that certain behaviors such as distractibility, impulsivity, and hyperactivity are often seen in all types of children. Which of the following is one of the symptomatic requirements for a diagnosis of ADHD?a) Symptoms must interfere with school, play, and homeb) Symptoms must interfere with schoolc) Symptoms must be present before 6 years oldd) Symptoms must persist for at least 6 months
Ans: DSymptoms must persist for at least 6 monthsAnother diagnostic requirement is the presence of symptoms that disrupt 2 life settings, not threeSymptoms need to occur before the age of 7, not 6
28
You are checking on a 6 year old whom you saw last month for strep throat. Since you know that rheumatic fever can follow strep throat by approximately 20 days, you wanted to make sure he has not developed this secondary condition. Which of the following is a major clinical manifestation of rheumatic fever?a) Polyarthritisb) Inflammatory changes in the oral cavityc) Inflammatory changes of the lipsd) Polymorphous rash
Ans: A polyarthritisPolyarthritis, a form of arthritis, is a major clinical manifestation of Rheumatic Fever. The affected joints will change every 1-2 days, and it is the large joints that are usually affected. A polymorphous rash and inflam changes in both the lips and oral cavity are diagnostic of Kawasaki Disease which causes another cardiac defects: Coronary vasculitis, myocarditis, Mitral regurg, and dysrhythmias
29
A 36 year old male has jaundice and fatigue after returning from travelling abroad. Lab results show the presence of anti-HBsAg and Anti-HBc as well as the absence of IgM. What type of hepatitis B do these findings indicate?a) Activeb) Chronicc) Recoveredd) Acute
Ans: CRecovered: Anti-HBsAg and Anti-HBc indicate recovered Hep B.Lab results for active and chronic Hep would include the IgM which is absent in this patient.Acute Hepatitis is a form of Hep C, not Hep B
30
A 51 year old man comes to clinic complaining of inflammation of his penile head. Upon assessment, you find that the glans is covered in a rash and is releasing a malodorous discharge. He tells you that the affected area is very painful. Which of the following medications would be best to prescribe for him?a) Griseofulvinb) Metronidazolec) Ceftriaxoned) Miconazole
Ans: D MiconazoleCandida balanitis: a fungal infection of the penile head. Miconazole is the topical antifungal used to treat this problem. It seems like it could be GC but there is no discharge and the patient has no other symptoms.Griseofulvin is for Tinea CapitusMetronidazole is an antibiotic for Rosacea, UTI and other bact infectionsCeftriaxone is for GC
31
Kerrie is looking to start a new birth control regimen after not using any for several years. She avoided birth control because of her somewhat high sensitivity toward estrogen. Her history also indicates that she sometimes has bouts of iron deficiency anemia. Which of the following is best as a recommendation for her?a) Ortho-Evrab) NuvaRingc) Depo-Proverad) IUD
Ans: C Depo proveraThe advantage of Depo is prolonged amenorrheaEstrogen based choices include Ortho Eva and the Nuva ring which trigger the intolerancethe IUD can lead to excess bleeding so that would not be a good choice with intermittent hx of Iron deficiency anemia
32
A newborn delivered via caesarean section at 38 weeks gestation without complications is in the nursery for initial assessment. If the child physical measurements are all average, which of the following measurements should you most expect?a) Wt. 3 kg; Head circ 33 cm; length 51 cmb) Wt 2.8 kg; Head circ 30 cm; length 50 cmc) Weight 1.8 kg; Head circ 33 cm; Length 52 cmd) Weight 4 kg; Head circ 36 cm; Length 51 cm
Ans: AWt. 3 kg; Head circ 33 cm; length 51 cmAverage measurements for a term baby areWeight 3.1 Kg ( varies with ethnicity)Head circ: 33-35 cm (13-14 inches)Length: 51 cm (20-21 inches)
33
During a visit to clinic, Mitch, age 2, presents with large muscular calves and demonstrated difficulty rising from a sitting position. Which lab test is indicated?a) Serum Calciumb) Serum magnesiumc) Serum phosphorusd) Serum creatine kinase
Ans: DSerum creatine kinase is elevated with muscle destruction. the large, muscular, "woody" calves is suggestive of Muscular dystrophy.
34
You are assessing a 2 month old girl for developmental warning signs. By what age should she pick up a toy, according to normal developmental guidelines?a) 6 monthsb) 3 monthsc) 5 monthsd) 4 months
Ans: A 6 months Be careful. The question asks for dev warning signsIt is a dev warning sign if an infant cannot pick up a toy or try to pick up a toy by 6 months. While a child may be able to pick up a toy before the age of 6 months, it is not considered a warning sign until 6 months
35
A 2 month old infant is presented for exam and immunizations. History includes an uncomplicated full term delivery and Hep B virus immunization shortly after birth. Exam is unremarkable except for a diffusely erythematous macular rash in the diaper area, sparing the inguinal folds. No satellite lesions are noted. The infant diaper rash is most likely caused by:a) Candida albicansb) Eczemac) Seborrheic dermatitisd) Contact dermatitis
Ans: D Contact dermthe key to this answer is the sparing of the inguinal folds where the diaper surface is unable to touch the skin. Also, the lack of a rash anywhere else in the body speaks to contact irritation.
36
A 29 year old male with non-complicated Chlamydia infection may exhibit:a) Urticarialb) No remarkable clinical symptomsc) A green mucoid penile discharged) A penile ulcer
Ans: B No remarkable clinical symptomsUrticaria is a rash associated with syphillis if on palmar surfacesGreen mucoid discharge is assoc with GC a penile ulcer is assoc with syphilis (painless), with HSV, (painful), HIV, Trichomonas,
37
A new patient comes to clinic seeking assistance in his recovery from a myocardial infarction. In his life, he has dealt with legal ordeals with his family. Even for the treatment he receives from you, he has a written statement of his intent regarding medical treatment. Of the following choices, which is the best description of this document?a) Living willb) Healthcare directivec) Patient self-determination statementd) Advanced directive
Ans: D This is an advanced directiveAn Advanced Directive is a written statement of intent regarding specifics of medical treatment.A healthcare directive is a type of Adv. Directive that may include a Living Will and/or a Durable Power of Attorney.
38
A severely injured patient in a filled-to-capacity emergency room is threatening the safety of the other patients. What is the best initial course of action?a) Call the policeb) Restrain the patientc) Call securityd) Eject the patient
Ans: CCall security
39
Tim is 38 and he says that he does not want to comply with medical intervention you recommend. Which of the following key ethical principles require you to respect the patient's individual thoughts and actions?a) Fidelityb) Veracityc) Autonomyd) Beneficence
Ans: C AutonomyFidelity is faithfulVeracity is truthfulnessBeneficence is to have the welfare of the patient as a prime goalAutonomy is the patient's freedom to make a fully informed decision about his care.
40
Your patient comes in for a checkup. His past medical history indicated that his heart has an inability to contract, which results in decreased cardiac output, a condition for which he takes captopril. The patient now also presents with an irregular and rapid heartbeat. Which of the following pharmacologic options would treat the patient's new and most likely condition?a) Enalaprilb) Benazeprilc) Thiazide diureticd) Anticoagulants
Ans: D Anticoagulants for A fib
41
Alison, a 30 year-old female is worried about the "mood" she has experienced for the past few weeks. She says that she has felt really sad, nearly every day and wants to know if she is clinically depressed. Which of the following findings are required to confirm this diagnosis?a) Fatigueb) Insomniac) Diminished pleasure in almost all activitiesd) Excessive guilt or feelings of worthlessness
Ans: C Diminished pleasure in almost all activities; anhedonia
42
Tanner stages help providers understand sexual development in an adolescent child. Which of the following best describes Tanner stage II in males?a) The penis elongatesb) Nocturnal emission beginsc) Testes and scrotum become largerd) Glans develops and rugae appear
Ans: CIn Tanner II, the testes and scrotum become largerTanner III the penis elongatesTanner IV the penis thickensTanner I is a babyTanner V is the adult
43
While doing a fundoscopic exam on your patient, you notice several arterioles that cross a venule, producing bulging on either side. Your patient, a 57 year old AA male is slightly overweight and admits to smoking approx. one pack of cigarettes per day. Which of the following is the most likely cause of these findings?a) Previous traumab) Cataractc) Hypertensiond) Diabetes
Ans: C Hypertension
44
A comprehensive history of a newborn should include a detailed assessment. When dealing with prenatal care, which of the following should NOT be assessed in prenatal history?a) Course of prenatal careb) Xenobiotic use during the gestational periodc) Birth size and weightd) Health problems during pregnancy
Ans: C Birth size and weight are part of the perinatal history not prenatal
45
Tina is 12 years old and presents with a lateral curvature of her spine. Which of the following tests would diagnose scoliosis?a) Positive Gower signb) Negative Gower signc) Positive Adams signd) Negative Adam Sign
Ans: CScoliosis is diagnosed by a positive Adam's Sign. Gower Sign is demonstrated when a child needs assistance from upper extremities to rise to a standing position. This is suggestive of proximal muscle weakness in Muscular dystrophy
46
A 3 yr old patient presents at an inner city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate?a) Throat cultureb) Sputum culturec) Mantoux PPD testd) Cold agglutinin test
Ans: B Sputum testThis came from the Pedi test. The same question on the FNP DRT said the answer is TB test. What do you thinkSince confirmation of TB occurs with a positive culture and a positive chest film, maybe go with sputum culture first since Mantoux is often so subjectively variable
47
Which of the following is the most consistent with Anemia of chronic disease:a) Macrocytic RBCsb) Elevated MCHCc) Hematocrit > 24%d) Decreased level of Ferritin
Ans: CACD is characterized by a reduced erythropoietin response that results in RBC hypo-proliferation. These patients have a hematocrit > 24%, slightly increased or normal Ferritin, normo-slightly microcytic RBCs and normal MCHC
48
A 12 year old girl comes to you in distress. She says that she is pregnant and wants to know what her options are. You tell her that it first must be determined if she has the capacity for informed consent. Which of the following abilities is NOT a component required for informed consent?a) Reasonb) Differentiatec) Communicated) Prioritize
Ans: DPrioritize
49
Jordan, 24, presents with complaints of painful, itchy lesions around her labia majora region. She adds, "I think I've had the chills a few times, and i've really felt sluggish for the past few days." Upon exam of the affected area, you note small, painful, fluid-filled blisters. Given her presentation and your assessment, which of the following tests should be ordered to confirm the most likely sexually transmitted disease?a) Enzyme immunoassayb) Western blotc) Gram stain of discharge smeard) Viral culture
Ans: D viral culture
50
Which of the following findings would you expect to see in a patient with Cholelithiasis caused by biliary obstruction?a) Sudden intensifying pain in the upper right abdomen, fever, dark urine, pale colored stoolsb) Upper abdominal pain, nausea, vomiting, and oily, smelly stoolsc) Mild to moderate aching abdominal pain in the lower left quadrant, loose stools, nausea, and vomitingd) Vague colicky umbilical pain that shifts to the right lower quadrant, pain with right thigh extension, and nausea with one or two episodes of vomiting
Ans: A Sudden intensifying pain in the upper right abdomen, fever, dark urine, pale colored stools
51
A 23 year old male comes to clinic complaining of nausea and vomiting, diarrhea and abdominal cramping. Upon reviewing his activity over the past 24 hours, you learn that he consumed supposedly spoiled sour cream. A physical exam indicates his blood pressure is 70/40 mmHg. Which of the following is the most likely cause of his symptoms?a) Gastroesophageal reflux diseaseb) Gastroenteritisc) Irritable bowel Syndromed) Appendicitis
Ans: BGastroenteritis
52
Your 53 year old patient presents with severe dyspnea, an S4 heart sound while at rest, and fatigue with exertion. His signs and symptoms are similar to angina but much more severe. Which of the following is the patient's most likely diagnosis?a) Hypertensive emergencyb) Myocardial infarctionc) Hypertensive urgencyd) Venous thrombosis
Ans: B MI
53
During a routine exam, your patient collapses. You revive and stabilize him then refer him for an overnight stay in your hospital for observation. Out of the following, which service would qualify as "incident to" billing?a) The initial office visitb) The overnight hospital stayc) Weighing him and taking his temperatured) The subsequent follow-up exam
Ans: CWeight and VS are considered "incident to" billing and can be charged even though the tasks are delegated to an MA or other office staff.
54
A 72 year old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout her marriage and childrearing, although her family history is significant for CVAs and nervous breakdowns. Since her husband died a year ago, she has been waking every morning at about 3 am, is reluctant to go out although she has family member living nearby, and she feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include:a) CVA, depression, hyperthyroidismb) Depression, unresolved grief, hypothyroidismc) Migraine, anxiety disorder, hypertensiond) Dementia, delirium, pneumonia
Ans: B Depression, unresolved grief, and hypothyroidism
55
Which of the following statements is true regarding the management of testicular torsion?a) Patients who have surgery within 6 hours of torsion have a nearly 100% chance of salvaging the testicleb) Patients must have urologic consultation even if it involves waiting until the next morningc) Suspected cases of torsion should be followed up within 2 weeksd) Patients should be referred to a urology clinic
Ans: APatients who have surgery within 6 hours of torsion have a nearly 100% chance of salvaging the testicle
56
Donna, 25,has a positive pregnancy test one week ago. Her mom is currently on insulin therapy to control DM and Donna has a BMI of 31. Since she is in her first trimester, which of the following diagnostic tests should you first order to assess the risk specific to this patient?a) CBCb) Urinalysisc) Chorionic villus samplingd) Hemoglobin and hematocrit
Ans: B Urinalysis
57
The most common bacterial agents responsible for pneumonia in older adults residing in the community are:a) Staphylococcus aureus and H. Flub) Strep pneumoniae and H. fluc) Pseudomonas aeruginosa and S. pneumoniaed) Moraxella catarrhalis and mycoplasma pneumoniae
Ans: BCAP is most commonly caused by Strep pneumoniae and h. influenzaTreat with Resp fluoro
58
Jax just graduated from college and is worried about PID. Her cousin has the condition and Jax knows that it can cause infertility. Since having a family is very important to her, she want to know the signs and symptoms that come with PID. A finding that is NOT typically associated with PID is:a) Lower abdominal painb) Vomitingc) Loss of elasticity of the skin around the pelvisd) Nausea
Ans: CLoss of elasticity of the skin around the pelvis is associated with menopause. The rest of these symptoms are associated with PID
59
A patient from years ago has come to clinic for the first time in years. Shanna, 52, has recently started experiencing menopause. She mentions that she is concerned about bone loss. To determine the risk-to-benefit ratio of prescribing hormonal replacement therapy, Shanna's history of myocardial infarction and coronary artery disease must be considered. Another factor that also needs to be considered, if present, is Shanna's history with:a) Colon cancerb) Uterine cancerc) Cervical cancerd) Ovarian cancer
Ans: B Uterine cancerConsider the effect of HRT on the lining of the uterus with the fact that HRT is primarily Estrogen with progesterone.
60
Steve, 48, has been brought to clinic for alcoholism treatment. Steve, however, denies being an alcoholic. At this point, which of the following questions is the most effective one to ask this patient?a) Do you ever drink to feel more attractive or charismatic?b) When did you start drinkingc) Have you ever felt the need to cut down on your drinking?d) How much money have you spent on alcohol in the past
Ans: C Have you ever felt the need to cut down on your drinking?
61
When a 20 month old presents with a diffuse macular rash that occurs after several days of high fever, the most likely diagnosis is:a) Roseolab) Rubeolac) Scarlet feverd) Rubella
Ans: A Roseola ( care is supportive): 6 - 24 monthsDIscrete rosy-pink macular rash that appears after several days of a high fever. Agent is Human Herpes Virus (HHV6).Rosie measles rash appears AFTER the fever. Rubeola presents with a fever and rash at the same time.
62
A 47 year old patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. There are no current medications taken. The most likely diagnoses would include:a) Peptic ulcer disease, colitisb) Gastritis, Peptic ulcer diseasec) Colitis, small bowel diseased) Gastritis, Crohn’s disease
Ans: B Gastritis/Peptic Ulcer diseaseGastritis and PUD both cause pain when the patient eats due to the increased acid secretion at meals. The symptoms are not consistent with lower bowel disease such as colitis, crohn's, or small bowel disease.
63
You examine a 1 month old girl whose parents are worried that she is not eating well. Aside from some mild spitting up, they do not report symptoms of nausea, or vomiting. Although the child's temperature is normal, you observe that her lips and fingernails have a blue tint. To diagnose the most likely condition, which auscultatory area should you listen to?a) Aorticb) Tricuspidc) Mitrald) Pulmonic
Ans: B Tricuspid The infant's cyanosis and poor diet are most likely due to a VSD which is associated with a holosystolic murmur that is best heard at the tricuspid area; LLSB at the mid sternum. An ASD is heard at the pulmonic valve: LUSBMitral is LLSB but midclavicular line so this may be too lateral for the best soundsThe aortic and pulmonic areas are in the upper parts of the body and therefore also unsuitable for diagnosing a VSD.
64
A CBC ordered for a 10 year old female indicates a low MCHC and a low MCV. Differential diagnosis for this result is:a) Sickle cell anemiab) Vitamin B12 deficiencyc) Pernicious anemiad) Iron deficiency anemia
Ans: DIron deficiency anemia is microcytic and hypochromic. B12 and Pernicious anemias are MacrocyticSSA is hypochromic but with sickled RBCs
65
Mary, 40, has come to clinic with painful swollen joints. She says that she often feels weak and has lost the desire to eat. You ask her about the intensity of her pain and she says that it is horrible in the morning but gets better as the day goes on. Which of the following single treatments would be least effective in her overall treatment plan in chronic management?a) Methotrexateb) Acetaminophenc) Steroidsd) Gold Salt injections
Ans: BAcetaminophenRA: Tylenol is the least appropriate med. Methotrexate, steroids, and gold salt injections are all regular parts of RA management
66
A man who recently attempted suicide is brought to your office by his wife. Having conducted a significant amount of research on her own about suicide prevention, she has many questions. Which of the following choices is the LEAST effective treatment for her husband?a) Antipsychotics if the patient is psychoticb) Antidepressants if the situation is chronicc) Intervention if the patient’s risk is escalatingd) Hospitalization if the situation is acute.
Ans: C Intervention if the patient's risk is escalating
67
You have been referred a patient who has depression. He presents with symptoms of mild depression, including anxiety and concentration problems; however, he seems to have been steadily improving and is responding to his medication. He does complain that he has been experiencing dry mouth and constipation. Which of the following types of antidepressant medications could be responsible for the patient's complaints?a) Serotonin-norepinephrine reuptake inhibitorsb) Monoamine oxidase inhibitorsc) Tricyclic antidepressantsd) Selective serotonin reuptake inhibitors
Ans: CTricyclic antidepressants
68
Which of the following criteria differentiates a TIA from a CVA?a) Focal symptomsb) Amnesia of incidentc) Slowness of onsetd) Absence of residual symptoms
Ans: D the definition of a TIA is that it lasts no longer than 3 hours and leaves NO residual symptoms
69
A 16 year old male, with no abnormalities in his medical records, presents with unusual body proportions and underdeveloped sexual characteristics. A blood test indicates Klinefelter Syndrome. Which of the following is NOT a typical feature of Klinefelter syndrome?a) Short Statureb) Hypogonadismc) Gynecomastiad) Learning disability
Ans: A Short stature is not characteristic of Klinefelter XXY syndrome.
70
A 7-year old male presents to clinic with a limp from pain on his right side. You ask how long he has been limping but the boy's mother is not sure. She says that she noticed him limping a few days ago, but the boy did not complain of pain until very recently. He is unable to walk long distances. His temp is 99F, which the mom explains is due to a recent cold. Upon physical exam, you see no obvious signs, but an internal rotation of the hip causes a spasm. The radiography appears normal. Which of the following conditions do you suspect is the most likely cause?a) Legg-Calve-Perthes diseaseb) Toxic synovitisc) Septic arthritisd) Slipped capital femoral epiphysis
Ans: BHip spasm on internal rotation and recent viral infection indicate toxic synovitis (TS). The insidious onset of the signs and symptoms make septic arthritis unlikely as this condition has an acute onset. Legg-Calves-Perthes disease is afebrile and less acute. The condition is apparent in radiograph studies and the physical finding include limited passive int rotation and abduction of the hip joint. A patient with slipped capital femoris epiphysis will be unable to flex his hip as the femur abducts and will be afebrile.
71
After presenting with a white vaginal discharge as well as vulvovaginal erythema with pruritus, you diagnose 38 year old Tess with candidiasis vulvovaginitis. Tess wants the condition to be treated as soon as possible. Which of the following is the best treatment?a) Metronidazole 500 mg po bid x 7 days or 2 gm. by mouth single dose or gel 5 gm. intravaginally bid x 5 daysb) Metronidazole 2 gm. po x 1 or 500 mg po bid x 7 daysc) Miconazole or Clotrimazole 5 gm. intravaginally HS x 7 daysd) Clindamycin vaginal cream 5 gm. intravaginally HS x 7 days or 300 mg po bid x 7 days
Ans: C Miconazole or clotrimazole 5 gm intravaginally HS x 7 daysAll of the others are antibiotics and not used for the treatment of candida
72
You see a 76-year old woman living at home who is accompanied by her home care provider. She has COPD and T2DM. An example of a secondary prevention strategy is:a) Administering the seasonal influenza vaccineb) Checking her blood glucose levelc) Screening for physical or financial abused) Adjusting her insulin dosing regimen
Answer: C Screening for physical or financial abuse is secondary prevention.
73
A 12-year-old boy presents to the clinic with several smalI, circular, erythematous lesions on his arm. Thelesions appear raised but have a central area of clearing. His mother reports that his sister has several similar 'spots' on her abdomen. Which of the following is the most likely diagnosis?A Tinea versicolorB Lyme diseaseC Tinea corporisD Molluscum contagiosa
Ans: Cmost easily identifiable are the enlarging raised red rings with a central area of clearing (ringworm).
74
A 7-year-old is brought in complaining of difficulty swallowing and drooling. During the exam, you note that the epiglottis is inflamed. Which of the following pathogens is usually not associated with this type of inflammation?a) Streptococcib) H. fluc) Pneumococcid) M. catarrhalis
Ans: D M cararrhalis
75
When a 20 month old presents with a diffuse macular rash that occurs after several days of high fever, the most likely diagnosis is:a) Roseolab) Rubeolac) Scarlet feverd) Rubella
Ans: ARoseola infantum: HHV6, 3 day measles where a very high fever abruptly ends when the rash appears
76
Doris, 77, reports abdominal pain in the lower left side of her abdomen. In the last few weeks, she has experienced frequent constipation and has taken laxatives for relief. However, her abd pain has become increasingly severe. Her labs show a SED rate of 45mm/hr and leukocytosis. Additionally, a sigmoidoscopy reveals inflamed mucosa. Based on her findings and labs, which of the following is the most likely diagnosis?a) IBSb) Bowel obstructionc) Diverticulitisd) Ulcerative colitis
Ans: C Diverticulitis
77
Betty visits the clinic with a very red, swollen face. While no purulent drainage is noted, she states that "it looks like I have a very bad sunburn on my cheeks". When you touch her face, the affected area feels very warm. Given this information and your most likely suspicion, what is the best first-line treatment to provide Betty?a) Betamethasoneb) Ultraviolet lightc) Penicillind) Miconazole
Ans: CPenicillin This is Erysipelas and usually is caused by Streptococcus. The usual approach for this problem is Penicillin however, Clindamycin also works well and will hit both strep and staph
78
Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis?a) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, many white blood cellsb) Squamous epithelial cells with clear cytoplasm and distinct borders, many lactobacillus rods, occasional WBCsc) Organisms about the size of WBCs with undulating flagellum, occasional lactobacillus rods, many WBCsd) Hyphae and spores, few lactobacillus rods, occasional WBCs
Ans: A Squamous epithelial cells with stippling appearance (Clue cells) and indistinct borders, no lactobacillus rods, many white blood cells.Stippling is characteristic of Clue cells and diagnostic of BV. With this bacterial infection, WBCs should be expected. The most widely accepted clinical criteria are 'Amsel's criteria'. This clinical diagnosis requires that three of the following four criteria be met: first, a vaginal pH of greater than pH 4.5; second, the presence of clue cells in the vaginal fluid; third, a milky, homogeneous vaginal discharge; and finally, the release of an amine (fishy) odor with KOHThe large gram-positive bacilli are Lactobacillus species, which are the predominant normal flora of the female genital tract
79
An 18-month-old has decreased appetite and her mom thinks she may be having abdominal pain. She has also been unusually tired. After a thorough history, you find that the family has been renovating their 1950s home. The child's hemoglobin is 11.2 and the lead level is 46 mcg/dL. What is the next step?a) Reevaluate the child in 1 monthb) Referral to hematologyc) Order a blood transfusiond) Evaluate other children in the home
Ans: B Referral to hematology with a lead level > 45Asymptomatic kids with lower levels of lead need to be observed for neuro sighs and watched for iron deficiencies
80
A 59-year-old man complains of an occasional tremor, and he is concerned that he has Parkinson's disease.While there are no specific laboratory/diagnostic tests to confirm this patient's suspicions, which of thefollowing would support the diagnosis?A A habit of consuming nitrate-containing foodsB Kernig' signC A history of alcohol abuseD Myerson's sign
Ans: D Myerson's sign is a tic-response to tapping above the nose and between the eyebrows. It is suggestive of Parkinson's.
81
When evaluating a patient with low back pain without radiculopathy, the NP will most likely identify:a) Discomfort to direct palpation of paraspinal musclesb) A positive straight leg raisec) Recent history of straind) Pain relief with lumbar flexion
Ans: Aa patient with low back pain and without radiculopathy means that there is no nerve root compression. We assume then that the problem is MSK and the patient will feel pain upon palpation of sore muscles HOWEVER, C-a history of recent strain could also be right but does not focus on the lack of radiculopathy
82
Of the total daily pancreatic insulin release, how much is basal?a) 10%b) 25%c) 50%d) 75%
Ans: C 50%
83
A 51 yr old woman presents with a 1 day history of fever, pain and vomiting. The diagnosis of acute cholecystitis would be confirmed by:a) Isolated lymphocytosisb) Elevated amylase and lipasec) Right upper quadrant abdominal ultrasoundd) Abdominal plain films
Ans: CUS is the least expensive/least invasive means of identifying gall bladder disease after a positive Murphy's Sign.Abd films may show gallstones but an US is the most effective imaging test
84
Actinic Keratoses can be described as:a) Hyperpigmented macules on sun-exposed areasb) Vesicular lesions along a dermatomal distributionc) Ulcerating lesions in groin foldsd) Slightly rough, pink or flesh colored lesions on the face
Ans: DSlightly rough pink or skin colored lesions on the face
85
Which of the following is the most serious outcome of Barrett's esophagus?a) Esophageal adenocarcinomab) GERDc) Peptic strictured) Esophageal varices
Ans: ABarrett's Esophagus can lead to esophageal cancers
86
Which test is not an appropriate test for determining the development dysplasia of the hip in an 18 month old infant?a) Allis signb) Skinfold symmetryc) Galeazzi signd) Ortolani maneuver
Ans: ortolani replaces the hip into the socket after we pop it out with Bartolani
87
Which of the following is correct regarding the eruption of permanent teeth?a) In 25% of people, wisdom teeth will never eruptb) Generally, all perm teeth except the third molar erupt by age 9c) Generally all perm teeth except the third molar erupt by age 12.5d) In 60% of people, wisdom teeth never erupt
Ans C Generally, all perm teeth except the third molar erupt by age 12.5The third molars are the wisdom teeth
88
A 37 year old woman with a history of miscarriages presents to your urgent clinic with vaginal bleeding and cramping. Upon examination, you find that her uterus is enlarged and note the absence of a fetal heart rate. You suspect spontaneous abortion. Which of the following diagnostic tests should be initially performed to confirm this?a) Human Chorionic gonadotropin levelsb) Cervical culturesc) PAP smeard) Hepatitis B surface antigen
Ans: AHuman Chorionic gonadotropin levels fall quickly in the presence of a failed pregnancy
89
Risk factors for analgesic-induced nephropathy include all of the following except:a) Male genderb) Age > 50c) Concomitant alcohol used) Presence of a chronic painful condition
Ans: A male genderThis condition is from the overuse of OTC NSAIDs and tylenol. While age >50 and alcohol use and chronic pain are all risk factors, the condition is actually more common in women
90
Trigeminal neuralgia manifests itself primarily with:a) Electric shock like unilateral facial painb) Unilateral facial asymmetryc) Burning bilateral facial paind) Jaw pain extending to the neck
Ans: AElectric shock like unilateral facial painunilateral facial asymmetry is Bell's Trigeminal neuralgia can burn but not bilaterally. Jaw pain extending to the neck is either CV or a distracter
91
Which of the following best describes psoriatic lesions in an elderly patient:a) Localized erythematous vesiclesb) Red, sharply defined plaques with silvery scalesc) Shiny purple smooth lesionsd) Erythematous plaques with central clearing
Ans: B Psoriatic lesions are typically defined as red sharply defined plaques with silvery scales that bleed when picked off.
92
A 70 year old male presents with paresthesia of the lower extremities. On exam, he appears pale and shows a decreased vibratory sense. Lab tests reveal elevated indirect bilirubin, Hct = 30%, MCV = 120. The most likely diagnosis is: a) Pernicious anemiab) Anemia of chronic diseasec) Folic acid deficiencyd) Iron deficiency anemia
Ans: APernicious anemiaPernicious anemia is macrocytic with neuro symptoms. None of the other anemias have neuro symptoms. Folic acid deficiency is macrocytic but presents with a big beefy tongue and is usually associated with alcohol abuse but the mention of elevated indirect bili could point to folic acid but does not account for the neuro signs. IDA is microcytic and ACD is normocytic/normochromic
93
Which of the following is least likely to be noted in a person with psoriasis vulgaris?a) The face is typically involvedb) Lesions are often seen as well-demarcated plaques on the kneesc) Aggravating factors include stress, alcohol abuse, and cigarette smokingd) Most milder cases can be successfully managed with a topical corticosteroid or vitamin D derivative
Ans: A Psoriasis vulgaris rarely involves the face
94
A common rule to follow when prescribing to the elderly is to:a) Give most medications in the morning to allow slowed body functions to have time to adjust to the drugb) Start at a lower dose that what is commonly prescribed for adults, and increase the dose slowlyc) Perform Creatinine clearance test for baseline data on all persons over age 70 before starting on new medications.d) Give medications with a full glass of water to promote absorption and limit harm to the kidneys
Ans: B Because of diminished renal function as we age, always start low and go slow.
95
Your patient comes in for a check for symptoms of wheezing. He indicates that the symptoms occurred soon after his treatment for a myocardial infarction. If heart failure is this patient's condition, which type of heart failure would this patient most likely have?a) Chronicb) Diastolicc) Acuted) Systolic
Ans: C Acute heart failurefollows an MI and with pulmonary symptoms, he is having left failure and his blood is backing up into the lungs.
96
Your middle-aged patient complains of a sensation of motion causing nausea and vomiting. The patient asks you what could be the cause. You tell him that he likely has vertigo and explain that there are many causes for which he should be tested. Which of the following tests should you NOT consider?a) Computed tomography scanb) Venereal disease research laboratory testc) Western Blotd) Hearing examination
Ans: C Western BlotWestern Blot is confirmatory primarily for HIV
97
Gastroparesis is a contraindication to the use of which of the following medications in T2DM:a) Exenatideb) Pioglitazonec) Acarbosed) Glyburide
Ans: A ExenatideExenatide is an incretin mimetic which stimulates insulin production.. It slows gastric emptying and often leads to appetite suppression. It causes N and v and not indicated for patients with impaired gastric emptying.
98
Which of the following is most consistent with anemia of chronic disease?a) Macrocytic RBCsb) Elevated MCHCc) Hct >24%d) Decreased levels of serum ferritin
Ans: C Hct > 24%ACD is characterized by a reduced erythropoietin response that results in RBC hypoproliferation. Lab findings with ACD include a Hct >24%, decreased levels of Iron, normal to elevated serum ferritin, normo to slightly microcytic RBCs, and NL MCHC.
99
Which of the following is the first component of quality assurance?a) Assessing the effectiveness of an actionb) Delineating the scope of practicec) Establishing thresholds for evaluations related to the indicatorsd) Collecting and organizing data
Ans: B Delineating the scope of practice
100
The NP is evaluating lab studies in a patient with newly diagnosed T2DM. Which lipid abnormality is most likely?a) Low total cholesterolb) High triglyceridesc) Low HDL-Cd) High HDL-C
Ans: B High triglyceridesHigh TG are a component of metabolic syndrome. other components include elevated BG, HTN, Low HDL and excessive belly fat.
101
Combined OC use is not advised in which of the following:a) An otherwise well woman > 35 yearsb) A 19 year old cigarette smokerc) A 32 year old with hepatic adenomad) A 35 year old with well-controlled HTN
Ans: COC are absolutely contraindicated in patients with thromboembolic disorders, hepatic or gyn cancers.
102
What clinical stage of syphilis would lymph node swelling appear on a patient?a) Tertiaryb) Secondaryc) Latentd) Primary
Ans: B SecondaryLymphadenopathy is a sign of the secondary stage of syphilis. The most visible sign of the primary stage are painless chancres. The latent stage is seropositive but asymptomatic. The 3ary stage presents with serious symptoms of cardiac insufficiency and an aortic aneurysm
103
A 2 year old child is diagnosed with radial head subluxation (nursemaid's elbow). After closed manipulation, the best indication of successful treatment is that:a) The child quickly begins to use the affected armb) A click is felt while the child is extending and rotating the armc) Swelling dissipates immediatelyd) Pulse and sensation are restored
Ans: A The child quickly starts to use the armthis is usually diagnosed when a child holds his arm close to his body thumb up.
104
Jackie has just graduated from college and is worried about PID and the infertility it can cause. Jackie wants to be sure that she does not have the disease. You tell her that there are many signs and symptoms that indicate PID. A finding that is NOT typically associated with PID however, is:a) Lower abdominal painb) Vomitingc) Loss of elasticity of the skin around the pelvisd) Nausea
Ans: C Loss of elasticity of the skin around the pelvisElasticity loss is associated with menopause rather than PID. Lower abd pain, nausea and vomiting are related to PID. If the patient has a family history of the condition, she should monitor herself for such symptoms.
105
Therapies for the treatment of rosacea in an otherwise healthy 54-year old woman include topical administration of al of the following except:a) Clindamycin creamb) Azelaic acid gelc) Corticosteroid creamd) Tretinoin cream
Ans: CThe goal for the treatment of Rosacea is to control flares rather than to cure the condition. Topical corticosteroids should be avoided on the fact as it can produce a rosacea-like syndrome or can worsen pre-existing rosacea
106
Darlene, 38, comes to clinic and says that she has difficulty hearing with her left ear. You conduct the Weber and Rinne tests and the results indicate lateralization to her right ear. Additionally, the test results show that air conduction is better than bone conduction, with a ratio of 2:1 in both ears. The air conduction time of the left ear is 10 seconds and the bone conduction time is 5 seconds. The air conduction and bone conduction time of the right ear is 30 seconds and 15 seconds respectively. What is the most accurate interpretation of these results?a) The patient may have conductive hearing lossb) The test results are reflective of normal hearingc) The patient may have left sensorineural hearing lossd) The patient may have right sensorineural hearing loss
Ans: CLateralization of sound to the unaffected side is an indicator of sensorineural hearing deficit. If she has hearing problems on her left and Weber/Rinne lateralize to her right, this is indicative of Sensorineural loss. If this were conductive, the Weber/Rinne would lateralize to the affected side; the left.
107
Which of the following is true concerning acute bacterial prostatitis?a) Gram positive organisms are the most common cause of infectionb) Length of antibiotic therapy is usually 1 weekc) Perineal pain with defecation is a common complaintd) Cephalosporins are first-line therapy
Ans: CPerineal pain with defecation is a common complaint. Anything that puts pressure in that area such as valsalva, will cause pain.
108
Martha is planning a diet overhaul for her whole family to make sure everyone is eating healthier. This overhaul includes changes for her, her husband, and the two teen children ages 14 and 16. As she looks to reduce her family's calorie intake, what should she be aware of in regards to her children?a) Nutritional requirements for adolescents are lower than adultsb) She should cut out all protein from the dietc) Nutritional requirements for adolescents are higher than for adultsd) Nutritional requirements for adolescents are the same as for adults
Ans: C Nutritional requirements for adolescents are higher than for adults
109
When Maria was 49-years-old, she had a scare when she discovered a lump in her breast. It was determined to be benign but since then, she has been diligent about monitoring herself for other lumps. She has also made sure to receive mammograms annually. Now, at 65, she is asking when these exams will end. What should you tell her?a) This yearb) Ten years from nowc) Five years from nowd) Fifteen years from now
Ans: B ten years from now
110
Michelle, 6, comes to clinic with a high fever. Immediately upon entering the exam room, she suddenly loses consciousness, has uncontrolled jerky motions, and urinary incontinence. How should the child's symptoms be initially managed?a) Lumbar punctureb) Lorazepam and diazepamc) Maintain airway and administer oxygend) CPR
Ans: C Maintain airway and administer Oxygen
111
Paul, 36, complained of headaches during his routine exam last week. Over the course of just a few days, he has experienced palpitations, weakness, and tachycardia, although he has no history of heart problems. Which of the following is NOT a common cause of what you suspect is his condition?a) Folate deficiencyb) Hematopoietic neoplasmc) Malabsorption of folic acidd) Malabsorption of B12
Ans: B Hematopoietic NeoplasmNeoplasms are tumors formed in the marrow that lead to leukemia, not anemia. Iron deficiency anemia is the most common form of anemia resulting from insufficient intake of iron to meet the body's needs.Folic acid deficiency is a deficiency of folic acid (macrocytic)Pernicious anemia is malabsorption of B12 due to a lack of intrinsic factor.
112
You are treating Ali, 22, who admits to you that she has never had sex. You know that the administration of a PAP test should start three years after a patient has become sexually active; however, if a female has not yet had sex, like Ali, then the administration of a PAP test should begin/should have begun:a) A year agob) Three years from nowc) When she was 13d) When she was 16
Ans: A one year ago. PAP is recommended at age 21
113
A 67 year old female is brought to your clinic by her adult son after she crashed her car into a pole. The son tells you that when the police arrived on the scene, his mother was unable to tell them what happened. The mother says that she was just "shaken up" but when you ask her to tell you what happened, she has great difficulty putting the words together saying, "I don't know" then gets very upset and stops speaking for more than 30 seconds. This verbal difficulty should be charted as:a) Aphoniab) Apraxiac) Aphasiad) Agnosia
Ans: CAphasia is "without words"Aphonia is the inability to produce voiceApraxia is the inability to do perform an action when askedAgnosia is the inability to recognize objects, persons, sounds, shapes
114
What is the purpose of the reporting system established by The Patient Safety and Quality Improvement act?a) Provide patients information about healthcare provider error ratesb) Resolve patient safety and health care quality issuesc) List patients with pre-existing conditions to healthcare providersd) List medical errors of healthcare providers and allocate liability
Ans: BTo resolve patient safety and health care quality issuesPurpose of the reporting system is to resolve patient safety and health care quality issues by providing measurable data for research and analysis.
115
You are treating a 67-year-old Latina. Based on her profile and family history, you decide to order a bone density to check for Osteoporosis. Which of the following is NOT a typical risk factor that would lead you to suspect osteoporosis in this patient?a) Hyperthyroidismb) Obesityc) Excessive Alcohol used) Smoking
Ans: B Obesity is not a risk factor for osteoporosis; nor is HYPOthyroidism
116
Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion?a) Olopatadine (Patanol)b) Cromolyn ophthalmicc) Timolold) Gentamicin optic
Ans: D Gentamycin Ophthalmic
117
After a 3-week camping trip, an 11 year old is seen for a target lesion with central clearing located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized MSK pain for several days. Pharmacologic management of this condition includes:a) TMP-SMZ (Bactrim)b) Azithromycin (Xithromax)c) Metronidazole (Flagyl)d) Doxycycline (Doryx)
Ans: DDoxycycline: First line treatment for both Lyme disease and Rocky Mountain Fever is Doxycycline
118
Of the following patients, which does NOT need to be reported to state or local authorities?a) Non-rabid dog biteb) A patient whose serology results are anti-HAV and IgGc) Accidental gunshot woundd) A low-risk patient whose tuberculin skin test result is 15 mm
Ans: BThis patient is recovered Hep A. IgG anti-HAV antibodies mean that you have had a hepatitis A viral infection. About 8 to 12 weeks after the initial infection with hepatitis A virus, IgG anti-HAV antibodies appear and remain in the blood for lifelong protection (immunity) against HAV.
119
A concerned mother tells you that her son has threatened to commit suicide. She states that it alarmed her, but she thinks that he may just have been acting overdramatic. In response you explain:a) 10% of those who state an intent to commit suicide dob) 20% of those who state an intent to commit suicide doc) 50% of those who state an intent to commit suicide dod) 80% of those who state an intent to commit suicide do
Ans: D80% of those who state an intent to commit suicide actually follow through on the attempt.
120
A 65 year old female presents with shoulder and pelvic girdle pain for the last 6 months. She reports recent unintentional weight loss. On physical exam, there is pain on ROM, with no weakness noted. Lab studies show a low hemoglobin and an elevated SED rate. Which of the following is the most likely diagnosis?a) Polymyositisb) OAc) Polymyalgia rheumaticad) Fibromyalgia
Ans: C Polymyalgia rheumaticaPR is an inflammatory disorder involving pain and stiffness in the shoulder and usually in the hip. treatment is steroids, WBC is usually normal but SED is elevated.
121
Which of the following statements is true about an infant patient with a fever?a) A temp of 101.8 F can be meaningless in the infantb) Temps over 101.8 F may result in febrile seizuresc) Fever is common in the first few months of lifed) A Fever in an infant is defined as a rectal temp of 100.4 F
Ans: DA fever in an infant is defined as rectal temp of 100.4 FAccording to the literature, febrile fevers occur at 102 but they can happen at lower temps so I suppose B is also accurate
122
A 30-year-old presents with a cough and headache. She reports that she also has been wheezing for nearly a full week. Upon examination, you note a low grade fever and bilateral rhonchi; however, after coughing, her lungs are relatively clear to auscultation. Of the following, which is the most likely diagnosis?a) Asthmab) Pneumoniac) Emphysemad) Acute Bronchitis
Ans: D Acute Bronchitis
123
A pregnant woman is diagnosed with chlamydia. She wants to know if the baby is at risk for any conditions because of her diagnosis. Which of the following most accurately states the risk?a) Baby at risk for ophthalmia neonatorumb) Baby at risk for deafnessc) Baby at risk for in utero deathd) Baby at risk for mental or growth retardation
Ans: ABaby at risk for ophthalmia neonatorum
124
A 28 month old girl is brought to you for examination with a three day history of runny nose, non-productive cough, and a mildly elevated temperature. Her grandmother is worried because the child's temp has increased to 101.9F after being awake all night with a persistent cough. Upon examination, you note a palpable liver and spleen. Which of the following findings would indicate a severe form of the most likely diagnosis?a) Altered sensoriumb) Pulsus paradoxus above 12 mmHgc) Bloody stoolsd) Salt-tasting skin
Ans: A Altered Sensoriumwhat does this kid have?
125
Sulfonylureas and meglitinides are characterized by their impact on:a) Insulin releaseb) Insulin receptor site activityc) Hepatic glucose productiond) Renal glucose excretion
Ans: Ainsulin release
126
Jake, 15, comes to clinic about what he hopes is just moderate acne. After examining him, the NP diagnoses Jake with severe pustular acne. Which of the following is the best treatment for the patient's condition?a) Salicylic acid preparationsb) Referral to a dermatologistc) Benzoyl peroxided) Retinoic acid cream
Ans: BJake, because of his pustular lesions, needs to be referred.
127
Three suicides have occurred in the USFSON-BSN-DNP program leading up to the National Certification Exam. The student health center is offering one-to-one and small group counseling to any student who is feeling stressed. Meeting with students who are anxious and showing signs of stress is an example of:a) Primary preventionb) Secondary preventionc) Community actiond) Tertiary prevention
Ans: DTertiary preventionCare is directed toward individuals or small groups who are already showing signs of stress. Tertiary strategies are aimed at reducing the risk of stress-related acts that may be detrimental to the health of the students.
128
Your patient comes in for a check. His past medical history indicates that his heart has an inability to contract, which results in decreased cardiac output, a condition for which he takes captopril. The patient now also presents with an irregular and rapid heart beat. Which of the following pharmacologic options would treat the patient's new condition?a) Enalaprilb) Benazeprilc) Thiazide diureticd) Anticoagulants
Ans: D Anticoags for the treatment of A-FibThis patient has heart failure which has been treated with an ACE inhibitor. A, and B are also ACE inhibitors which will not manage new symptoms. Atrial Fib is treated with anticoag therapy.Thiazides would help the patient's heart failure, but these do not treat A-Fib
129
To ensure that your research methods are providing intended data, you choose three parameters that you wish to test for and construct three questions as each. After collecting the results, you look for variance within each group of three answers. Which of the following research principles have you appealed to in verifying your research?a) Validityb) Internal consistencyc) Reliabilityd) Sensitivity
Ans: BInternal consistency measures the reliability of inquiries or instruments to determine if they all are aimed at the right response. Validity is tested by ensuring that the variable itself is tested accurately and yields the intended informationREliability guages if an instrument will measure results the same way over time.
130
The NP is conducting an interview with a patient. The patient describes a number of symptoms she feels. In the middle of describing her symptoms, she jokingly says, "if this turns out to be something bad, I don't want you to tell me". If the NP accedes to this request, the NP would be in violation of which ethical principle?a) Fidelityb) Veracityc) Beneficenced) Justice
Ans: BVeracityThe duty to be honest with a patient about serious conditions is known as the duty to veracity.Fidelity is faithfulBeneficence is about the duty to prevent harmJustice is about "fair"this is a tough one for me and could have been more clear in the question
131
Which of the following conditions is best evidenced by papilledema?a) Diabetesb) Hypertensionc) Vascular hemorrhage and perforationd) Heart failure
Ans: BHypertension
132
One site for atopic dermatitis usually only noted during infancy is the:a) Faceb) Antecubital fossac) Buttoxd) Hands
Ans: ABabies sometimes present with atopic dermatitis on the face
133
During an employment physical exam of a 21 year old female, bruising around the areola on the breasts is noted. An appropriate health history for these findings should include all the the following except:a) Socioeconomic statusb) Current social relationshipsc) History of present or past traumad) Mental health status
Ans: APhysical and sexual abuse is not particularly affected by SE status whereas the health history should include investigation of all these other areas.
134
A 30-year-old AA patient complains of being constantly out of breath in the absence of strenuous physical activity. He has also noticed the sudden onset of severe pain in his back and chest. Lab tests show a Hemoglobin level of 13g/dL. Given your suspicion of anemia, you know that which of the following would be LEAST appropriate to order as a course of treatment?a) IV fluidsb) Analgesicsc) Oxygend) 5 units of red blood cells
Ans: D 5 units of RBCs
135
You have already seen Grant, a sex addict, for treatment of a few sexually transmitted diseases. This time, you observe several lesions on his trunk and genitals that are 1-1.5 mm in length. Furthermore, you chart that these are smooth, rounded, and possess flesh-colored to pearly white papules. What is the best treatment for this case?a) Trichloroacetic acidb) Electrocauteryc) Laser therapyd) Liquid nitrogen
Ans: D Liquid nitrogenThis patient has probable Molluscum Contagiosum; a viral disorder with this presentation. Liquid nitrogen is used to remove the rounded shiny flesh colored lesion with minimal scaring
136
A friend comes to clinic to chat in private. His relationship with his father is strained and they have not spoken in a number of years. He overheard his mother say that his father returned from his physician and has "abnormal, permanent enlargement of the spaces in this lungs". Your friend wants to know what condition causes this finding. What should you tell him his father has?a) Chronic Bronchitisb) Tuberculosisc) Pneumoniad) Emphysema
Ans: DEmphysema: this problem is permanent and treatment should include methods of stopping the progression and minimizing infection
137
A punch biopsy is best presented to the pathologist when it is obtained from:a) The center of the lesionb) The darkest spot of the lesionc) The border between the lesion and unaffected skind) Any area of the lesion in question
Ans: CThe pathologist is evaluation the difference between normal and abnormal cells. A biopsy that contains both cell types is the most valuable for exam.
138
Using the Dubowitz/Ballard exam to estimate gestational age of a caucasian newborn, you determine him to be post term. Which of the following is a finding NOT related to a criterion included in this exam?a) Plantar creases over the sole of the feetb) Elasticity of cartilage in the nosec) Hypertonic flexion of kneesd) Thickness and size of breast tissue
Ans: B Elasticity of cartilage in the nose
139
The NP is seeing a 19 year old male for follow-up. The patient has been suffering from cluster headaches and has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headaches?a) Oxygen therapyb) Beta adrenergic blockadec) Tricyclic antidepressantsd) Dietary reduction of amines
Ans: A Oxygen therapyOxygen therapy has been recognized as beneficial to cluster headache sufferers and is most effective when used at the onset of the HA. Oxygen therapy has not shown to be effective for migraines whereas Beta Blockers, tricyclics, and amine reduction in the diet are approached for the management of migraines
140
The mechanism of action of metformin includes:a) Attenuation of insulin resistanceb) Promotion of renal glucose excretionc) Increase in insulin released) Decrease in gastric emptying
Ans: AAttenuation of insulin resistanceMetformin increases the sensitivity of the insulin receptors thereby making the body respond better to its insulin.
141
Joe, 21, comes to clinic complaining of a painful bump with a small red-looking halo on his penis. The affected area is about 5 mm in diameter, soft and tender to the touch. He states that the halo has been there for about a week and is VERY painful. He doubts that he has a STI since the only unprotected sex he has ever had is with his L-T girlfriend. He adds that his girlfriend can be trusted and that she has never had an STI. Given this information, the most likely diagnosis is?a) Chlamydiab) Genital wartsc) Gonorrhead) Chancroid
Ans: D Chanroid for Syphillis
142
Which of the following statements regarding cystic fibrosis is FALSE?a) CF is an autosomal recessive disorder that causes the production of thick mucusb) CF requires a specialist referral for managementc) The respiratory tract is the only body system affected by CFd) Initial presentation of CF may appear as a meconium ileus
Ans: CC is false. CF is a multi-system disease
143
An 85 year old man presents to clinic stating that on his drive over he suffered a sudden loss of vision in his right eye characterized by "a bunch of lights" and a feeling that "a curtain came down". The most likely diagnosis is:a) Vitreal hemorrhageb) Optic nerve lesionc) Central Retinal nerve occlusiond) Retinal detachment
Ans: D Retinal detachmentAcute onset, "curtain coming down" loss of vision
144
A 75 yr old woman presents for evaluation. She enjoys good health and her medical history is significant only of OA and a remote history of diverticulitis. She recently joined a senior jazz class and is concerned because the workouts make her really dizzy. Physical exam shows a 3/6 systolic murmur heard best at the base of the heart with radiation to the neck. With these findings, the NP suspects:a) Aortic stenosisb) Aortic regurgitationc) Mitral regurgitationd) Mitral stenosis
Ans: A Aortic StenosisMr AssBase = top = aorticSystolic murmur
145
The pathology of which of the following conditions includes the detection of islet cell antibodies in approximately 90% of patients within the first year of diagnosis?a) T1DMb) Hyperthyroidismc) T2DMd) Hypothyroidism
Ans: AT1DMType 1 DM is characterized by islet of langerhan antibodies. This is an autoimmune disease where the body makes antibodies against the Islets where insulin is produced.
146
To assess ability to think abstractly, you could ask the patient:a) The meaning of a common proverbb) What action would be taken if there was a fire in the housec) To count backward from 100 by 7sd) To spell a word backwards
Ans: A The meaning of a common proverb
147
Maria, a 22 year old patient just gave birth to a boy. You conduct a general physical exam on the baby. Based on the weight, length, and head circumference, which of the following would NOT be average measurements?a) Length 21 inches; weight 7 pounds; Head circ 13 inchesb) Length 19 inches; weight 6.8 pounds; Head circ 12.5 inchesc) Length 21.5 inches; weight 7.2 pounds; Head circ 13.2 inchesd) Length 20.5 inches; weight 7.1 pounds; Head circ 14 inches
Ans: B too short/low weight/small headAverage Full term measurements:Weight 7 pounds (3.1 kg)Length: 20-21 inches (51 cm)Head Circ: 13-14 inches (33-35 cm)
148
A 14 year old male with bronchitis is being treated with fluids and expectorants. He returns to clinic with a fever of 103F, right pleuritic chest pain, and green sputum. Which of the following examination results would be expected:a) Right lower lobe cracklesb) Decreased fremitusc) Bilateral wheezingd) Normal percussion
Ans: A Right lower lobe crackles suggestive of pneumonia/consolidationFremitus would increase over an area of consolidation
149
The most common cause of Pernicious Anemia is:a) Occult blood lossb) Intestinal Malabsorptionc) Dietary deficiency of B12d) Reduced intrinsic factor production
Ans: DPernicious anemia is caused by a deficiency in Vitamin B12 due to an inability to absorb B12 from food due to reduced production of intrinsic factor in the stomach which causes B12 not to be absorbed in the small intestine.
150
Of the following, what causes the most missed days of work in America?a) Migrainesb) Sinusitisc) Low back paind) Headaches
Ans: CLow Back Pain
151
A mom brings her 18 month old son in with lethargy and a decreased appetite. After taking a history, you realize that the child has been exposed to lead. Labs reveal the hemoglobin level is 11.2 and the lead level is 46 ng/dL. Which of the following indicates the most appropriate management option for this patient?a) Order a blood transfusionb) Notify child protective servicesc) Re-evaluate the child in one monthd) Refer to a hematologist for chelation therapy
Ans: Dthe limit that indicates a need for a heme referral and chelation therapy is 45 ng/dL
152
The results of Feverfew use can include which of the following:a) Proinflammatory activityb) Antiplatelet effectc) Dopaminergic activityd) Norepinephrine inhibition
Ans: B Antiplatelet effectFeverfew is used for migraines and other types of headaches as well as dizziness, RA, fever, and abd pain. Its effect is to cause vasodilation but it also inhibits platelet aggregation. Who knew?!
153
When counseling for melanoma risk and reduction, the NP advises the patient:a) Avoid the sun between 9am and 3pmb) That family history is not a significant risk factorc) That serious burns in middle age confer the greatest riskd) To use sunscreen with sun protection factor of 45 or higher
Ans: AAvoid the sun between the hours of 9am and 3pm.Damage from the sun is greatest when the sun is directly overhead as this is when UV exposure is greatest. Best to avoid the sun when "your shadow is shorter than your height"
154
Jackie has a two-day history of an eye infection. Her signs and symptoms include erythema on the right eyelid, localized pain, and tearing. A physical exam reveals a tender mass on the infected eyelid. Which of the following is the most likely diagnosis of Jackie's condition?a) Chalazionb) Hordeolumc) Bacterial conjunctivitisd) Blepharitis
Ans: B Hordeolum
155
A 45 year old woman has diagnosed herself with depression through her internet search. She complains of feeling tired throughout the day, even though she sleeps for more than half the day. She also complains of feelings of worthlessness, everyday indecisiveness over the littlest things, and weight gain. Which of the following additional signs and symptoms would confirm that the patient indeed has depression?a) Alternating episodes of insomnia and hypersomniab) Anhedoniac) Psychomotor agitationd) Suicidal ideation
Ans: BAnhedonia
156
Which of the following contraceptive methods, if prescribed to a female patient, should you recommend that she does not massage the injection site after administration?a) Depo-Proverab) Intrauterine devicec) Implanond) Ortho-Evra
Ans: ADepo-ProveraAlso, Depo should be shaken well to create a homogeneous solution, should be at room temperature, and should be injected into the abdomen or thigh at a 45 degree angle to assure that the medication is deposited in fatty tissue
157
Jo Anne, 65, comes to the office wearing high heeled shoes. She states, "I feel as though I am standing on a pebble", and she complains of a shooting pain between her toes. What is the most likely diagnosis?a) Polymyalgia rheumaticb) Morton’s Neuromac) Plantar Fasciitisd) Costochondritis
Ans: BMorton's Neuroma
158
One week into treatment for iron deficiency anemia, you anticipate which of the following clinical responses?a) Increase in hemoglobin level by 2g/dLb) Normal ferritinc) 12% increase in hematocritd) Reticulocytosis
Ans: D ReticulocytosisTreatment of iron deficiency may take several months to replenish the iron reserves. With treatment, reticulocyte production will peak in about 6 days. With every 3 weeks of treatment, Hg levels will increase at 2g/dL and Hct will increase 6%. Ferritin levels will reach normal levels 3-6 months after normal hemoglobin levels are reached.
159
7 year old Bobby comes to clinic with inspiratory stridor, drooling, and a temp of 105 F. He insists on sitting up during the exam. What is your diagnosis?a) Foreign body aspirationb) Reactive airway diseasec) Croupd) Epiglottitis
Ans: DChildren who present with fever, drooling, and an unwillingness to recline should be evaluated for epiglottitis
160
To ensure that your research methods are providing the intended data, you choose three parameters that you wish to test for and construct three questions for each. After collecting the results, you look for variance within each group of three answers. Which of the following research principles have you appealed to in verifying your research?a) Validityb) Internal consistencyc) Reliabilityd) Sensitivity
Ans: BInternal consistency
161
You meet your new patient Ali in the exam room. You see that Ali has drawn a picture of her mother that includes a face, body, legs, arms and hair. Based on this behavior, how old do you think Ali is?a) 3 yearsb) 2 yearsc) 4 yearsd) 5 years
Ans: C 4 years old
162
During a physical exam, Brett mentions that he wants to quit his job but is worried about losing his health insurance. You inform him that the HIPAA will provide protection for workers when they change or lose their jobs. This includes certain private information that pertains to Brett's experience with the healthcare system. What is NOT true about HIPAA?a) All sharing of a patient’s information requires written authorizationb) Patient info stored in a health insurer’s computer is always protected informationc) Health care clearing houses are covered under the billd) Conversations among healthcare providers about one’s care or treatment are protected information.
Ans: A All sharing of a patient's information requires written authorization
163
A 16 year old female in the first month of taking Ortho-Novum 777 complains of midcycle spotting. She has not missed any doses and uses no other medications. Which of the following is most appropriate:a) Discontinue useb) Double dosing x 2 daysc) Change to Ortho Novum 1/35d) Provide reassurance
Ans: DProvide reassuranceShe is only 4 weeks into this new form of OC. Women who use OC may experience breakthrough bleeding and irregular periods for the first three months of use.
164
Your patient Frank comes in for an exam. He says that he was exercising and suddenly felt an onset of chest discomfort. When asked to describe the discomfort, he clenches his fist. Which of the following medications should you prescribe for the patient's symptoms?a) Nitroglycerineb) Thiazide diureticsc) Benzodiazepinesd) Angiotensin II receptor blockers
Ans: ANitroglycerineClenched fist is called Levine's Sign and is characteristic of angina
165
The presence of abnormally shaped red blood cells is known as:a) Anisocytosisb) Reticulocytopeniac) Poikilocytosisd) Hypochromic RBCs
Ans: C PoikilocytosisPoikilocytosis is the presence of abnormally shaped RBCsAnisocytosis refers to an increase in the normal variation of RBC size
166
One week into treatment for iron deficiency anemia, you anticipate which of the following:a) Increase in the hemoglobin level by 2%b) Normal ferritinc) 12% increase in hematocritd) Reticulocytosis
Ans: DTreatment for IDA may last several months and retic production peaks at about 6 days. Hemoglobin levels will increase about 2g/dL and Hct will increase 6%. Ferritin levels will reach normal in approx 4-6 months
167
A 35 year old female has recently been diagnosed with myasthenia gravis. Which of the following is a treatment for this condition?a) Antispasmodicsb) Interferon therapyc) Edrophoniumd) Plasmapheresis
Ans: DPlasmapheresis is a treatment used for both MG and MS. Antispasmodics and interferon therapy are used to treat MS.Edrophonium is used to differentiate between a myasthenia gravis crisis and a cholinergic crisis and does not treat either of those conditions.
168
Which of the following is associated with the physiological differences in children rather than adults?a) Their circulatory system compensates during hypovolemic shock, giving a false impression of normalcyb) A limited store of glycogen with higher relative metabolism puts children more at risk for hyperglycemiac) The children’s airway is narrow and angular, which always requires a tracheotomy for airway-constriction reliefd) The smaller lungs in children make them less vulnerable to aerosolized biological and chemical agents
Ans: ATheir circulatory system compensates during hypovolemic shock, giving a false impression of normalcy
169
Kevin is a 46 year old male who was diagnosed with gout and managed with colchicine for acute pain. He returns for follow-up 2 weeks later and is much improved symptomatically. Which of the following finding would warrant the addition of a new medication for Kevin?a) Elevated serum uric acidb) Continued edema and erythema of the jointc) Impaired renal functiond) Recurrence of joint pain
Ans: A Elevated serum uric acidColchicines is for pain management. In order to reduce the likelihood of further episodes, serum uric acid levels need to be maintained within normal range. If Kevin has elevated serum uric acid following a gouty attack, a medication to facilitate excretion of uric acid should be considered.
170
Tom, 24, visits clinic complaining of a red rash that has spread very quickly over the past day. The rash is red, warm to touch, and has a glossy appearance. You ask Tom how he feels and he says, "my muscles have been aching since yesterday; in fact, I've an altogether ill feeling" you suspect cellulitis, which you know may be caused by one of a few organisms. Which of the following orgs is the leading cause of cellulitis, keeping in mind that Tom is an outpatient?a) Strep. pyogenesb) E. Colic) Staph aureusd) Enterobacter
Ans: A Strep pyogenes is the prime organism for community born cellulitis.
171
All of the following conditions are detectable in the cerebral spinal fluid taken with lumbar puncture except:a) Multiple sclerosisb) Encephalitisc) Meningitisd) Muscular dystrophy
Ans: D Muscular dystrophy
172
Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis?a) UA and cultureb) Scrotal palpation and urine culturec) Prostate specific antigen (PSA)d) CBC with differential
Ans: AUA and culture is always done to identify the causative organism and to rule out UTI
173
You have been treating Daniel 41, for asthma for the past 10 years. He has rarely experienced any symptoms but lately, he has noticed some shortness of breath. You determine a X-ray should be part of the exam. Which of the following findings should you expect?a) Kerley’s B Linesb) Increased densityc) Sporadic consolidationd) Hyperinflation
Ans: D Hyperinflation
174
You are working on a study comparing the differences between patients with glaucoma and those with cataracts. Which of the following tests would be the best to employ to test differences in this case?a) T-testb) F-testc) Wald testd) A-test
Ans: A T test a T-test is used to determine if two sets of data are significantly different from each other.An F-test is used in ANOVA: analysis of variance between data sets.
175
A 32 year old male comes to the emergency room with a gunshot wound on his arm. He states that the bullet grazed him, leaving a minor injury. The patient adds that he and his friends were hunting when the accident occurred and that there was no foul play. After assessing the patient, what is the next appropriate step?a) Report to local authoritiesb) Discharge the patientc) Notify the patient’s next of kind) Confirm the accident story with the patient’s friends
Ans: A Report to the local authorities
176
The parents of a 16 year old are concerned that their kid may be depressed. The parents state that their child has increasingly isolated himself and has an overall sad demeanor. While interviewing the child, which of the following guidelines for effective communication is needed?a) Telling the patient the exact details for goal resolutionb) Active listening skills and therapeutic responsec) Asking the patient to repeat to you what the school counselor has told themd) Taking a lead in the conversation and stay on topic
Ans: B DUH! Active listening skills and therapeutic response
177
Your clinically depressed patient has attempted suicide twice in the last five years. He recently told you that he has been having overwhelming suicidal thoughts over the last week. Which of the following is the best way to proceed?a) Involuntary commitmentb) Restrain the patientc) Refer the patient for a psychiatric appointmentd) Contact the local police to have the patient arrested
Ans: AInvoluntary commitment since he is a risk to himself.
178
Rosario just gave birth to her first child born in the US. She and her family, which includes two other children, recently immigrated from Mexico. You compliment her baby for doing well and being adorable. The next day, your supervisor gets an angry call from Rosario's husband regarding your behavior. Which of the following is the most likely complaint?a) In some Mexican cultures, you must always touch the baby when complimenting him or herb) You did not compliment the other childrenc) In some Mexican cultures, only the mother can compliment the childd) In some Mexican cultures, you should not compliment how a child is doing because that could “jinx” the child.
Ans: A In some Mexican cultures, you must always touch the baby when complimenting him or her.
179
A 66-year-old female has a history of varicose veins and presents to clinic complaining of aching and water retention in her legs during the last few months. She also complains of night cramps in her lower extremities. Which of the following disorders best characterizes her symptoms?a) Superficial thrombosisb) Sciaticac) Peripheral Vascular diseased) Chronic venous insufficiency
Ans: D Chronic venous insufficiency
180
Johnny comes to clinic. He is 6 years old and has not received any immunizations. Which of the following is not necessary at his age?a) MMRb) Dtapc) HIBd) Varicella
Ans: CHIB is not given after the age of 5 years
181
The best lab test to distinguish iron deficiency anemia from other anemias is:a) Serum ferritin levelsb) MCHCc) MCVd) Transferrin saturation
Ans: AFerritin levels show the level of iron stores in the body. With IDA, those levels will be low. TIBC will be high because there is a huge closet capacity to store iron and it is empty.
182
When obtaining a pedigree history, how many generations must be included?a) 1b) 2c) 3d) 4
Ans: C 3
183
A 56-year-old patient comes to clinic complaining of pain and pressure over his face, reaching as far back as his teeth. He also has a fever of 102F which he has been treating with fluids and rest. When asked when these symptoms occurred, the patient said, "about three days ago" which of the following is the most effective way to treat this patient's complaint?a) Antibioticsb) OTC oral decongestantsc) Diazepam for the paind) OTC antihistamine
Ans: A This patient needs antibiotics
184
A 24-yr-old comes to clinic with a sore throat, nasal congestion, and a cough. The patient repeatedly clears her watery congestion into a tissue. The patient does not have a fever and the PE is unremarkable. Given only this information, what is the most likely cause of her condition?a) Influenzab) Common coldc) Mononucleosisd) Tonsillitis
Ans: B The common cold
185
Your hospital risk management team is concerned with establishing legal defense in the case of a sentinel event. Which of the following action-taking initiatives is most important to ensure this goal?a) Documentationb) Preventionc) Departmental coordinationd) Correction
Ans: ADocumentation
186
You see a 24-year old woman who states that she cannot receive the flu vaccine because she experiences a severe allergic reaction to eggs (i.e. respiratory distress, angioedema) requiring the use of epinephrine. The most appropriate response is:a) Recommending vaccination with live attenuated influenza vaccine (LAIV)b) Recommending vaccination with recombinant influenza vaccine (RIV)c) Not recommending the flu vaccine until allergy testing is completedd) Recommending the quadrivalent influenza vaccine every other year.
Ans: Brecommending vac with recombinant influenza vaccine (RIV). RIV is egg-free and indicated for persons 18-49 years of age. All vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxix are available. For those who report having a more severe reaction to eggs involving angioedema, resp distress, lightheadedness or emesis/ or those requiring Epinephrine, ACIP recommends RIV3. If RIV3 is not available, the patient should be referred to an allergist.
187
Match each type of asthma med with its mechanism of action:SABALABALAMAICSa) Bronchodilatorb) Anti-inflammatoryc) Mucolytic activityd) Reduce the production of leukotrienes
Ans:SABA: BronchodilatorLABA: BronchodilatorLAMA: BronchodilatorICS: Anti-inflammatoryShort and long acting beta2 antagonists are bronchodilatorsLAMA is a long acting antimuscarinic agent and has anticholinergic effects that relax smooth muscles and broncho dilate ICS is an anti-inflamLeukotriene modifiers block the action of leukotriene on the smooth muscle receptor and is an inflammatory mediator that contributes to broncho constriction
188
After taking the BP of a 14 year old patient who is in the 90% for height, you suspect that she is Hypertensive. You know that considering her age, her current BP readings most indicate that she has Stage 1 HTN. which of the following BP readings, if present in 3 consecutive readings on 2 separate occasions, would warrant this diagnosis?a) 136/86 b) 122/78c) 126/82d) 142/92
Ans: D: 142/92Pre HTN: 120-139 / 80-89Stage I: 140-159 / 90-99Stage II: >160 / >100
189
Aubrey, 36, is looking for a new form of birth control. You take her history and learn that she had a stroke when she was just 20 years old. Which of the following would greatly increase her risk for a cardioembolic event?a) Ortho-Evrab) Copper-releasing intrauterine devicec) Implanond) Depo-Provera
Ans: AOrtho-Evra is an Estrogen/Progesterone patch
190
Match each of Peplau's Interpersonal Nursing Roles with its appropriate description:a) Active Leadership Roleb) Teaching Rolec) Counseling Roled) Resource Role
This is in the back of Barkley but I am willing to miss this question if it is not intuitive
191
Mary, a 40 year old female, comes to clinic complaining of painful swollen joints. She says that she often feels weak and has lost the desire to eat. You ask her about the intensity of her pain and she states that it is "dreadful in the morning, but get better as the day goes on". Which of the following single treatments would be LEAST effective in her overall treatment plan for chronic management?a) Methotrexateb) Acetaminophenc) Steroidsd) Gold Salt injections
Ans: BAcetaminophen is the least effective for chronic management of RA
192
A 4 year old girl complains of localized, painful swelling on her left eyelid. Her parents say that an abscess on her eyelid seems to be causing the swelling and redness. Your exam confirms the parent's suspicions concerning the abscess. Which of the following would be the most likely cause?a) Conjunctivitisb) Blepharitisc) Chalaziond) Hordeolum
Ans: D Hordeolum is painful, chalazion is painless. The rest are just wrong
193
Which of the following is least likely to pose a risk of genetic problems?a) A history of premature pregnanciesb) Advanced parental agec) Family history of birth defectsd) Fetal exposure to intrauterine infections
Ans: AA history of premature pregnanciesRisk: history of advanced parental age, family history of birth defects and fetal exposure to intrauterine infection are all risks The history of premature pregnancies does not increase the risk of genetic problems.
194
A 25-year-old male visits clinic complaining of external burning and itching on his penis. He reports that his condom broke during recent sex and he has since switched to a different brand. There are rumors that the partner he was with has HPV. He is worried that he may have been infected with the virus. Which of the following options is the best initial course of action?a) Test for GCb) Assume nothing, just analyze a blood samplec) Test for HPVd) Skin test to check for latex and/or spermicidal allergy
And: D Skin test to check for latex/spermicidal allergy
195
According to the recommendation by the USPSTF, a 52-yr old woman should undergo a mammogram :a) Every yearb) Every 2 yearsc) Annually beginning at age 55d) Every 5 years
Ans: B Every 2 years
196
Andre, an 89 year old male, enters the hospital with pneumonia. Of the choices below, which details the best way and time to deal with an advanced directive?a) Advise him as soon as he enters the hospitalb) Advise his family as soon as he enters the hospitalc) Advise him when it seems his symptoms will lead to a comad) Advise his attorney when symptoms look like they will lead to coma
Ans: A Advise him as soon as he enters the hospital
197
When considering possible drug-herb interactions, the clinician considers that St. John's Wort is a potential cytochrome P450:a) 3A4 inhibitorb) 2D6 inducerc) 2C9 inhibitord) 3A4 inducer
Ans: D St. John's Wort is a CP450-3A4 inducerand it diminishes clinical effectiveness of substrates such as OC and alprazolam by inducing them to be metabolized and unloaded too quickly
198
Which of the following is least likely to pose a risk of genetic problems?a) A history of premature pregnanciesb) Advanced parental agec) Family history of birth defectsd) Fetal exposure to intrauterine infections
Ans: AA history of premature pregnancies does not affect the genetic development of the fetus
199
During auscultation of a 3-year-old's heart, you note an irregular heartbeat of 90 beats per minute that slows when the respiratory rate slows and accelerates when the child breathes faster. The rest of the exam is normal. What is an appropriate response to this finding?a) Record the finding in the child’s chartb) Order a chest x-rayc) Order an echocardiogramd) Refer the child to a cardiologist
Ans: Athis finding is typical of Pulmonary stenosis and without symptoms, should just be observed but noted in the chart
200
Actinic keratosis can be a precursor to:a) Malignant melanomab) Acanthosis nigricansc) Basal cell carcinomad) Squamous cell carcinoma
Ans: D Sq cell carcinomaSeborrheic keratosis on the other hand, is rarely precancerous but have been reported in the literature.
201
A 48 year old female complains of a severe headache with throbbing pain. Her children are entering college, and she admits that she has been drinking alcohol at a higher rate than usual. Furthermore, she states, "I haven't gotten a good night's sleep in weeks". Of the following types of headaches, which is she most likely experiencing?a) Tension headacheb) Migraine headachec) Vascular headached) Cluster headache
Ans: B Migraine is throbbing
202
A mother comes to clinic with her toddler girl Monica. Monica is still in diapers, but the mom is anxious to begin toilet training as soon as possible. She asks you when might be the right time to begin toilet training Monica. what is your best advice?a) By the time children are 12 months old, they have control over their bladderb) Some children are not ready to toilet train until 30 monthsc) Children should be ready to toilet train by 18 monthsd) Most children are not dry until age 4
Ans: BSome children are not ready to toilet train until 30 months
203
Secondary preventions is best defined as a focused effort to:a) Prevent a health problem from occurringb) Detect disease in an early, asymptomatic state to minimize its impactc) Initiate treatment prior to a definitive diagnosis based on clinical experience and observationsd) Optimize current treatment regimens to minimize negative disease-induced outcomes
Ans: BDetect disease in an early, asymptomatic state to minimize its impact
204
Ray comes to clinic complaining of intermittent numbness in the lateral aspect of his foot. He explains that he does very labor intensive work that requires him to lift heavy objects. Which of the following is NOT a finding typically associated with the patient's condition if it is the result of one of the most often cited causes of missed work days?a) Diminished reflexesb) Sexual dysfunctionc) Pain along the sacral curved) Pain along the scapula
Ans: D Low back pain does not manifest as Pain along the scapula
205
A newborn is found to have one undescended testicle and hypospadias. Which of the following actions should you take?a) No action is needed at this pointb) The testicle will need to be surgically brought down if it doesn't drop by age 1 yr.c) Order a chromosomal and endocrinology evaluationd) Refer to a Urologist
Ans: DRefer to a urologistA newborn with hypospadias warrants a referral.Hypospadias is a uro referral if the testicle has not descended by 1 year. Interestingly, if a child has bilateral undescended testes, that warrants a referral for chrom analysis.
206
A 37 year old patient presents with dyspnea and sputum production. His history indicates that he has been smoking for the past 15 years. Which of the following additional findings would help the NP diagnose the patient's condition as chronic bronchitis?a) Mild clear sputumb) Increased chest anteroposterior diameterc) Productive cough for three months in the past two yearsd) Blunting or shadowing of the costophrenic angle
Ans: CProductive cough for three months in the past two years establishes a diagnosis of chronic Bronchitis
207
Sarah, 30, comes to clinic with a red and very swollen knee. She is clearly in pain and struggles to walk. She states that she was playing ice hockey the day before and received a very hard slap-shot to her knee. She tells you the same thing happened only a few months ago and that she already knows it is bursitis. Initially, she had been treated with a steroid injection. At most, how many additional steroid injections should she be allowed this year?a) 5b) 2c) 3d) 4
Ans: Bshe got 1 " a few months ago" and the annual limit is 3 so she can only get 2 more.....1+2=3the answer is B....2 morebe careful to answer the question asked!!
208
All of the following are associated with or are complications of allergic rhinitis except:a) Asthmab) Bacterial pharyngitisc) Otitis mediad) Sinusitis
Ans: B Bacterial pharyngitisPatients with allergic conditions often have more than one condition. Like allergic rhinitis, asthma has an allergic component. Acute bacterial OM and sinusitis often occur as a consequence of pathogen trapping in the sinuses with allergic inflammation. GABS is most commonly transmitted by close contact with infected persons or secretions.
209
Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor?a) Pain worse in supine position, focal neuro signsb) Hyperreflexia; personality changesc) Acute onset; increasing pain over hours to daysd) Pupillary constriction; stupor
Ans: APain is worse in supine due to increases in IC pressure and slow growth of a tumor causes neuro changes types of which are dependent on the location of the tumor.
210
Chlamydia is the most common bacterial sexually transmitted disease in the US, with over 40 million infections occurring annually. Which of the following most accurately describes how chlamydia can be spread?a) Vaginal, anal, or oral intercourseb) Physical contact with a toilet seatc) Kissingd) Vaginal intercourse
Ans: AVaginal, anal, or oral intercourse
211
When examining Bob, age 10, you note that his upper incisors slightly overlap the lower incisors. The second and lower first molars are absent. Your assessment is:a) Malocclusionb) Delayed mandibular dentitionc) Normal dentitiond) Hyperdontia
Ans: BDelayed mandibular dentition as his 1st and 2nd molars should have come in though his 3rd molars should not appear until 9-12 years.
212
A 27-year-old female comes to clinic and explains that she has recently felt an itching and inflammation in her vagina, despite being sexually inactive for several months. Upon exam, you note vulvovaginal erythema. In addition, you discover a thick white curd-like discharge. Which of the following is she most likely experiencing?a) Candidiasisb) Trichomonasc) BVd) HIV
Ans: A Candidiasis
213
Which of the following choices correctly lists the common factors of anemias?a) Blood loss, bone marrow failure, impaired production, hemolysis, or destruction of red blood cellsb) Islet cell antibodies and human leukocyte antigensc) Cortisol, aldosterone, and androgen deficiency in addition to an autoimmune destruction of the adrenal glandd) Atrial fibrillation, endocarditis, and valve disease
Ans: ACauses of anemias are:Blood loss, Bone marrow failure, impaired production, hemolysis or destruction of red blood cells
214
Chris is 17 and has T2DM. He manages his DM with a controlled diet. His family informs the NP that he has been recently abusing alcohol and he admits that he likes to drink with his friends at parties. Given this information, which of the following is the least appropriate as an oral antidiabetic medication to prescribe?a) Dipeptidyl-peptidase 4 inhibitorsb) Alpha-glucosidase inhibitorsc) Insulind) Biguanides
Ans: D BiguanidesBiguanides should not be given to heavy alcohol users or to those prone to hypoxia. Patients who take biguanides can become sick if they consume more than two to four alcoholic drinks per weekDipeptidyl peptidase 4 inhibitors and alpha-glucosidase inhibitors do not adversely interact with alcohol and are therefore safe.Insulin is not given orally and is not currently indicated in this patient.
215
Match each bacterial organism with its predominant mechanism of bacterial resistance:a) S. pneumoniaeb) H. influenzaec) M. Catarrhalisresistance choices:a) Beta-lactamase productionb) Alteration of protein binding sitesc) Failure of DNA gyrase reversal
Ans: Strep Pneumo: Alteration of protein binding sitesH. Flu: beta lactamase productionM. Catarrhalis: beta lactamase productionFailure of DNA Gyrase reversal is a resistance mechanism for fluoroquinolones.
216
Which of the following confirms and grants hospital privileges to the NP?a) The state board of licensureb) Department of Risk managementc) Credential committeed) Collaborating physician
Ans: C Credentials committeeThe hospital committee grants privileges to the NP
217
One of the major psychosocial tasks of infancy is:a) Development of secure attachmentb) Separation individuationc) Symbiosisd) Regulation
Ans: ADevelopment of secure attachment
218
There is a break in immunizations from the recommended schedule. What should the NP do?a) Conduct tests to see which vaccines were already administeredb) Refer to an immunologistc) Resume immunizations according to the child’s current age, regardless of the vaccines previously missedd) Administer all vaccines that the child has not received
Ans: CResume immunizations according to the child's current age, regardless of the vaccines previously missed.
219
You have been treating a 62 year old woman with osteoarthritis in her left knee. At first, she was not having too much trouble with movement but as the months passed, the condition became more severe and movement became more difficult. She asks you to provide her with a cane which you do. You should teach her to hold the cane on which side?a) Right sideb) Left sidec) Alternating every other dayd) Either side will work though not to excess
Ans: A Right sideThe right side is the proper side to use the cane. It should be used on the side opposite the OA leg which in this case is the left.
220
Abigail, a 21 year old college student with meningococcal meningitis. You inform the school officials that:a) Individuals with household-type or more intimate contacts should receive antimicrobial prophylaxisb) Asymptomatic nasopharyngeal carriage of the causative organism is rarec) All on-campus student need antimicrobial prophylaxisd) This type of meningitis is not contagious
Ans: Aa) Individuals with household-type or more intimate contacts should receive antimicrobial prophylaxisMeningococcal meningitis is contagious and is spread via nasopharyngeal droplets
221
The NP is treating 12 year old Ben for T2DM. In addition to dietary and lifestyle management, the NP is looking to add an oral anti-diabetic medication to his regimen. Which ofthe following medications would be the most appropriate for Benny?a) Dipeptidyl-peptidase 4 inhibitorsb) Glucagon-like peptide 1 agonistsc) Metformind) Thiazolidinediones
Ans: CMetformin (biguanide) is the first step in the management of T2DM
222
When examining a patient's retina, the artery-to-vein ratio is usually 4:5. which other ratio represents a normal variation of the artery-to-vein ratio within the eye?a) 1:3b) 4:6c) 2:3d) 5:6
Ans: Ca ration of 2:3directly out of Bark
223
A 34 year old male is complaining of pain in his wrist. He says that he is a tailor and that he sews for nearly eight hours a day, and the pain is especially bad by the time he gets home at night. The NP taps a specific nerve on the flexor surface of the patient's wrist to determine if a tingling sensation radiates from the wrist to the hand. Which nerve did the NP tap?a) Medianb) Radialc) Ulnard) Medial
Ans: ACarpal tunnel is a disturbance in the function of the Median Nerve
224
You see a 38 year old woman with moderate persistent asthma who is otherwise healthy. Which of the following would you most likely find during an asthma flare from this patient?a) Cracklesb) Inspiratory wheezingc) Expiratory wheezingd) Bradypnea
Answer: C Expiratory wheezeDuring an asthma flare, the airways become swollen and air is trapped by narrowing of the bronchial tubes. Signs of a flare include expiratory wheeze, coughing, sob and chest tightness along with low Peak Expiratory Flow
225
Which of the following best describes behavior associated with Piaget's concrete operations?a) Learning primarily by trial and errorb) Interpreting events in relationship to selfc) Categorizing informationd) Drawing logical conclusions
Ans: CCategorizing information
226
An 18 month old child presents with a bulging, immobile TM, and a temp of 103F. Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiating treatment for OM, the most appropriate interventions is to:a) Obtain an EKGb) Obtain and echocardiogramc) Reevaluate the patient in 10 daysd) Refer the patient to a cardiologist
Ans: CThis is the presentation of a child with AOME who also has a stills murmur. Physiologic murmurs are primarily systolic and grade II-III/VI.
227
A 43 year old patient presents to the ED complaining of sudden, severe pain in his epigastrium. The patient has a slight fever. Upon exam, you note right upper quadrant tenderness and pain under the right rib cage upon inhalation. Which of the following is the most likely diagnosis?a) Peptic ulcer diseaseb) Irritable bowel syndromec) Cholecystitisd) Ulcerative colitis
Ans: C CholecystitisThis is a positive Murphy Sign
228
A 30-yr-old female presents to clinic with frequent and debilitating headaches that are particularly intense about her neck. She says that her neck and shoulders feel extremely tight and tense and during these headaches. However, she denies any neurologic deficits. Based upon her complaints, what type of headache is this patient most likely experiencing?a) Vascularb) Migrainec) Clusterd) Tension
Ans: D Tension
229
Jason, 35, is being treated for HIV and will be in the hospital for a few days. His medical bills are being paid by his Aunt who wants to know why her nephew is hospitalized but Jason is not willing to share that information. Of the following, which is the most appropriate action for the NP to take?a) The NP should forward the aunt’s request to the hospital ethics committeeb) The NP should not release the details of Jason’s health status to his auntc) The NP should encourage Jason and his aunt to work out their differences before disclosing any patient detailsd) Since Jason’s aunt is paying the bill, she has the right to his medical information and the NP should provide it.
Ans: B The NP should not release the details of Jason's health status to the aunt
230
Dori, 64, has experienced recurring bouts of shingles. Although you note during today's appointment that her skin eruptions have disappeared, she complains of pain and burning sensations that remain in the areas of the outbreak. These sensations, she adds, have been severe enough to interfere with her sleep. Which of the following do you prescribe to alleviate the patient's complaints?a) Gabapentinb) Zostavaxc) Acyclovird) Famciclovir
Ans: A Gabapentin
231
Which of the following is suspected as a cause of intussusception?a) Clostridium difficileb) Adenovirusc) Chronic constipationd) Influenza virus
Ans: BAdenovirusIntussusception has also been linked to the Rotavirus vaccine that is given up to but not beyond 8 months of age. Intussusception presents within approx 3-14 days after the initial dose of the vaccine which is given at age 2, 4, and 6 months.
232
Which of the following is not a criterion for a level 4 office visit?a) At least four elements of HPI, + or – responses to at least 2 ROS questions; at least 1 notation about past hx, family hx, or social hxb) At lease 12 elements of Physical examc) Medical decision making of moderate complexityd) Patient must be seen by a physician at some point in the visit.
Ans: DThere is no requirement for the patient to be seen by a physician during a level 4 visit
233
Which of the following is the leading cause of Cancer-related deaths in women?a) Cervicalb) Ovarianc) Breastd) Lung
Ans: D LungThe others are in fact killers of women and though all are GYN, in fact, Lung cancer is the #1 killer of women AND of men.
234
A 32 Year old woman presents with a recent onset of copious green-yellow vaginal discharge. Microscopic exam reveals many WBCs and large motile organisms. Visual examination of the cervix is likely to reveal:a) Scattered vesiclesb) Strawberry spotsc) Purulent discharge from the cervical osd) Cervical ectropion
Ans: Bthis presentation is consistent with Trichomonas and is often accompanied by Strawberry Spots on the cervix
235
The NP is suturing a simple laceration on an 11 year old patient. The use of lidocaine with Epi is contraindicated in all of the following areas except the:a) Scalpb) Nosec) Fingersd) Earlobe
Ans: A ScalpLido with epi is contraindicated in any area that has limited "one-way" perfusion because the Epi is a strong vasoconstrictor
236
A 32 year old woman reports a 6-month history of intermittent symmetrical swelling of the wrists and daily morning stiffness lasting one hour or more in and around other joints. What is the most likely diagnosis?a) RAb) OAc) Gouty arthritisd) Reiter’s syndrome
Ans: RAOA is not multi-joint and not symmetrical; also usually presents in older adults and from joint overuseGout presents in a distal joint or in the outer ear where cool temps crystalize the uric acidReiter's is "can't see, Can't Pee, Can't Climb a tree" joint pain associated with Chlamydia
237
A 1 week old is brought to the clinic because of drainage from the infant's left eye. The parent states that the infant has had the condition since birth, and the it might be "pink eye" needing antibiotic treatment. The NP should:a) Ophthalmic gentamicin with a follow up in 1 weekb) Neomycin polymyxin (cortisporin) suspension, with follow up with an ophthalmologistc) Topical erythromycin, returning for eval in 2 daysd) Ketorolac drops (acular) with follow up in 3 days.
Ans: C Topical erythromycin and reevaluate in 2 days. This child at 1 week probably has exposure to Chlamydia. First line treatment is topical erythromycin. Alternatives are oral macrolide or DoxyAcular is a steroid for allergic inflammation
238
A 27 year old woman presents to the ED with vaginal bleeding. She states taht she is 14 weeks pregnant and has not had any prior bleeding or spotting. Of the following signs, which would be the most serious in regard to the patient's pregnancy?a) Cramping and pelvic pressureb) Pink discharge containing mucous plugc) Frequent or painful urinationd) Constipation
Ans: A Cramping and pelvic pressure
239
Which of the following is NOT an indication of preeclampsia:a) Visual disturbancesb) Glucosuriac) Edema of the face and handsd) Headaches
Ans: BPatients with preeclampsia present with headache, generalized edema, sudden weight gain, and visual disturbances (sometimes pre-seizure) Also common is trace to +1 proteinuria but glucosuria is not part of this pattern.
240
A mother brings her 5-month old son for a check. She is concerned that his right leg appears shorter than his left. She states that his right leg looks as if it were turned outward. She adds that it does not seem as if her child is in any pain. Suspicious, the NP examined the child by adducting his right hip while applying pressure on the knee. For which of the following conditions is the NP examining?a) Genu valgumb) Genu varumc) Slipped capital femoral epiphysisd) Hip dysplasia
Ans: D Hip dysplasia
241
An 88 year old male presents with concerns about memory loss. He feels good, takes aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests would you choose?a) Folstein Mini Mental State examb) Geriatric depression scalec) Minnesota multiphasic personality inventoryd) Myers-Briggs Test
Ans: AFolstein Mini Mental State Exam
242
A 7-yr-old patient is brought to you complaining of difficulty swallowing and drooling. During the exam, you note that the epiglottis is inflamed. Which of the following pathogens is usually NOT associated with this type of inflammation:a) Streptococcib) H. influenzaec) Pneumococcid) M. cararrhalis
Ans: DWhile three common pathogens can cause epiglottitis, M. cararrhalis is often associated with sinusitis and acute OM. Pneumococci, Strep, and H. flu are all pathogens to consider when determining the cause of epiglottitis.
243
An HIV positive male comes to clinic complaining of SOB and a serious cough. Given this information, which condition should you be most cautious to monitor for in this patient?a) Pneumocystis jiroveci pneumoniab) Mycoplasma pneumoniaec) Cytomegalovirusd) Acute Bronchitis
Ans: A Jiroveci pneumonia
244
An HR rep is asking about your 55 year old patient, Carmen, who has gone through extensive treatment for alcoholism. The HR person says that since the company she works for is paying for her treatment, it would like to know whether she has been successful in treatment. How do you best respond to the company rep?a) You say that any information about the patient would need written approval from herb) You say you will forward the request to your supervisorc) You say that though you would be happy to share the good news, you cannot because Carmen first need to sign a release formd) You say that you would be happy to share the good news and that indeed, Carmen is improving.
Ans: A Information about Carmen would need written approval from her
245
Principles of therapy in Rheumatoid arthritis include:a) Starting with an NSAID and then escalating therapy in a step-wise approachb) Rapid relief with hydroxychloroqine usec) Early treatment with disease modifying therapy to minimize joint damaged) Pain relief as the main goal
Ans: C Early treatment with DEMARDs to minimize joint damage
246
The parents of a 2 month old male bring him to the ED. His parents inform you that he has a history of irritability. He has developed recurrent vomiting and choking while feeding. You ask the parents about the child's stools, and they respond saying that he has been going less frequently but there are no noticeable changes in the stool itself. Of the following choices, which is the most likely cause?a) Pyloric stenosisb) Gastroesophageal reflux diseasec) Meningitisd) Hirschsprung’s Disease
Ans: BGERDHirschsprung's disease is aganglionic mega colon.Pyloric stenosis presents with projectile vomiting Meningitis? NO..
247
Tanya is 10 years old, 4'8" and weighs 110 pounds. Tanya's mom is concerned about her weight and eating habits as she has found junk food wrappers hidden around the house. She adds that Tanya is very defiant when it comes to food restrictions. Which of the following is the most appropriate way of approaching the topic of diet with Tanya?a) Explain that being overweight puts her at an increased risk for developing many types of cancer and heart diseaseb) Explain that being overweight can cause type 2 dm, which can lead to major complications including amputations and early deathc) Review the new MyPlate standards with Tanya and help her understand why a balanced diet and maintaining a healthy weight are importantd) Explain that junk food, especially sweets, can lead to tooth decay.
Ans: C Review the new MyPlate standards with Tanya and help her understand why a balanced diet and maintaining a healthy weight are important
248
During routine physical exam, 35 year old Sarah says that she and her partner are in a committed relationship and are looking for a long-lasting effortless birth control method. She wants to explore her options but mentions that she has an allergy to estrogen-based birth control. Under the circumstances, which of these choices should you recommend?a) Cervical Capb) Ortho Evrac) Oral contraceptivesd) Implanon
Ans: D Implanon
249
Thomas, 72, comes to clinic for a check. Upon examination, you see bruises on his legs. His past medical history does not indicate any conditions or disorders that would cause the bruising. When asked, Thomas was hesitant at first to provide any explanation but later said, "I fell". After assessing the patient, which of the following actions is the most appropriate to take?a) Verify the patient’s claims with family membersb) Report the findings to social servicesc) Refer the patient to an internal medicine physiciand) Report possible abuse to the police
Ans: B Report the findings to social services
250
The NP orders pulmonary rehab for a 75 year old with COPD. Expected outcomes of this program include all of the following except:a) Enhanced quality of lifeb) Increased lung capacityc) Decreased in-patient hospitalizationsd) Improved exercise capacity
Ans: Bin a patient with COPD, the disease cannot be reversed. The damage is there for the duration of the patient's life. Rehab can serve to improve any complications associated with diminished pulmonary function.
251
Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates:a) Oxygen saturationb) If airway obstruction is from pulmonary fibrosisc) Chronic carbon dioxide retentiond) If a patient has reversible airway obstruction
Ans: DIf a patient has reversible airway obstruction. This test differentiates asthma where the symptoms can be reversible from COPD where the changes are permanent
252
A school-aged child is diagnosed with a hordeolum on her left eyelid. Which of the following would be the most appropriate means of management?a) Cool compresses to affected eyelidb) Ophthalmology referral if no resolution in 48 hoursc) Penicillin administered orallyd) Incision and drainage in the primary care clinic
Ans: BWithout resolution of the hordeolum in 48 hours, this child needs a referral. I&D is outside the scope of care in the primary care clinic.
253
Which of the following policies protects the patient's right to refuse care?a) Danforth Amendmentb) Good Samaritan Statutesc) Comprehensive Omnibus reconciliation actd) Blunt Amendment
Ans: A Danforth Amendment
254
8 year old Martin presents with brightly colored cheeks. At first his mother thought Martin was in another fight, but the color had begun to spread to other parts of his body including his upper arms and trunk. Which of the following best describes Martin's condition?a) Lyme diseaseb) Fifth Diseasec) Rubellad) Coxsackie virus
Answer: BFifth Disease; Parvo
255
You begin to notice that your elderly patient's forgetfulness has been gradually worsening. You suspect dementia and want to find out the cause. Which is the leading cause of dementia?a) Impactions on the elderlyb) Drug or alcohol abusec) Alzheimer’s diseased) Parkinson’s disease
Answer: D Alzheimer's disease
256
A punch biopsy is best presented to the pathologist when it is obtained from:a) The center of the lesionb) The darkest spot of the lesionc) The border between the lesion and unaffected skind) Any area of the lesion in question
Ans: C The border between the lesion and unaffected skin.The pathologist is evaluating the difference between normal and abnormal cells; therefore, a biopsy that contains both cell types is most valuable for examination
257
Which of the following is present in over 90% of duodenal ulcers and over 75% of gastric ulcers?a) Helicobacter pylorib) Clostridium difficilec) Staphylococcus aureusd) Salmonella
Ans: AHelicobacter pylori
258
While examining a well-child, you note an innocent heart murmur. The NP knows that which of the following is true about these murmurs?a) They are best heard in diastoleb) It must radiate to the axillac) The intensity is no greater than a II-III/VId) There is no variation with changes in position
Ans: CThe murmurs must be of grade II-III, they may vary with position change, and are strictly systolic
259
What is the most commonly used initial screening test for HIV?a) Western Blotb) Polymerase chain reactionc) ELISAd) CBC
Ans: CELISA for screening/Western Blot for confirmationEnzyme-Linked ImmunoSorbent Assay uses antibodies and color change and is a Wet-Lab
260
An 8-year-old who presents with a sore throat, tonsils are +4 without exudate and afebrile. The NP should strongly consider:a) Normalb) Strep throatc) Hodgkin diseased) Pharyngitis
Ans: CAn afebrile child with +4 tonsillar enlargement without exudate should raise a flag for Hodgkin Disease
261
Jennifer, 18, comes to clinic for the first time. She mentions that she has now missed her last 2 menstrual cycles. She also tells you that though she is sexually active, she and her boyfriend have always been responsible when it comes to safe sex. She does not want her parents to find out if there is a problem. Of the following, which is the best approach to this situation?a) Ask the patient to come back after her next anticipated cycleb) Refer the patientc) Administer a pregnancy testd) Tell the patient’s parents
Ans: CAdminister a pregnancy test
262
What is the "TNM Classification of Malignant Tumors" meant to assess?a) Types of Cancerb) Lifespan assessmentc) Probability of malignancyd) Stages of cancer
Answer: D Stages of Cancer
263
A regular patient of yours comes in for a check. In conversation, he mentions that he just moved to a new apartment that is infested with cockroaches. Which of the following conditions would be most triggered by this environmental factor?a) Pneumoniab) Asthmac) Acute bronchitisd) Emphysema
Ans: BAsthma
264
What is the purpose of the reporting system established by the Patient Safety and Quality Improvement Act?a) Provide patients information about health care provider error ratesb) Resolve patient safety and health care quality issuesc) List patients with pre-existing conditions to healthcare providersd) List medical errors of healthcare providers and allocate liability
Ans: BResolve patient safety and health care quality issues
265
You are assessing a dehydrated and malnourished 56 year old woman who was found wandering in the desert. She had gotten lost during a business picnic to days ago. She is very confused and does not seem to know her identity or where she is. She is muttering nonsense and does not answer any of your questions. When her husband comes in, he says that she has never acted this way before. Of the following choices, which is the most likely diagnosis?a) Alzheimer’s diseaseb) Deliriumc) Dementiad) Psychosis
Ans: BDelirium
266
Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion?a) Olopatadine (Patanol)b) Cromolyn ophthalmic (Crolom)c) Timolol (Timoptic)d) Gentamycin ophthalmic (Genoptic)
Ans D Gentamycin gttsThe concern with corneal abrasion is infection. Gent gtts is the proper treatment.Patanol if for allergic conjunctivitisCromolyn is a mast cell stabilizerTimolol is a beta adrenergic receptor blocker for glaucoma
267
According to recommendations by the USPSTF, a 52 year old woman should undergo a mammogram:a) Every yearb) Every 2 yearsc) Annually beginning after age 55 yearsd) Every 5 years
Ans: BEvery 2 years.women between the ages of 50-74 are screened q2 years (biennially)The American Cancer Society recommends an annual mammogram beginning at age 40
268
A woman in week 28 of her pregnancy presents to clinic complaining of frequent headaches which are causing vision problems. You note that her weight has gone up 15 pounds in 30 days. Her symptoms are most consistent with which of the following conditions?a) Hemolysis, elevated liver enzymes, and low plateletsb) Pregnancy induced hypertensionc) Preeclampsiad) Eclampsia
Ans: C PreeclampsiaElevated BP is present in both PIH and preeclampsia and is what is probably causing her headaches and vision disturbances. Eclampsia includes a seizure. HELLP includes nausea and jaundice and extreme fatigue.
269
A middle aged patient presents with a fever. According to his chart, he has also lost 25 pounds since the last time you examined him. While in the exam room, he coughs productively and repeatedly at one point, he even coughs up blood. You eventually diagnose him with Tuberculosis. Which of the following regimens would be the correct way to treat this patient?a) Daily regimen for four months of isoniazid 300 mg, rifampin 600 mg, Pyrazinamide 1.5 gm., followed by four more months of Isoniazid and rifampin daily.b) Daily regimen for one month of isoniazid 300 mg rifampin 600 mg, pyrazinamide 1.5 gm., and ethambutol 25 mg followed by four more months of isoniazid and rifampin dailyc) Daily regimen for 6 weeks of isoniazid 300, rifampin 600, pyrazinamide 1.5 gm.; followed by four more months of isoniazid and rifampin dailyd) Daily regimen for 2 months of isoniazid 300, rifampin 600 mg., Pyrazinamide 1.5 gm. and ethambutol 15 mg; followed by four more months of isoniazid and rifampin daily.
Ans: D Standard treatment for TB is a 6 month course as shown below:Daily regimen for 2 months of isoniazid 300, rifampin 600 mg., Pyrazinamide 1.5 gm. And ethambutol 15 mg; followed by four more months of isoniazid and rifampin daily.
270
When counseling for melanoma risk assessment and reduction, the NP advises the patient:a) To avoid the sun between 9am and 3pmb) That family history is not a significant factorc) That serious burns in middle age confer greatest riskd) To use sunscreen with sun protection factor of 45 or higher
Ans: A Avoid sun exposure between 9a and 3p
271
Which of the following is most accurate in describing characteristics of bupropion?a) T1/2 >= 5 daysb) Adjunct in the treatment of bulimiac) Potentially energizingd) High potential for abuse
Ans: C Potentially energizingBupropion is potentially energizing and often used in patients with low libido. It is not a potential for abuse and is actually good option for patients with addiction. It can exacerbate addictive disorders and consequently is not an adjunct for bulimia. How do these last two sentences work together?
272
A patient threatens to sue you for invasion of privacy because his health insurance company increased his premiums due to the updated patient information that was provided. You know that:a) A patient’s medical information should be released only if the patient authorizes the releaseb) You did not invade the patient’s privacyc) The patient should sue the health insurance company for discriminationd) You inadvertently slandered the patient
Ans: B You did NOT invade this patient's privacy
273
Three suicides have occurred at a university leading up to finals week. The student health center is offering on-on-one and small group counseling to any student who is feeling stressed. Meeting with students who are anxious and showing signs of stress is an example of:a) Primary preventionb) Secondary preventionc) Community actiond) Tertiary prevention
Ans: DTertiary prevention involves efforts directed toward individuals in order to reduce the impact of dysfunction, disease, or distress and to reduce the duration of the condition. If students are already showing signs of distress, tertiary prevention minimizes the effect of that stress
274
The NP is counseling a patient who is new to insulin therapy. The patient is advised that when injecting short-acting formulation such as insulin aspart, the peak risk time for hypoglycemia is:a) 15-60 minutes after injectionb) 1-3 hours after injectionc) 3-4 hours after injectiond) 4-5 hours after injection
Ans: B1-3 hours after injectionlook up insulin aspart? I did not do a typoInsulin aspart is a fast-acting insulin analog
275
You see a 54 year old man with chronic bronchitis and who has smoked for the past 10 years. During this visit, he states, "I set a quit date after my son's wedding in 2 weeks". According to Prochaska and DeClementi's stages of change model, this patient is at which stage of change?a) Precontemplationb) Contemplationc) Preparationd) Action
Ans: C PreparationPrecontemplation: no intent to changeContemplation: starting to think about maybe changingPreparation: Made the decision and is planning on acting within 30 daysAction: Implementation of changeMaintenance: where the goal is to sustain change
276
The MMR vaccine must be administered in 2 doses. When should the MMR vaccines typically be given?a) First dose: 1-2 years old; second dose: 15 yearsb) First dose: 1-4 years; second dose 10 yearsc) First dose: 12-15 months; second dose 6 yearsd) Both doses given between the ages of 13 and 18 years
Ans: CFirst dose between 12-15 months with the second dose at 6 years
277
You are seeing a 4 year old boy who appears pale and listless. He has a 2 day history of fever and painful limbs. On exam, you notice petechiae on his legs and abdomen as well as a bulging and immobile tympanic membrane. The painful limbs appear to be caused by joint pains. Which of the following indicates the most appropriate next step for this patient?a) Antibioticsb) CBCc) X-ray of the affected limbsd) PT and PTT tests
Ans: BThe fever, painful limbs, and petechiae are all indicators of possible leukemia. The first step should be a CBC
278
Infants identified as having intrauterine growth retardation are prone to developing hypoglycemia due to:a) Decreased metabolic rateb) Low levels of glycogen storesc) Systemic acidosisd) Susceptibility to sepsis
Ans: BLow levels of liver glycogen stores
279
Carrie, 74, comes to clinic for a check up. During the interview, she mentions that her eyesight has deteriorated drastically. She states, "although I am old and have less than 20/20 vision, my eyesight has become cloudy, and I sometimes see halos around lights". Carrie denies pain when asked. Accounting for her age and stated symptoms, which of the following would best serve to confirm the most likely diagnosis?a) Single-eye diplopiab) Constriction of visual fieldsc) Dilated pupilsd) Halos around lights
Ans: A Single eye diplopia is characteristic of Cataracts
280
Concerning the evaluation of a red blood cell folate level, which of the following is true?a) Potentially falsely lowered in person with rapidly developing folate deficiencyb) Influenced by dietary intake over the 24 hours prior to the testc) Remains stable throughout the lifespan of the RBCd) Evaluates Vitamin C deficiency in a chronically ill person
Ans: C The folate level in an RBC remains stable throughout the entire life of the RBC.Folate is incorporated into the RBC during development. The folate level in RBCs is not influenced by diet. Common causes of folate deficiency include inadequate dietary intake (elders, alcoholics), decreased ability to absorb folate (malabsorption syndromes), and a high demand state for folate such as in pregnancy.
281
Research findings have shown that in order to improve the longevity of a patient's COPD, the treatment of choice is:a) Oxygenb) Anticholinergic drugsc) Systemic steroidsd) exercise
Ans: A OxygenOxygen therapy is found to be helpful in patients with COPD and patients are advised to use it >15 hours per day
282
A 68 year old male presents to the office complaining of sporadic numbness in his big toe that occasionally affects his entire foot. His history is positive for smoking, hypercholesterolemia, as well as type 2 DM. On physical exam, you note that the skin on his feet and lower legs is shiny and significantly less hairy; however, neither his feet nor legs are remarkably swollen or red. Which of the following is the most likely diagnosis?a) Chronic venous insufficiencyb) Superficial claudication with ischemiac) Deep vein thrombosisd) Peripheral arterial disease
Ans: D Peripheral arterial disease
283
Psoriasis is a common, benign, hyperproliferative inflammatory skin disorder. Which of the following statements regarding psoriasis is true?a) Psoriasis presents with lesions that are red, sharply defined plaques that are covered with silvery scalesb) Patients with psoriasis have severe erythema and vesicles that are treated with Burow’s compresses.c) Psoriasis presents with papules, vesicles, and crustsd) Psoriasis will resolve completely with high-potency, topical steroid treatment
Ans: APsoriasis presents with lesions that are red, sharply defined plaques that are covered with silvery scales.
284
Clari comes to clinic concerned about her fingernail. She states, "it looks as though it is about to come off!" You notice that the area around the nail is red and swollen and indeed that the nail appears detached. When you touch the infected area, Clari pulls away and screams in pain. What treatment option would be the most effective to provide for Clari at this time?a) Clindamycinb) Ultraviolet B lightc) Miconazoled) Betamethasone
Ans: A Clindamycin
285
The NP is reading an interesting article that outlines a new protocol for the management of COPD. She notices that the article was published in a well known peer reviewed journal. Concerning the efficacy of the new protocol, which of the following is the most important to consider before the practitioner adopts this new protocol in her practice?a) T-testb) P-valuec) Standard deviationd) R-Value
Ans: BThe probability level is usually at the 95% (.05) or the 99% (.01) level of significance. When a researcher states that a difference between groups is significant at the .05 level, this means that this difference would occur 5 times out of 100 by chance rather than by manipulation of the independent variable. It also means that there is a 95% chance that the difference occurred because of the manipulation of the independent variable. When a difference is significant at the .01 level, it means there is a 99% chance that the difference can be attributed to the independent variable.
286
A physical exam on an 18 year old male reveals tenderness over the tibial tubercle. Proximal tibial swelling and tenderness is also noted. When asked to stand, the patient experiences a "weak feeling" in his quadriceps. Which of the following signs or symptoms is consistent with the patient's presentation?a) Diminished patellar reflexb) Feeling as though “standing on a pebble” under his toesc) Pain originating from the heel and radiating to the toesd) Painful lump below the kneecap
Ans: DPainful lump below the kneecapDiminished patellar reflex is Low back injury at L3/4Standing on a pebble is Morton's NeuromaPain originating in the heel is Plantar Fasciitis
287
Melanie, an 8-month-old comes to clinic with bluish skin and a cleft palate. The NP notes that the baby has twitching around her mouth with spasms of her hands and arms. Melanie's parents also report seizures. Upon further observation, the NP learns that the baby is also developmentally delayed in many areas. Which of the following should be a part of your differential?a) Turner syndromeb) Marfan syndromec) DiGeorge Syndromed) Tay-sachs disease
Ans: C DiGeorge Syndrome
288
You tell a young woman that you want to prescribe an OC to treat her acne. She says that her previous treatment of topical antibiotics had some unpleasant side effects and asks what some of the negative side effects of using the OC are? Which of the following is a side effect specifically associated with oral contraceptives?a) Superficial itchingb) Generalized hyperpigmentationc) Mild swellingd) Redness to cheeks
Ans: BGeneralized hyperpigmentation: melasmaOC may cause brownish blotches or melasma on the skin (hyperpigmentation). Swelling, redness and superficial itching may be side effects of topical acne treatments but are not side effects of the OC
289
A 3 year old female presents with reports of recent "cold symptoms" according to her mom. On exam, you note that she has a low grade fever, cough and dyspnea. Her lungs are clear on auscultation. Radiographs of the neck show a "steeple shaped narrowing of the trachea". Which of the following is the most likely diagnosis?a) Croupb) Common coldc) Epiglottitisd) Group A beta-hemolytic streptococcal infection
Ans: ACroup traditionally shows up on xray as a "steeple shaped narrowing of the trachea"Epiglottitis shows on Xray as a banana shaped swelling and the child presents with heavy drooling.
290
Based on a friend's recommendation, 21 year old Kathy is interested in using the NuvaRing as a birth control method. With its 92-99.7% effective rate based on a once a month insertion, it is an attractive choice. What is a disadvantage you must inform Kathy about?a) Menstrual irregularitiesb) Increased vaginal dischargec) Prolonged mensesd) Cramping and pain
Ans: BIncreased vaginal discharge
291
You are performing the first physical exam of Terry, a first time mother-to-be in her first trimester. She knows that pregnancy induced hypertension occurs during 12% of all pregnancies and is concerned. Which of the following conditions is a contributing or predisposing factor to PIH?a) Diabetesb) Sudden weight gainc) Hyperthyroidismd) Herpes
Ans: A DiabetesDM is one of the many factors that can contribute to PIH along with pre-existing HTN, renal, and CVD. Neither hyperthyroidism nor herpes is associated with PIH.Sudden weight gain is a symptom that pertains to preeclampsia, another pregnancy complication but is not associated with PIH.
292
A 14 year old who fell on her outstretched hand complains of proximal forearm pain. X-ray reveals a positive fat pad sign and the patient is unable to fully extend the elbow. No bony changes are seen on Xray. The most likely diagnosis is:a) Upper extremity sprainb) Lateral epicondylitisc) Radial head fractured) Olecranon bursitis
Ans: C Fracture of the radial headThe fat pad sign is characteristic of a radial head injury or an occult elbow fracture; even when xray does not show any sign of fracture. The displaced fat pads, a useful sign of an intraarticular fracture of the elbow, is the clear depiction of displaced humeral capsular fat-pads
293
Although a chest X-ray is not necessary during an asthma attack, the NP would expect to see which of the following on the film if one were taken?a) Low, elevated diaphragmb) Blunting of the costophrenic anglec) Moderate hyperinflationd) Minor infiltrates
Answer: C Moderate hyperinflation
294
David and Sally want to make their home as safe as possible for their toddler. They come to clinic asking for advice. When discussing safety, which of the following is the best advice to give?a) It is crucial to nail into place all window guardsb) Test the temperature of hot water before giving a bathc) Train the toddler to stay off the stairsd) Talk to the toddler about staying away from poisons
Ans: B Test the temperature of hot water before giving a bath.
295
The most common cause of pernicious anemia is:a) Occult blood lossb) Intestinal Malabsorptionc) Dietary deficiency of vitamin B12d) Reduced intrinsic factor production
Ans: DReduced intrinsic factor production in the stomach.Pernicious anemia is a deficiency of B12 which is needed for RBC production. The reduction in intrinsic factor production is caused by an autoimmune response that attacks the parietal cells lining the stomach which interferes with the B12 being absorbed in the small intestine.
296
A patient 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate intervention to aid in the diagnosis of this case?a) Ultrasoundb) Non stress testc) Nitrazine testd) Bimanual cervical examination
Ans: A UltrasoundThis woman may be presenting with placenta previa. An ultrasound is the least expensive least invasive test
297
In advising a woman with menstruation-related migraine and combined oral contraceptive use, the NP considers that:a) A high dose estrogen pill should be prescribedb) Uninterrupted use can help minimize headache frequency and severityc) Headache severity is likely to increased) Cardiovascular risk is markedly increased
Ans: BUninterrupted use can help minimize headache frequency and severity
298
You are reviewing the chart of a patient with terminally ill bone cancer. A section of the chart pertains to the confidence interval (CI) of nausea for the patient. Which of the following statements is true about CI?a) The smaller the confidence interval, the more precise the range of values.b) The larger the confidence interval, the more precise the range of valuesc) The smaller the confidence interval, the less the values deviate from the meand) The smaller the confidence interval, the more values deviate from the mean.
Ans: AA confidence interval (CI) is a range or interval of values, between which an estimation of the unknown population parameter can be reliably estimated. The only true statement is that a small confidence interval implies a very precise range of values. Value deviation does not apply to a CI
299
Which of the following is the most common cause of bladder obstruction for men over the age of 50 in the United States?a) Prostate cancerb) Benign prostatic hypertrophyc) Epididymitisd) Acute bacterial prostatitis
Ans: BBenign prostatic hypertrophy
300
Developmental assessment of a healthy 11 month old born at 32 weeks gestation is expected to reveal an infant who:a) Follows a 2-step commandb) Plays Peek-a-booc) Feeds himselfd) Imitates “bye bye”
Ans: B11 months less 2 = 9 monthsthese kids don't catch up until 2 years
301
A 23 year old female comes to your office complaining of debilitating, throbbing pain that always occurs on the right side of her head. She states that the pain builds gradually and lasts for several hours. She had tried to endure it, but she decided to visit clinic after she started vomiting and seeing flashes of lights when she closed her eyes. She adds that this is the first time that she has ever experienced a "really bad headache". Of the following choices, what should your first course of action be?a) Prescribe daily prophylactic therapyb) Run baseline studiesc) Advise the patient to engage in relaxation and or stress managementd) Order sumatriptan
Ans: B Run baseline studies. This is initial onset and a better history needs to be taken to determine HA cause/treatment
302
Beth, 31, comes to clinic with a six-month history of receiving her menses more often than usual, sometimes every 2 weeks but the amount and time bled seems normal. Which of the following terms best describes the patient's sign or symptom?a) Menorrhagiab) Polymenorrheac) Menometrorrhagiad) Metrorrhagia
Ans: B PolymenorrheaPolymenorrhea is the too frequent occurrence of a woman's menstrual cycle.Menorrhagia patients have regular cycles but bleed heavily and longerMenometrorrhagia have more frequent cycles with heavy bleeding that is prolongedMetrorrhagia is bleeding between cycles
303
You have a patient with anemia which resulted from a poor diet. To treat him, you will need to comprehensively understand the measurements regarding anemia. For the mean corpuscular hemoglobin levels (MCH), normal reading are found between which min and max pictograms per cell?a) 17 and 20b) 21 and 25c) 26 and 34d) 35 and 39
Ans: C 26-34
304
Sharon is 29 with moderate persistent asthma. She is not using prescribed inhaled corticosteroids but is using albuterol as needed to relieve her cough and wheeze. Currently, she uses about 2 albuterol inhalers per month and is requesting a prescription refill. You respond that:a) Theophylline should be added to her treatment planb) She should also use salmeterol to reduce her albuterol usec) Albuterol use can continue at its current leveld) Excessive albuterol use is a risk factor for asthma-related death
Ans: D Excessive albuterol use is a risk factor for asthma-related deathShe needs a more aggressive controller of her asthma. It is important to have her use her inhaled ICS as prescribed then she can be further assessed for added meds.
305
The process of absorption, distribution, metabolism, and elimination of a drug is known as:a) Pharmacokineticsb) Therapeutic transformationc) Pharmacodynamicsd) Drug interactions study
Ans: C PharmacoKineticsPK is what the body does to the drug: ADMEabsorptiondistributionmetabolismeliminationPD is what the drug does to the body
306
A 38 year old male comes to clinic with acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies recent trauma or previous groin injuries. Exam reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is:a) Testicular cancerb) Testicular torsionc) Appendicitisd) Epididymitis
Ans: G Torsionthe only other possible answer is Epididymitis but with that condition, the patient feels relief with the lifting of the scrotum....cremasteric reflex.
307
A 37 year old non smoker with CAP who took an antibiotic for a UTI 3 weeks ago, you prescribe:a) TMP-SMZb) Azithromycinc) Moxifloxacind) Cefpodoxime
Ans: C MoxifloxacinThe guidelines state that the primary treatment target is S pneumoniae and atypical pathogens. However, this patient has DRSP risk which requires a high dose betalactam given WITH a macrolide or doxy), or a resp fluoroquinolone
308
The NP is providing a follow up visit for a patient who is being managed with an HMG-CoA reductase inhibitor. Lab assessment should include an initial measurement of:a) LDLb) ALTc) ALPd) GGT
Ans: ALTInitial hepatic enzymes prior to initiating statins is needed to establish a baseline.
309
Autism in kids is generally identified by 3 years of age. Alice is 30 months and her mom mentions that she is not playing with others, is unable to pretend play, has a very limited vocabulary. Her only interest is in stacking blocks at which she is very good. When considering the disorders in the spectrum of pervasive development disorders, which of the following should be your initial consideration in your differential?a) Autismb) Asperger’s syndromec) Fragile Xd) Down Syndrome
Ans: A Autism
310
Prophylactic treatment options for migraine include:a) Ergotamineb) Sumatriptanc) Gabapentind) Naproxen Sodium
Ans: C GabapentinTriptans and Ergots are abortive
311
You had previously prescribed a 19 year old female treatment for her acne. She returns to clinic several weeks later and angrily complains that her skin has not improved. You decide to switch her to a keratolytic treatment. Given these concerns, which of the following pharm agent is best to prescribe?a) Salicylic acidb) Tretinoinc) Benzoyl Peroxided) Adapalene
Ans: A Salicylic acid is the key component in Aspirin however, it also is a key component is many derm-acne preparations.
312
Candy has dealt with a few complications during her pregnancy. She presents with edema, which started in her face but then spread to other parts of her body. She also complains of headaches, particularly pain around her eyes, which she feels is affecting her vision. She also shows signs of jaundice. Which of the following is the patient's most likely diagnosis?a) Eclampsiab) Hemolysis, elevated liver enzymes, and low platelet syndromec) Preeclampsiad) Pregnancy induced hypertension
Ans: BHemolysis, Elevated Liver enzymes, and Low Platelet syndrome...HELLP syndrome
313
An elderly man presents with swollen lymph nodes and a painless lump in his neck. He also reports that he recently has been feeling generally weak and sometimes has a fever. During the exam, you note tiny, red spots on the skin of his hands. Which of the following is required to confirm the diagnosis that is most likely the cause of his symptoms?a) Bone marrow aspirationb) Magnetic resonance imagingc) Erythrocyte sed rated) Peripheral blood smear
Ans: A Bone Marrow Aspiration.This is the typical presentation of leukemia
314
A 60 year old man reports to the emergency room with severe epigastric pain. On exam, you note that the patient's abdomen if "board-like", and you hear absent bowel sounds. You ask the patient what he was doing when the onset of pain occurred and he replied, "I was having dinner with my family and suddenly there was a severe pain in the upper part of my stomach". These signs and symptoms are most indicative of which of the following conditions?a) Gastric ulcer with perforationb) Gastroenteritisc) Duodenal ulcer with perforationd) Gastroesophageal reflux disease
Ans: A Gastric ulcer with perforation
315
Elly, 21, seeks counseling on contraceptive methods. She plans on having children within the year but would like a convenient, long-acting contraceptive method. Which of the following contraceptive methods is relatively contraindicated for this patienta) Oral contraceptivesb) Ortho Evrac) Injected contraceptiond) Contraceptive ring
Ans: C Injected contraception
316
An 11 year old has a 2 day history of chills and cough that produces green-tinted sputum. His temp today is 102.8F. Auscultation reveals wet lung sounds. You order a chest film. Which of the following bacteria is the most likely pathogen if patchy infiltrates and pleural effusion are seen on film?a) Pneumocystis pneumoniab) Streptococcus pneumoniaec) Klebsiellad) E. Coli
Ans: DE. colithe high fever, chills and purulent sputum indicate bacterial pneumonia. Patchy infiltrates and pleural effusion suggest E. coli. Klebsiella and S. pneumoniae usually present as lobar consolidation. Pneumocystis pneumonia presents as diffuse infiltrates in the upper lobes.
317
A 66 year old presents with bilateral OME and white patches in the mouth that do not rub off when wiped with a 4 x 4 gauze. The patient should be evaluated for:a) HIV Infectionb) Myelodysplastic syndromec) Congenital lymphoproliferative diseased) Non-hodgkin’s lymphoma
Ans: A
318
Your patient has been on oral contraceptives for 4 years and now is ready to start a family. She asks how long she should wait after stopping her pills. You advise that it is safe to conceive:a) Immediatelyb) After 1-2 monthsc) After 3-4 monthsd) After 2 normal menstrual cycles
Ans: AImmediately
319
Janet is a 30 year old Greek journalist who comes to clinic for a complete physical exam before accepting a long-term post in the Middle East. She says that she is feeling healthy but upon reviewing her blood work, you notice smaller than normal erythrocytes and decreased beta hemoglobin chains. Given the most likely diagnosis, which of the following is NOT an expected finding?a) Low serum ferritinb) Decrease in alpha and beta hemoglobin chainsc) Low mean cell hemoglobin concentrationd) Normal total iron-binding capacity
Ans: APatients with Thalassemia have normal serum ferritin, they make small RBCs of normal color. However, given the smaller size of the RBC, they tend to make many more of them similarly to someone who lives in a high elevation.
320
A patient, 43, visits clinic complaining of severe suboccipital pulsating headaches occurring in the morning and fading throughout the day. He is somewhat overweight and smokes. Which of the following should you most likely suspect as the primary diagnosis?a) Migraine headacheb) Hypertensionc) Heart failured) Brain Tumor
Ans: B Hypertension
321
You have just diagnosed a 67 year old patient with pneumonia. The patient also has two other conditions: Diabetes Mellitus Type 2, and metabolic syndrome. According to the latest guidelines of the Infectious Disease Society of America and the American Thoracic Society, which treatment would be best for this patient?a) Doxycyclineb) Azithromycinc) Clarithromycind) Moxifloxacin
Ans: DThis patient needs a Fluoroquinolone such as MoxiMacrolides are not a good choice because of his age and the chance of QT prolongationClarithromycin is a huge CP450 3A4 inhibitor
322
Which of the following GYN cancers has the highest mortality rate?a) Ovarianb) Cervicalc) Uterined) Vaginal
Ans: A Ovarian Uterine is the most commonly developed form of gyn cancer with more than 43,000 annual incidences. Ovarian cancer while affecting half that number, cause more deaths than all other gyn cancers combined. Cervical CA is the third most common while vaginal cancer is the rarest.
323
A 75-year-old diabetic male requires treatment for pneumonia. Which of the following drugs is NOT recommended for this patient?a) A respiratory fluoroquinolonesb) Moxifloxacinc) Gemifloxacind) A Macrolide antibiotic
Ans: D Macrolides are not given to elders due to Q-T prolongation.
324
Which of the following combination of supplements is a possible preventative treatment option for migraines?a) Calcium and Vitamin B12b) Magnesium and riboflavinc) Zinc and Vitamin Cd) Aluminum and Niacin
Ans: B Magnesuim and riboflavinbut I am not sure about this
325
A reasonable alternative diagnosis for an adult with acne vulgaris would be:a) Rosaceab) Tinea facialisc) Hidradenitis suppurativad) Seborrheic dermatitis
Ans: A RosaceaAcne vulgaris and rosacea are characterized by similar morphologies and distributions and are both frequently on the same list of differentials.
326
During development of a treatment plan for an 84 year old patient with hypothyroidism, the NP must keep in mind the possibility for the worsening of:a) Renal insufficiencyb) Osteoporosisc) Dementiad) Anemia
Ans: B Osteoporosisthere is a high prevalence of bone loss in patients with hypothyroidism treated with exogenous thyroxine.
327
Joan, a 46-year-old woman comes to clinic with worries pertaining to a lump she found in her breast. During examination, it is clear she has a mass, although the type is unclear. What is the best diagnostic test to use at this time to distinguish a liquid-filled cyst from a solid mass in the breast?a) Ductoscopyb) Ultrasoundc) Mammographyd) Biopsy
Ans: B Ultrasound
328
You and a student NP are reading the chart of a 55 year old female with a history of glaucoma. The chart indicates that the patient was prescribed pilocarpine eye drops for treatment. You ask the student NP to categorize this type of treatment, and he correctly responds with:a) Beta-adrenergic blockersb) Alpha-2 adrenergic agonistc) Carbonic anhydrase inhibitord) Miotic agents
Ans: DMiotic agents are cholinergics: These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork. Cholinergics can be used alone or combined with other glaucoma medications. A combination of medications can help control how much fluid is produced in the eye and increase the amount of fluid that drains out of the eye.
329
A 25-year-old presents with a bubo in the right groin as well as stiffness and aching near his genitals. You note that there is swelling in his right inguinal area. You aspirate the bubo and prescribe Doxy. For what condition would this be the proper treatment?a) HSV type 2b) Lymphogranuloma venereumc) Molluscum contagiosumd) Genital warts
Ans: B Lymphogranuloma venereum
330
A new patient tells you that he has been under the care of an endocrinologist for years. In reviewing his current meds, you notice the drug Fludrocortisone. For which of the following conditions is this patient being treated?a) Hyperthyroidismb) Cushing’s syndromec) Addison diseased) Hypothyroidism
Ans: A Addison's diseaseCushing's is too much cortisol so clearly we should not add more. Addison's is inadequate levels of steroid so this drug gives the patient more.
331
You see a 76 year old woman living at home who is accompanied by her homecare provider. She has COPD and T2DM. An example of secondary prevention is:a) Administering the seasonal influenza vaccineb) Checking her blood glucose levelsc) Screening for physical or financial abused) Adjusting her insulin dosing regimen
Ans: CScreening for physical or financial abusesecondary prevention is screening
332
There are organic causes of enuresis that should be ruled out by laboratory and diagnostic testing. Which of the following conditions is an organic cause of enuresis?a) UTIb) Behavioral issuesc) Hepatitisd) Hypospadias
Ans: A Urinary tract infection
333
A child's serology results come back showing Anti-HCV and HCV RNA. Which of the following may be included in his treatment plan?a) Oxycodoneb) Interferon and ribavirinc) Erythromycind) Trimethoprim-Sulfamethoxazole
Ans: B Interferon and ribavirin
334
All of the following are required Medicare terms and conditions for paying NP services except:a) The services are within the NP scope of practiceb) The services performed are those for which a physician would be able to bill medicarec) The services are performed in collaboration with a physiciand) Separate charges are billed for NP services and facility charges
Ans: D Separate charges are billed for NP services and facility charges
335
Which of the following is unlikely to be noted in a person with psoriasis vulgaris?a) The face is typically involvedb) Lesions are often seen as well-demarcated plaques on the kneesc) Aggravating factors include stress, alcohol abuse, and cigarette smokingd) Most milder cases can be successfully managed with a topical corticosteroid or vitamin D derivative cream
Ans A The face is NOT typically involvedPsoriasis is most often seen on extensor surfaces like knees and elbows, but can show up in discrete lesions on the trunk and limbs. The condition does not customarily affect the face.
336
In the hospital in which you work, a patient dies unexpectedly during the course of treatment. The hospital declares the incident a sentinel event and orders immediate response. As an NP, which of the following are you most expected to do next?a) Root cause analysisb) Policy change addressing the eventc) Assessment of risks and benefitsd) Documentation of remediation
Ans: ARoot cause analysisRCA analyzes the cause of the problem and is the first step
337
A mother has just given birth to an infant daughter. The mother's chart indicated that she is positive for HBsAg. Regarding hepatitis B vaccination, which of the following is the correct action to take?a) Administer the Hep B vaccine and 0.5 ml Hep B immune globulin within 12 hoursb) Test for HBsAg and antibody to HBsAg in the infantc) Administer the Hep B vaccine before the child discharges and follow up with another two vaccinations given at 2 and 6 months of aged) Arrange an appointment for the mother to bring her daughter in for Hep B vaccine when the child is 1-2 months of age
Ans: A Administer the Hep B vaccine and 0.5ml Hep B immune globulin within 12 hours
338
A patient with OCD comes to the clinic after recently having sex with a prostitute. The patient presents with no findings indicative of any STD but he wants to know which symptoms he should watch for particularly in regards to HIV. Which of the following is traditionally not one of the early signs and symptoms of HIV infection?a) Weight lossb) Night sweatsc) Headachesd) Fever
Ans: C Headaches are not typically symptomatic of early HIV
339
A disheveled 32 year old woman comes to clinic. She presents with bruises and a black eye that she said resulted from "running into a door". However, you suspect a case of possible domestic violence. Which of the following is initially necessary in managing this patient's care?a) Immediately report abuse to the policeb) Check the patient’s vitalsc) Refer the patient to a crisis intervention counselord) Prescribe selective serotonin reuptake inhibitors
Ans: BCheck the patient's vitals.Although abuse is unacceptable, this woman is an adult and has the right to manage her own life. The NP should however address the issue openly and offer any support that might be appropriate.
340
Criteria for “incident to” services include all of the following except:a) An integral part of the patient’s treatment courseb) Associated with an expensec) Of a type commonly furnished in an office or clinic rather than an institutional settingd) Normally rendered for a minimal fixed fee
Ans: D“Incident to” qualifications are: a) the service is an integral part of the patient care, b) it is commonly rendered without charge (height weight etc) and is part of physician billingc) the service is commonly furnished in an office or a clinic ( not an institution)d) there is an expense for the service
341
You saw Alex and Maya through the birth of their son David. Now, three months later, they say they are ready to resume sexual intercourse. They do not want to conceive but they are against using contraceptive measures, as it conflicts with their religious views. Of the choices, which provides the longest period in which a couple could engage in intercourse with minimized risk of conception?a) Cervical mucus testb) Calendar methodc) Basal body temp graphd) Lactational amenorrhea method
Ans: D Lactational amenorrhea method with no solid food supplementation
342
Therapies for the treatment of rosacea in an otherwise healthy 54 year old woman include topical administration of all of the following except:a) Clindamycin creamb) Azelaic acid gelc) Corticosteroid Creamd) Tretinoin Cream
Ans: Ccorticosteroid creamThe goal for rosacea management is to control flares rather than cure the condition. Topical therapies used for treatment include metronidazole cream or gel, sulfur creams, clindamycin, erythromycin, tretinoin, azelaic acid and benzoyl peroxide. Topical corticosteroids should be avoided on the face as it can produce a rosacea-like syndrome and can worsen pre-existing rosacea
343
A diabetic patient comes in complaining of dry mouth and fatigue. You also note a moderate fever. You conduct a number of tests which reveal a state of greatly elevated serum glucose, hyperosmolality, and severe dehydration without ketone productions. Which of the following complications of diabetes is indicated by the patient's signs and symptoms?a) Diabetic ketoacidosisb) Hyperthyroidismc) Hyperglycemic hyperosmolar non-ketosisd) Hypothyroidism
Answer: CHHNK
344
The most common site of osteoporosis-related fracture is:a) Wristb) Hipc) Vertebraed) Ankle
Ans: C VertebraeThe single most common site is the vertebrae. the second most common site is the wrist followed by hip fractures and the ankle is least common.
345
George is complaining of tender, red bumps on his armpits. These bumps have irritated him for a week and he is now seeking help after his wife noted his poor mood the other day. When you look closely, you notice that there are also blackheads. An even closer examination reveals that some of the red bumps have broken and are leaking pus. Given your most likely suspicion, what treatment would be the best to give to George?a) Clindamycinb) UV Lightc) Miconazoled) Betamethasone
Ans: AClindamycinthis is the presentation of Hidradenitis suppurativa; a staph infection commonly in the groin or axilla
346
A 35 year old female has recently been diagnosed with myasthenia gravis. Which of the following is a treatment for this condition?a) Antispasmodicsb) Interferon therapyc) Edrophoniumd) Plasmapheresis
Ans: D Plasmapheresis
347
Which of the following cranial nerves does NOT control eye movement?a) CN VIb) CN IIIc) CN IId) CN IV
Ans: C Eye movement is controlled by CN III, IV, and VI. CN II controls pupillary motion and vision
348
Katherine, 33, has recently been diagnosed with uncomplicated hyperthyroidism. She arrives in clinic complaining of muscle cramps, anxiety, heat intolerance. Of the following choices, which is the most appropriate medication to prescribe?a) Propranololb) Metforminc) Thyroid hormone replacement therapyd) levothyroxine
Ans: APropranolol is a beta blocker that is used to manage the symptoms of hyperthyroidism including nervousness, heart racing, anxiety, heat intolerance.
349
All of the following are used to routinely assess the impairment domain of asthma severity and control except:a) Pulse Oxymetryb) Asthma control testc) Spirometryd) Frequency of short acting beta2-agonist use for symptom relief
Ans: A Pulse OximetryPublished guidelines for the assessment, classification, and evaluation of asthma control include Spirometry and frequency of use of SABA. Pulse Ox is not used to determine asthma severity and control.
350
Which of the following would be an appropriate alternative to erythromycin therapy in an 18 year old patient with mycoplasma pneumoniae infection?a) Azithromycinb) Cephalexinc) Amoxicillind) Clindamycin
Ans: AAzithromycin is in the same class as erythromycin: they are both macrolidesI was not sure what this question was asking....did alternative mean another drug that covered m pneumoniae? or a drug in the same class.....tricky
351
You would expect a school age child to:a) Grow 1 inch and gain 5 pounds per yearb) Grow 0.5 inch and gain 2 pounds per yearc) Gain about 6 pounds and grow 2.5 inches per yeard) Height and weight changes per year can not be estimated
Ans: CGain about 5-6 pounds and grow 2.5 inches per year
352
Earl comes to clinic very distressed by the blisters on his face. The blister are unsightly as many of them have popped and dried into honey-colored crusts. He works behind the desk of a very classy hotel and he knows that this is affecting his business and how he greets guests. What is the best treatment for Earl at this time?a) Bactrobanb) UV Lightc) Miconazoled) Betamethasone
Ans: A Bactroban
353
During a clinic visit, Alex, 27, reports an adverse reaction to Mesalamine suppositories and requests an alternative treatment. Which of the following conditions does Alex have?a) Diverticulitisb) IBSc) PUDd) Ulcerative Colitis
Ans: D Ulcerative colitis
354
In a test for accommodation, what is the normal reaction of a patient's pupils when his eyes are following your finger to his nose?a) The patient’s eyelids will droopb) The patient’s pupils will slightly dilatec) The patient’s pupils will constrictd) One of the patient’s pupils will dilate more than the other
Ans: C The answers will constrict; Think less light entering the eye as focus is taken to the nose
355
Now that he has turned 60 years old, Terry visits you to get a full physical. Knowing that his father had prostate cancer, there would be cause for concern if the prostate surface antigen was at least over which level?a) 2.5 b) 3.5c) 4d) 4.5
Ans: D Less than 4.5Age/Level should be less than40-49/2.550-59/3.560-69/4.570-79/6.5
356
A woman brings her husband to you. She explains that the two of them were at the mall when he began exhibiting erratic behavior, including yelling and screaming for no clear reason. You eventually conclude that prescribing an antipsychotic medication is appropriate. According to the patient's history, he is susceptible to liver and kidney failure. Which of the following antipsychotic meds should you avoid prescribing because of its very low therapeutic index?a) Lithiumb) Depakotec) Phenytoind) Clozapine
Ans: A Lithium
357
A portly cauc patient who is 43 comes to clinic for a checkup. While reviewing his history, you learn that he has diabetes and two previous BP reading of 140/90 on 2 different occasions. Concerned, you check his BP again and get 142/94. You now consider the patient as hypertensive. After the initiation of a thiazide diuretic, which of the following meds would be most appropriate for this patient?a) Beta blockerb) Ca channel blockerc) Angiotensin-converting enzyme inhibitord) Nitrates
Ans: C ACE inhibitor is the best choice since Beta-blockers are contra in patients with DM since they mask the physiologic signs of hypoglycemia.
358
Kaitlin, 18, has recently become sexually active. She requests a contraceptive from your clinic. A PE indicated that she is 5'6" and 205 pounds. Based on her Height and weight, which would be the least effective form of contraception?a) Ortho Evrab) NuvaRingc) Oral contraceptivesd) Diaphragm
Ans: A The patch is not indicated for those with a high BMI though i have no idea what the cut-off is. Seems like 205 is pretty big for a kid!
359
Your elderly patient Jim has recently been diagnosed with hyperthyroidism. After informing him, he explains that his brother has the same condition and has "always been fine". You tell Jim that hyperthyroidism can be asymptomatic, but it may also cause a number of problems. Which of the following is the most likely complication of this disorder?a) Thyroid stormb) Tachycardiac) Weight gaind) Thyroid cancer
Ans: B Hyperthyroidism can cause tachycardia, exacerbated osteoporosis, eye problems (blurring, exopthalmia, photophobia), thyrotoxic crisis- a sudden intensification of symptoms leading to fever, tachycardia and even delirium and is a result of hyperthyroidism which makes this a poor question for an exam
360
A 32 yr old male marathon runner reports to the urgent care center with severe pain in his RLQ that began shortly after a 15 mile training run. While examining the patient, you find that Freddy clutches his RLQ upon contact and when asked to extend his right leg, he explicitly describes pain. Given this info, which of the following findings would best assist you in differentiating the most likely diagnoses of appendicitis, colon cancer, gastroenteritis, or IBS?a) His temperature is normalb) He is experiencing nauseac) He has experienced vomitingd) His bowel habits are normal
Ans: D Normal bowel habits rules out most of these conditions
361
Clinical presentation in severe anorexia nervosa includes all of the following except?a) Hyponatremiab) Somnolencec) Hyperkalemiad) Bradycardia
Ans: C Hyperkalemiaactually, they suffer from HYPOkalemia
362
Infants with Down Syndrome have a specific appearance at birth such as intercanthal folds, hypotonia, and a protruding tongue. But there are findings that go beyond the appearances of the patient. Which of the following are NOT a finding of Down's Syndrome?a) Congenital heart defectsb) Failure to thrivec) Seizuresd) Hearing and/or vision impairment
Ans: B Down syndrome children do not suffer from failure to thrive.
363
A 54 year old woman complains of pain when she breathes and coughs. You palpate her chest and she winces specifically when you touch the region where, in several places, her ribs connect to her sternum. What is the most likely diagnosis?a) Plantar fasciitisb) Polymyalgia rheumaticc) Costochondritisd) Morton’s Neuroma
Ans: CCostochondritisUGH I had this when I started yoga! it was horrible
364
You are discussing at-home maintenance of chronic asthma using a metered-dose inhaler. Which of the following is NOT true about using metered dose inhalers?a) The increased use of a quick-release inhaler should be promptly reportedb) Patients should shake the canister while taking a deep breathe in and outc) Patients should breathe the medication mist in deeply and hold breath for a count of 10d) Metered-dose inhalers should not be used with antileukotrienes
Ans: D Metered-dose inhalers CAN be used with antileukotrienesNot a good question as B: patient should shake the canister... while taking deep breaths can be interpreted as shaking it while inhaling it. nuance but still subj to confusion.
365
A life insurance company sends your office a written request for verification of a patient's record to review for possible fraud. The letter informs you that the company will be checking the patient's record against various third party sources. The company requests that you call to verify the dates of patient procedures. After verifying the legitimacy of the letter, and the patient's medical release, you should respond by:a) Informing the company that it is illegal to share the patient’s informationb) Asking the company to check with the patientc) Talking with office administratorsd) Providing the requested information
Ans: DProvide the requested informationthe documentation has been verified and the patient has given permission to release the records. All is in good shape here.
366
You see 12 year old Maggie in clinic who is unable to sleep. She tosses and turns at night and says that she gets very hot. Maggie states that she cannot focus on anything for a long time which was not the case before. Her mom adds that her academic performance has decreased because of her recent inability to maintain focus. The mom also states that Maggie has been more irritable and excitable than usual. You notice a slight tremor in Maggie's hands when she straightens out her arms. Of the following, which is Maggie's most likely diagnosis?a) Type 2 Diabetesb) Hypothyroidismc) Type 1 diabetesd) Hyperthyroidism
Ans: DHyperthyroidism
367
A 65 year old male presents to clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild HTN for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On exam, the patient is tachycardic, positive for JVD, and positive for S3 with a systolic murmur. Chest films revealed cardiomegaly with vascular redistribution. The NP diagnosis is:a) MIb) Pneumoniac) CHFd) Pleural effusion
Ans: C Congestive Heart FailureCHF is associated with an S3 and blood volume changes. An S3 is often found with the fluid volumes found in pregnancy however, it is also heard in the abnormal conditions of hyperthyroidism
368
After reviewing Betsy's EKG and echo results, it is clear that her heart is unable to contract sufficiently, resulting in decreased CV output. Which of the following types of heart failure does this best describe?a) Systolicb) Diastolicc) Leftd) Right
Ans: A Systolic (filling)Diastolic is "rest"
369
A unilateral, pulsating headache preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm and lasting approximately 20 minutes is most typical of:a) Migraine with aurab) Cluster headachec) Transient ischemic attackd) Tension-type headache
Ans: A Migraine with aura
370
Two adult children come to clinic because they are concerned that their 72 year old father has Alzheimer's disease. You ask what signs he is exhibiting and are alert to listening for early indicators of the disease. Which of the following is the most common early complaint made by families of persons with Alzheimer's disease?a) Forgetfulnessb) Hallucinationsc) Confusiond) Violent behavior
Ans: AForgetfulnessthough forgetfulness can lead to confusion, the former is the most common initial complaint.
371
During a check, Gary 66 reports thin stools and recurring bouts of constipation or diarrhea. He has also experienced rapid and unexplained weight loss in the last month. Gary is concerned because he has a family history of cancer. Of the following, which procedure would you order to best rule out colon cancer?a) Sigmoidoscopyb) Barium studiesc) Colonoscopyd) Complete Blood Count
Ans: C Colonoscopy
372
The mechanism of action of nasal cromolyn is as a(n):a) Anti-IgE antibodyb) Vasoconstrictorc) Mast cell stabilizerd) Leukotriene inhibitor
Ans: CNasal cromolyn MOA is as a mast cell stabilizer
373
Martin, 22, has been seeing you for migraine treatment. During the visit, you notice his strange stance. You ask about it , and he reluctantly admits to a recent onset of testicular pain. You tell him that it is in his best interest to tell you what is wrong so you can help him. He informs you that he has also experienced thick discharge from his penis along with painful urination. Based on these symptoms, you suspect chlamydia. Which of the following tests would best confirm your suspicion?a) Enzyme-linked immunosorbent assayb) Viral culturec) Enzyme immunoassayd) Papanicolaou stain
Ans: CEnzyme immunoassayEnzyme immunoassay is the preferred method used to test for chlamydia however, EIA is also used. This is not such a good question since ELISA and EIA are so close and often interchanged. (http://www.webmd.com/sexual-conditions/chlamydia-tests). Enzyme-Linked ImmunoSorbent Assay (ELISA) is used not in diagnosing chlamydia but rather in diagnosing AIDS or Sickle Cell Anemias. PAP and Tzanck are used for herpes. Chlamydia is bacterial, not a virus so a viral panel is not helpful.
374
You perform the Lachman's test on a 47 year old male. This means that you are assessing for an injury of which of the following?a) Anterior and posterior cruciate ligamentb) Medial collateral ligamentc) Meniscusd) Lateral collateral ligament
Ans: A Ant and post cruciate ligaments
375
A 39 year old patient was diagnosed with acute bronchitis in the ED and treated with tylenol, dextromethorphan, and metaproterenol (alupent). The patient's history reveals a smoking habit of 1 pack per day. He now presents to clinic with a fever of 101.2F and a cough productive of thick yellow-green foul smelling sputum. You would encourage smoking cessation and prescribe: a) Theophyllineb) A penicillin antibioticc) An inhaled corticosteroidd) A macrolide antibiotic
Ans: DA macrolide antibiotic because of ABRS and comorbidities
376
A 55 year old male comes to clinic complaining of severe pain that is centered in his right eye. He also has nasal congestion in his right nostril. You learn that his symptoms have been occurring several times each week for the past month. Which of the following is the most likely diagnosis?a) Trigeminal neuralgiab) Cluster headachesc) Tension headaches d) Migraine headaches
Ans: BCluster headaches
377
Medicare part A coverage includes:a) Limited care in a skilled nursing facilityb) Outpatient care with the primary care providerc) 120 days in a skilled nursing facilityd) Outpatient medication prescriptions
Ans: ALimited care in a skilled nursing facility
378
In severe eczema, patients tend to prefer _________ but providers should prescribe __________a) Ointment/lotionb) Cream/gelc) Lotion/ointmentd) Gel/cream
Ans: CPatients tend to prefer lotion because this form is soothing, easy to apply, and soaks in readily. However, severe eczema requires the highest potency with respect to both delivery and absorption; this is the ointment which delivers the greatest concentration of drug to the affected area.
379
The preferred pharmacologic management of recurrent cough in a 25 year old woman with acute uncomplicated bronchitis would most likely include:a) Antibiotic therapy to cover atypical pathogensb) An inhaled anticholinergicc) An inhaled corticosteroidd) A dextromethorphan based cough suppressant
Ans: BPatients with bronchitis have excessive secretions. an inhaled anticholinergic will reduce those secretions.
380
A 56-year-old marketing exec has various past blood pressure readings between 140-150 systolic and 80-100 diastolic over the last few months. During an office visit, you find his current BP is 142/88. This collective data confirms a diagnosis of HTN. Based on national guidelines and the patient's current BP, how would you classify his HTN todaya) Normalb) Stage Ic) Stage IId) Pre-Hypertension
Ans: B Stage IStage one is either a sustained elevation of systolic blood pressure (SBP) 140 - 159 mm Hg or a DBP 90-99Other stages of HTN are:normal
381
Criteria for "incident to" billing services include all of the following except:a) An integral part of the patient’s treatment courseb) Associated with an expensec) Of a type commonly furnished in an office or clinic rather than an institutional settingd) Normally rendered for a minimal fixed fee
Ans: DNormally rendered for a minimal fixed fee."Incident to" services are defined as those services that are furnished incident to professional services in the office or in a patient's home. To qualify as an "incident to" service, it must meet 4 criteria: the service is an integral part of the patient treatment course; it is commonly rendered without additional charge; it is of a type commonly furnished in a clinic or office (non institutional); and there is an expense for the service.
382
You tell a young woman that you want to prescribe oral contraceptives to treat her acne. She says that her previous treatment of topical antibiotics had some extremely unpleasant side-effects and asks what some of the negative side effects of this therapy are. Which of the following is a side effect specifically associated with oral contraceptives?a) Superficial itchingb) Generalized hyperpigmentationc) Mild swellingd) Redness to cheeks
Ans: BGeneralized hyperpigmentationbe careful....the OC is systemic and the other answers are local or topical complications....read the question and answers carefully
383
Patient presentation common to both anxiety and depression can include:a) Dry mouthb) Worthlessnessc) Sleep disorderd) Appetite disturbance
Ans: C Sleep disorderWhile anxiety and depression are distinctly different, there are several symptoms that are often found in both: sleep disorders, difficulty concentrating, irritability, fatigue, and psychomotor agitation are among them. Conversely, dry mouth is seen in anxiety but not depression; while worthlessness and appetite disturbances are seen in depression but not in anxiety
384
A patient is referred with a diagnosis of diabetes, hypertension, and CAD. He is on both insulin and a beta blocker. Assuming the patient will continue the beta blocker, it would be important to educate him on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient?a) Edemab) Tachycardiac) Palpitationsd) Sweating
Answer: D SweatingBeta-Blockers interestingly block the counter regulatory mechanisms that "warn" of hypoglycemia. The hypo--at least gives the victim some warning that one is coming by causing shakes and pounding pulse. Though this answer is "sweating", I would support that answer of Tachycardia however the lit supports that HR changes occur after sweating. Hard to say.
385
A fat caucasian, 43, comes to clinic for a check. While reviewing his hx, you see that he has DM2 and 2 previous readings of 140/90. Concerned, you check his BP again to get a reading of 142/94. You now consider the patient as hypertensive after the initiation of a thiazide diuretic. Which of the following is the best next step?a) Beta blockerb) Calcium channel blockerc) ACE inhibitord) Nitrates
Ans: CACE InhibitorsThe best choice is an ACE given the history of DM. Betablockers are contraindicated in patients with DM because they mask the normal physiologic body responses to hypoglycemia subjecting the patient to hypoglycemia without warning signs.
386
With nuptials ahead, Cassie wants to try a new type of birth control. She asks about Ortho-Evra. It does have a -2% failure rate and is easily reversible, which is especially important if Cassie decides to have a child. What is a disadvantage of Ortho-Evra you must inform Cassie about?a) Menstrual irregularitiesb) Delayed return of fertilityc) Irregular menstrual periodsd) Reduced effectiveness when used with certain antibiotics
Ans: D Reduced effectiveness when used with certain antibiotics
387
The management of choice for Polymyalgia rheumatica includes:a) Whirlpoolb) Prednisonec) Analgesicsd) Celebrex
Ans: B PrednisonePolymyalgia rheumatica is an inflammatory disorder involving pain and stiffness in the shoulders and usually the hip. Treatment includes the use of steroids for symptom management
388
A 17 year old female is suspected of having polycystic ovarian syndrome. In addition to testosterone, the most appropriate diagnostic test to order would be:a) BUN, Creatinine, electrolytes, and dehydroeipandrosterone (DHEA)b) CBC, BUN, Creatinine, and estronec) Fasting Blood sugar, CBC, BUN, and sex hormone binding globulind) Follicle-stimulating hormone (FSH), lutenizing hormone (LH), prolactin, and TSH.
Ans: Dd) Follicle-stimulating hormone (FSH), lutenizing hormone (LH), prolactin, and TSH are lab standards for the diagnosis and confirmation of PCOS. TSH is especially important to rule out thyroid disease as the cause of symptoms.
389
To reduce incidence of flushing when starting a patient on Niacin, the nurse practitioner should advise pretreatment with:a) Aspirinb) Hormone therapyc) An ACE inhibitord) Exercise
Ans: AAspirin
390
Samantha, 15, has been dealing with asthma since she was 4 years old. She is now showing signs of HTN. She asks your advice about management of the condition and expresses concerns about any prescription that may cause her to wheeze. With this concern in mind, which of the following should you NOT advise her to prescribe for her new condition?a) Beta blockerb) Calcium channel blockerc) Angiotensin converting enzyme inhibitorsd) Angiotensin II receptor blocker
Ans: A Beta Blocker = wheezingACE = cough
391
Which of the following findings is typically a sign of acute appendicitis:a) Periumbilical ecchymosisb) Rebound tenderness at McBurney’s Pointc) A Negative Rovsing’s signd) Pus and mucus in stool
Ans: B Rebound tenderness at McBurney's point.Periumbilical pain is where appy pain starts but there should not be bruising.
392
A 31 year old patient comes to clinic complaining of hearing loss but only in the right ear. When examining her, you notice some erosion on her eardrum in the middle ear. Which of the following is the most likely diagnosis and treatment?a) Serous OM; antibioticsb) Cholesteatoma; surgeryc) OE; Surgeryd) Cholesteatoma; antibiotics
Ans: B Cholesteatoma indicates a surgical referral
393
A newly pregnant 23 woman comes to clinic. She has been experiencing food cravings, including a desire to consume ice. You suspect a specific type of anemia. Which of the following findings would you most expect as a result?a) Low hemoglobin / high serum ferritinb) Low hemoglobin / normal ferritinc) High hemoglobin / high total iron binding capacityd) Low hemoglobin/high total iron binding capacity
Ans: D Low hemoglobin and High total iron binding capacity
394
A 22 year old man presents for hepatitis screening. He is without symptoms but needs the testing for a job in the foodservice industry. Lab results are as follows:Anti-HCV and HCV RNAHBsAG = positiveAnti HAV = negativeYou advise the patient that he:a) Has chronic Hep A, B, and Cb) Is immune to Hep A and B but has Hep Cc) Has chronic Hep B and C and needs immuniz against Hep Ad) Had Hep A in the past, is immune to Hep B and has chronic Hep C
Ans: CThe Anti HAV = negative means that he has not had Hep A and needs immunization.
395
A 34 year old female comes to clinic with a purplish bruise on her face. She was hurt playing football the day prior and she wants to make sure that she was not seriously injured. You note that the bruised area is not palpable. You can tell her that she has which type of minor bruising?a) Lacerationb) Hematomac) Abrasiond) Contusion
Ans: DContusion
396
Kathy is a 3 year old who has bronchopulmonary dysplasia. Kathy has already received her pneumococcal vaccine during her first year, and she is in need of more because of her condition. What is the next step that should be taken by the NP?a) Wait 3 years to administer the Pneumovax vaccineb) Wait at least 6 weeks to administer another dose of pneumococcal vaccinec) Do not administer the Pneumovax vaccined) Administer the Pneumovax now.
Ans: D Give it nowDue to her bronchopulmonary dysplasia, the NP should give 23PS (Pneumovax) right away. The 23PS vaccine can be given 24-59 months after the PCV13 (Prevnar) vaccines. The PCV13 vaccine is still active and should not be redosed.
397
For a 37 year old non-smoker with CAP who is otherwise well and has no reported medication allergies and no recent systemic antimicrobial use, you prescribe:a) Azithromycinb) Amoxicillinc) TMP-SMZd) Cefpodoxime
Ans: A AzithromycinThe primary treatment targets in CAP for an otherwise healthy patient are S pneumoniae and atypical pathogens. Atypicals are not responsive to beta-lactams such as amox and cefpodoxime. TMP-SMZ is no longer recommended for lower respiratory tract infections. A macrolide or doxy is indicated for these targets.
398
A 5 year old comes to the clinic with his parents who are concerned that their son frequently appears pale and tired. Lab tests reveal enlargement of both the spleen and liver. Which of the following diagnoses is NOT consistent with these findings?a) Leukemiab) Thalassemiac) Sickle Cell Diseased) Iron Deficiency Anemia
Ans: D Iron deficiency anemiaAll of the others present with possible Hepatosplenomegaly but Iron deficiency does not.
399
Your 57-year old male patient has awakened nightly for the last three weeks to severe throbbing pain around his left eye, particularly after drinking alcohol. The pain usually subsides within an hour. A physical exam reveals nothing too unusual, other than eye redness and rhinorrhea. Of the following, which would be the best way to manage the patient's condition:a) OTC analgesicsb) Clopidogrelc) Ticlopidined) Sumatriptan
Ans: DThis patient has cluster headaches. A typical prescription for this condition is a triptan. Analgesics and/or relaxation is the treatment for tension headaches rather than the more severe cluster HA. Ticlopidine and Clopidogrel are prescribed for prophylaxis of TIA which has different presentation.
400
Which of the following statements is true regarding screening adolescent and adult males for testicular cancer?a) Screening is not recommendedb) Screening by self-exam offers significant health benefitsc) Screening by clinician examination offers significant health benefitsd) Screening for testicular cancer should be conducted every 5 years starting at age 18 years.
Ans: AScreening is unlikely to offer meaningful health benefits given the very low incidence and high cure rate of even advanced testicular cancer. The risk of false positives, anxiety is high.
401
When a patient is seen by the NP, the visit can be charged to medicare using "incident to" billing. If the criteria for this type of visit are fulfilled, then anticipated reimbursement is at what percentage of the physician rate?a) 75%b) 80%c) 90%d) 100%
Ans: D 100%
402
You conduct an exam on an infant. During the exam, you flex the infant's knees in the supine position so that his ankles touch his buttox. You note that his knees are not level. What should you note this finding as?a) Barlow’s signb) Ortolani signc) Galeazzi signd) Genu varum
Ans: CGaleazzi kneezie
403
A 20 year old male presents with a 1 month history of a "bump on my testicle". He reports being sexually active, with frequent episodes of unprotected intercourse. with multiple partners. Which condition should be suspected?a) Cancer of the testiclesb) Torsion of the testesc) Acute epididymitisd) Gonorrhea
Ans: A Cancer of the testiclesTorsion and acute epididymitis are painful and present differently.Gonorrhea presents with a discharge and not a testicular bump
404
A 35 year old man presents with complaints of a strange swelling in his throat. He also mentions that he has lost about 12 pounds in the past several months. A Physical Exam reveals that he has swollen lymph nodes and there is involvement in the right axilla and right side of the neck. Based on the suspicion of lymphoma, which stage of disease does this presentation most likely represent?a) Stage IVb) Stage IIc) Stage Id) Stage III
Ans: B Stage II because it has not crossed the diaphragm
405
Reggie, a 30 year old male comes to clinic with a skin infection on his arm. It is as big as a grape. You note that the infection is pus-filled and originated around a hair follicle. Which of the following organisms is the most likely cause of this infection?a) Enterobacterb) E. colic) S. aureusd) S. pyogenes
Ans: CStaphylococcus aureusLikely pathogen is S. aureus. S. Pyogenes is the leading cause of outpatient cellulitis but is not typically associated with a furuncle
406
Paul, 36, was complaining of headaches during his routine exam last week. Over the course of just a few days, he has experienced palpitations, weakness, and tachycardia although he has no history of heart problems. Which of the following is NOT a common cause of what you suspect is Paul's condition?a) Folate deficiencyb) Hematopoietic neoplasmc) Malabsorption of folic acidd) Malabsorption of B12
Ans: BThis is not the presentation of Hematopoietic neoplasm. The presence of this neoplasm is the cause of leukemia which presents differently. All of these symptoms are suggestive of poor absorption of the B vitamins.
407
Your patient comes to clinic for outpatient management of his asthma. He is somewhat overweight and would like to take up running but is afraid to do so because of his symptoms. Which medication would you initially prescribe to this patient?a) A Short-acting beta2-agonistb) Anticholinergicsc) Long-acting beta2-agonistsd) Antileukotrienes
Ans: A First line treatment is a SABA
408
The primary complaint of the patient with BV is usually:a) Copious dischargeb) Painful intercoursec) Intense pruritusd) Profound vaginal odor
Ans: DProfound vaginal odor: Malodorous "fishy" copious discharge most evident after intercourse. Labs show clue cells. Cultures are not useful because G. vaginalis is part of the normal flora
409
You are evaluating 7 month old Marcy who babbles and smiles at her mother. The lack of which of the following signs would be most concerning at this stage in her development?a) Understands “no”b) Crawlingc) Pulling to standd) Sitting up with support
Ans: DIt would be a red flag if this child could not sit up with support at the age of 7 months
410
All 50 states require the reporting of which of these conditions in the newborn?a) PKUb) Galactosemiac) Hemoglobinemiasd) Congenital hypothyroidisme) Trisomy 21f) Trisomy 18
Ans: A, B, C, and DPKUGalactosemiaHemoglobinemias (SSA)Congenital hypothyroidism-do TSH and T4
411
When evaluating a patient being treated for seizure disorder with Phenytoin, which of the following findings would warrant immediate assessment of a phenytoin level?a) Headacheb) Gingival hyperplasiac) Alopeciad) Bradycardia
Ans: D BradycardiaPhenytoin is an anti-eipleptic med that when toxic, causes bradycardiaPhenytoin can cause headache and gingival hyperplasia, but these occur in therapeutic doses.Phenytoin is actually said to improve hair growth
412
Which of the following GI changes is associated with normal aging?a) Decreased production of gastric acidb) Increased salivationc) Decreased incidence of gallstonesd) Increased esophageal emptying
Ans: A Decreased production of gastric acid.In aging individuals, just about everything decreases but NOT the incidence of gallstones...that is just silly
413
The term "pervasive developmental disorders" refers to a group of conditions that involve delays in the development of many basic skills. Children with these conditions often are confused in their thinking and generally have problems understanding the world. Which of the following is a factor leading to this condition? a) An x-chromosome breakb) No known factorc) Lack of maternal infant bondingd) Failure of a parent to respond to their infant’s cues
Ans: B No known factor
414
You are evaluating a 40 year old patient suspected of having a PE. The patient complains of anxiety and cough. His STAT X-ray proves to be normal. The next test should be?a) Spirometryb) MRIc) Contrast Venogramd) Helical CT Pulmonary angiography
Ans: D Helical CT Pulmonary angiography
415
A 36 year old female comes to clinic after getting a positive result on a pregnancy test. She says that she has some dull pain in her lower abdomen, adding that the day before she experienced some spotting in her underwear. During the physical exam, the patient winces when you palpate the left side of her pelvis. Which of the following is the most likely cause of her complaints?a) Ectopic pregnancyb) Abruption placentac) Pyelonephritisd) Placenta Previa
Ans: A Ectopic pregnancy
416
Eclampsia is characterized by the findings of pregnancy-induced hypertension and preeclampsia combined with a seizure. There may also be prodromal symptoms such as severe headache plus either epigastric or right upper quad pain. Which of the following would NOT be employed in testing for eclampsia?a) A 24-hour urine for proteinb) Urine human chorionic gonadotropinc) Fetal surveillanced) Complete blood count
Ans: B This woman is already pregnant. NO need to reconfirm
417
A 40 year old male presents with a 2 week history of rectal pain and itching. He reports a past history of constipation and finding spots of bright red blood on toilet paper several times a week. Rectal exam reveals a tender, swollen, ovoid mass. The stool guaiac test is negative. Which of the following actions should the NP take?a) Refer the patient to a gastroenterologist for a malignancy workupb) Schedule a colonoscopy to rule out colon cancerc) Repeat the guaiac test three times and obtain a CBCd) Prescribe a bulk-forming agent and hydrocortisone suppositories
Ans: Dbulk forming agents (fiber) will help with the passage of stool, and hydrocortisone suppositories will help reduce the swelling and irritation for this patient with hemorrhoids.
418
Mandy comes to clinic with her 1.5 year old toddler Tamara. A former dancer, Mandy is distraught that her daughter may not be able to dance herself unless corrective measures are taken. Tamara is otherwise perfectly healthy. What should the NP advise the mother concerning her child's bowlegs?a) Braces for the legsb) Limited walkingc) Wait and continue to observed) Exercise and physical therapy
Ans: CWait and continue to observe. Genu Varum is not a concern until a child achieves the age of at least 2 years.
419
You are examining a new patient. During a review of the chart, you see that he is currently taking inhaled ipatropium bromide. This medication is for what conditions?a) Asthmab) TBc) Pneumoniad) Emphysema
Ans: D EmphysemaInhaled ipratropium bromide is commonly used in the rx of emphysema to prevent wheezing, difficulty breathing, chest tightness and cough
420
You see 46 year old Tammy in clinic for what she believes is bacterial vaginosis. She is familiar with this condition because she has been diagnosed with it before. She states she suspects this condition because she has been experiencing vaginal spotting. If this is the diagnosis, which should you expect to find in the patient's labs?a) Motile trichomonadsb) Clue cellsc) Pseudohyphaed) Gram-negative diplococci
Ans: B Clue cells
421
An 88 year old patient has had a gradual onset of hearing loss in the left ear. Exam shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, you would expect the Weber test to:a) Lateralize to the leftb) Lateralize to the rightc) Be inconclusived) Not lateralize
Ans: A Lateralize to the affected side with conductive hearing impairment.
422
While treating 29-year-old Sue for vulvovaginitis, you inquire about her sexual history. She states that she has been sexually active for about 10 years. There are many causes of vulvovaginitis, but only one is a sexually transmitted disease. Which of the following is it?a) GCb) Chancroidc) Chlamydiad) Trichomoniasis
Ans: D: Trichomoniasis
423
What is the purpose of Case Management:a) To reduce and contain risks, cut costs, and improve efficiency of a clinic or institutionb) To establish the qualification and mastery of skills of nurse practitionersc) To mobilize, monitor and control resources used by patients during illnessd) To improve the quality of health care through continuous monitoring and evaluation
Ans: C To mobilize, monitor, and control resources used by patients during illness. Case management is a comprehensive and systematic approach to providing quality health care that balances the quality and cost of resources used by the patient during the course of his illness. Risk management relates to ACertification relates to BContinuous Quality Improvement is D
424
A mom brings in her 2 month old girl because the baby's legs spasm, from time to time, and there is swelling in her hip area. You decide to conduct the Ortolani Test. Which of the following is the diagnostic use of this test?a) Dislocates the head of the femur from the hip jointb) Reduces hip joint dislocationc) Screens for unequal knee heightd) Screens for unequal leg length
Ans: B Reduces hip joint dislocationBarlow pops it outOrtolani clicks it back inknee height is GaleazziLeg length is Allis
425
After being laid off six months ago, your patient Martin, is doing everything he can to save money. He has on occasion, kept food past its expiration date rather than buy more. Now he comes to clinic and presents with signs of a bacterial infection. You decide to prescribe a beta-lactam antibiotic. Which of the following medications should you NOT prescribe?a) Penicillinb) Keflexc) Amoxicillind) Bactrim
Ans: D Bactrim is not a beta-lactamBeta-lactams are penicillins and select cephalosporins including Penn, Keflex, and amoxicillin
426
You see a 24 year old woman who states that she cannot receive the flu vaccine because she experiences a severe allergic reaction to eggs (respiratory distress, angioedema) requiring the use of epinephrine. The most appropriate response is:a) Recommending vaccination with Live Attenuated influenza vaccine (LAIV)b) Recommend vaccination with the recombinant influenza vaccine (RIV)c) No recommending the flu vaccine until allergy testing is completedd) Recommend the quadrivalent influenza vaccine every other year
Ans: BRecommend vaccination with recombinant influenza vaccine (RIV). RIV is egg-free and indicated for persons 18-49 who exhibit an allergic reaction to eggs.If the patient experiences egg related:Hives: use the IIV or RIV
427
A 54-year-old former pro athlete is being screened for HTN which runs in his family. Which of the following findings is NOT consistent with a diagnosis of significant HTN?a) Blurred visionb) An S4 heart soundc) A subparietal headached) Epistaxis
Ans: C HTN presents with an occipital headache.
428
Which diagnosis should be considered when there is a report of a "cold spot" on a thyroid scan?a) Malignancyb) Autoimmune diseasec) Iodine deficiencyd) Necrosis
Ans: AMalignancy
429
Your 42 year old patient presents with complaints of calf pain, numbness in his feet and hands and pain while at rest. Your patient's past medical history included T2DM, smoking for the past 20 years, and hyperlipidemia. Upon exam, you note shiny, hairless skin on his extremities, pallor and cyanosis in the extremities. Which of the following tests should you administer to diagnose his most likely condition?a) Serum lipid panelb) Blood glucosec) Arteriographyd) Exercise echocardiogram
Ans: CArteriography: the most likely diagnosis is Peripheral Vascular Disease with dependent rubor and elevational pallor
430
A CPT is an acronym for:a) Clinical practice templateb) Current procedural terminologyc) Current practice termsd) Clinical procedural testing
Ans: BCurrent Procedural terminologyThese codes were developed by the AMA and are used to describe and bill for medical, surgical, and diagnostic services.
431
Joanne is being treated for major depressive disorder. She started on Sertraline 2 weeks ago and presents today for her first follow-up visit. At this visit, the NP is assessing primarily for:a) Remission of symptomsb) Suicidal ideationc) Medication toleranced) Readiness for counseling
Ans: C Medication toleranceRemission of symptoms will not likely occur for 4-6 weeks. At 2 weeks, the NP should evaluate for how the patient is tolerating the medication.
432
Newly single Samantha, 45, comes to clinic worried about the unsightly toenails on her feet. Upon assessment, you see that her toenails are thick and yellow. Some nails are even crumbling and coming off at the nail bed. Which of the following antifungals would be the best to prescribe?a) Miconazoleb) Griseofulvinc) Metronidazoled) Itraconazole
Ans: D ItraconazoleThis patient has tinea unguium. Itraconazole is an oral antifungal used to treat this condition. Miconazole is a topical antifungal that is used predominantly for tinea pedis and tinea manuum but not tinea unguium. Griseofulvin is usually used to treat serious skin fungal infections such as tinea capitus. Metronidazole is an antibiotic used to treat moderate infections such as rosacea (facial redness).
433
A 51 year old patient comes to clinic complaining of moderate episodes of shortness of breath. He is producing copious amounts of sputum and his coughing fits have become disruptive to his work and sleep. These episodes have become so severe that theses are even beginning to cause marital problems. You suspect chronic bronchitis. Which of the following should you NOT prescribe to help him manage his condition?a) Streptomycinb) Discontinuation of smokingc) Avoidance of irritants or allergensd) Inhaled ipratropium bromide
Ans: A Streptomycin
434
Vomitus that is bilious suggests:a) Obstruction proximal to the pylorusb) Obstruction below the ampulla of Vaterc) Pyloric stenosisd) Peptic ulcer disease
Ans: BObstruction below the ampulla of Vater
435
Which of the following disorders occur more commonly in women at a ratio of 8:1 ?a) Hyperthyroidismb) Type 1 diabetes mellitusc) Type 2 diabetes mellitusd) Hypothyroidism
Ans: AHyperthyroidism
436
A patient is prescribed nitro to alleviate symptoms of chest discomfort that occurs especially during activity such as exercise but also sometimes at rest. The patient's echo is normal. for which of the following conditions is the patient most likely being treated?a) Prinzmetal’s anginab) Stable anginac) Chest wall paind) Myocardial infarction
Ans: A Prinzmetal's anginaPrinzmetal's angina: symptoms occur during exertion but also occur at rest. Stable angina is excluded because symptom only occur during exertion.
437
During an annual exam, you notice that a 12-year-old Lisa has breast enlargement without separate nipple contour. You tell her that she can expect which of the following in the next stage of her development?a) Sparse pale fine pubic hairb) Breast buds with areolar enlargementc) Receding areolas and retracting nipplesd) Onset of menses
Ans: D Onset of menses. Lisa is at Tanner III
438
In adults, infarction of the bony epiphysis of the femoral head, resulting from idiopathic avascular necrosis, is known as Chandler's disease. What is the name for this condition when it appears in children?a) Panner’s diseaseb) Legg-Calve-Perthes diseasec) Osgood Schlatter diseased) Haas’ disease
Ans: B Legg-Calve-Perthes Disease
439
Your patient has syphilis and presents to clinic with a rash on her palmar and plantar surfaces. She also complains of swollen lymph nodes and malaise. With which of the following clinical stages of syphilis would you diagnose her?a) Primaryb) Secondaryc) Latentd) Tertiary
Ans: B She has secondary syphilis
440
Marge visits clinic asking about a vaccination for her 13 year old daughter. Her daughter is about to enter high school. Marge, being realistic, is asking about the Gardasil vaccination for HPV. Marge asks how young someone can be for the vaccine. What can you tell her is the youngest age that a patient can receive the HPV vaccine?a) Age 9b) Age 11c) Age 16d) Age 18
Ans: AGardasil can be administered to patients as young as 9 years old.
441
Concerning the evaluation of a red blood cell folate level, which of the following is true:a) Potentially falsely lowered in a person with rapidly developing folate deficiencyb) Influenced by dietary intake over the 24-hour period prior to the testc) Remains stable throughout an individual RBC lifespand) Evaluates Vitamin C deficiency in a chronically ill person
Ans: CRemains stable: Folate is incorporated in erythrocyte during cell development and does not change over the life of the cell. It is not immediately influenced by diet.
442
When determining whether or not an individual is obese, which of the following factors would NOT be a factor?a) Serum calciumb) Decreased energy expenditurec) Diet high in simple carbohydratesd) Body mass index
Ans: A Serum calcium is not a factor in diagnosing obesity
443
A 23-year-old male presents with inflammation and itching of the penile head. He reports being in a long-term, monogamous relationship and states that he knows that he and his partner have been faithful for their entire relationship. Which of the following is the most likely diagnosis and treatment?a) Tinea cruris; topical antifungalb) Lichen planus: topical corticosteroidc) Candida balanitis; topical antifungald) Tinea capitis; oral antifungal
Answer: C Candida balanitis with topical antifungal
444
Which of the following would be appropriate alternative to erythromycin therapy in an 18 year old with Mycoplasma pneumoniae infection?a) Azithromycin (Zithromax)b) Cephalexin (Keflex)c) Amoxicillind) Clindamycin (Cleocin)
Ans: A AzithromycinA macrolide is the best choice for an atypical pathogen pneumonia. A floxacin is also appropriate especially for an elder since macrolides are associated with prolonged QT interval, but is not offered as an answer
445
A 67 year old patient with T2DM, CHF, and mild CAD is currently taking Digoxin, Hydrochlorothiazide, and atorvastatin. Which of the following is an accurate statement regarding this medication regimen? a) The glipizide will increase the risk of potassium depletionb) The digoxin will increase the risk of hypoglycemiac) The hydrochlorothiazide will predispose the patient to digoxin toxicityd) The atorvastatin will worsen the diabetes.
Ans: ?When Hydrochlorothiazide and digoxin are taken together, the NP must watch for potassium and Magnesium levels. Why does this cause Dig toxicity? Look it up
446
A new 27 year old female patient presents for a health maintenance exam as required by her employer. She says that she has had a heart murmur "all her life' and has been told that it is an innocent murmur. Anticipated findings include:a) A harsh late systolic snapb) A soft systolic murmur that disappears when in a standing positionc) A diastolic murmur best heard at the base of the heartd) A High-pitched murmur that is synchronous with the carotid pulse
Ans: BStills murmurs are systolic and change in tone with position changes
447
In severe eczema, patients tend to prefer ____ but providers should provide ____.a) Ointment/Lotionb) Cream/Gelc) Lotion/Ointmentd) Gel/cream
Ans: CPatients prefer lotion because it is soothing and easy to apply but providers prefer ointment because it has a greater concentration of drug delivered to the affected area.
448
A mother brings her 4 year old son to clinic. She is concerned about the blisters on his skin. Upon exam, you find erythema in the affected areas. When you look at him immuniz hx, you see that he had a vaccination four weeks ago and suspect that his rash is an adverse response to the vaccination. Which of the following vacs did he most likely last receive?a) Inactivated poliovirus vaccineb) Varicella vaccinec) Influenza vaccined) Pneumococcal vaccine
Ans: B Varicella Vaccine: a reaction of fever and mild rash can occur usually after the first dose but reactions are uncommon (1/20)
449
Peter comes to clinic after having stood for four straight days. He complains of intermittent numbness and tingling on his right foot up to his calf as well as pain in that calf. During exam, you have Peter walk on his heels and you note pain and weakness of the dorsiflexion mechanism of the great toe and foot. Which of the following is our most likely suspicion?a) L3-L4 disk pathologyb) L5-S1 Disk pathologyc) T5-T6 pathologyd) L4-L5 disk pathology
Ans: D L4-L5 disk pathology
450
A 66 yr old patient presents with bilateral otitis media with effusion and white patches in the mouth that do not rub off when wiped with a 4x4. The patient should be evaluated for: a) HIV infectionb) Myelodysplastic syndromec) Congenital lymphoproliferative diseased) Non-hodgkin’s lymphoma
Ans: AHIV infection
451
Nonviral microorganisms most frequently found to cause acute sinusitis are:a) Strep pneumoniae and H flub) Strep pneumoniae and staph aureusc) Staph aureus and pseudomonas aeruginosad) Strep pneumoniae and pseudomonas aeruginosa
Ans: A Streptococcus pneumoniae and Haemophilus influenzae are the most common non viral pathogens that cause acute sinusitis.
452
A 5 year old boy comes to clinic with his parents. They are concerned because he frequently appears pale and tired. Labs reveal enlargement of both the liver and spleen. Which of the following is NOT consistent with these findings?a) Leukemiab) Thalassemiac) Sickle cell diseased) Iron deficiency anemia
Ans: D Iron deficiency anemiaAlthough his pale and tired appearance is consistent with iron deficiency anemia, this condition is not accompanied by hepatosplenomegaly. SSA, Thalassemia, and leukemia ALL cause hepatosplenomegaly.
453
After a car accident, Renee, a 35-yr-old female needs surgery. You are called to coordinate her care. She has refused a blood transfusion because she is a Jehovah's Witness. However, her husband asks that you give her blood if needed. Of the following, which is the correct choice of action?a) Follow Renee’s husband’s orders and give the blood transfusionb) Ensure proper documentation and follow Renee’s refusal of a transfusionc) Since it is the only method of saving her life, follow the Hippocratic Oath to “do no harm” and give Renee a blood transfusiond) Wait until Renee loses consciousness and then, administer the transfusion with the husband’s request
Ans: B Ensure proper documentation and follow Renee's refusal of a transfusion
454
During a routine PAP smear, an overall healthy 29 year old female complains of mood swings and nausea. You suspect these may be side effects of her birth control. What type of birth control should you ask if she is using?a) Diaphragmb) Oral contraceptivesc) Implanond) NuvaRing
Ans: B oral contraceptives
455
Which drug is important in the symptom management and the prevention of complications in Kawasaki's disease?a) Aspirinb) Corticosteroidsc) Acetaminophend) Penicillin
Ans: AChildren with Kawasaki's disease present with a 5 day high fever. It is one of the few conditions where high dose aspirin for the purpose of reducing clotting. These kids need a cardiac referral for prolonged PR and QT intervals
456
You have been treating Bernie, 43, through his anemia which resulted from a poor diet. To treat Bernie, you will need to comprehensively understand the measurements regarding anemia. For the Mean Corpuscular Hemoglobin levels, normal readings are found between which min and max pictograms per cell?a) 17 and 20b) 21 and 25c) 26 and 34d) 35 and 39
Ans: C 26 and 34Mean corpuscular hemoglobin is defined as an expression of the average amount of hemoglobin contained in an individual RBC. The normal level is between 26 and 34 pg.
457
You are performing a newborn exam. You notice Brushfield spots in the baby's eyes. What will you also assess for?a) Hypertonicityb) Cherry red spot on the maculac) Heart murmurd) Cleft palate
Ans: Heart MurmurBrushfield spots occur in infants with Trisomy 21. Cardiac abnormalities are common in these children. Cherry red macula occurs in children with Tay Sach's disorder
458
All of the following are required Medicare terms and conditions for paying NP services except:a) The services are within the NP scope of practice as defined by state lawb) The services performed are those for which a physician would be able to bill Medicarec) The services are performed in collaboration with a physiciand) Separate charges are billed for NP services and facility charges
Ans: DSeparate charges are billed for NP services and facility chargesFor Medicare to pay:NP meets medicare qualification requirementsThe practice accepts Medicare paymentsServices performed are "Physician services"The services are performed in collaboration with the MDthe services are within the NP scope of practiceNo facility or other provider is paid or charges for the billed patient services (double billed)
459
There is concern at your clinic that some children with developmental delays are not being identified soon enough. You are examining a 6 year old male. Of the following, which is the best tool to identify risk for developmental delay in this child?a) Cognitive adaptive testb) Denver IIc) Ages and Stages Questionnaired) M-CHAT
Ans: B Denver II through age 6 years.
460
A 34 year old man is being evaluated for a potential diagnosis of a panic disorder. You would expect to find all of the following as part of his clinical presentation except:a) Report of chest pain during panic attackb) Concomitant thought disorderc) History of agoraphobiad) Peak symptoms approximately 10 minutes into the panic attack
Ans: B Concomitant thought disorderPanic attacks present with chest pain and symptoms peak about 10 minutes into the attack. There is frequently a history of agoraphobia but there is not the presence of thought disorders.
461
Which of the following is not a criterion for a level 4 office visit:a) At least 4 elements of HPI; + or – responses to at least 2 ROS questions, and at least 1 notation in past history, family or social history.b) At least 12 elements of physical examinationc) Medical decision-making of moderate complexityd) Patient must be seen by a physician at some point during the visit.
Ans: DThere is no requirement for the patient to be seen by a physician during a level four office visit. All of the rest are true and at least 2 of the three must be met.
462
Your patient comes in for a check. His past medical history indicates that his heart has an inability to contract, which results in decreased cardiac output, a condition for which he takes captopril. The patient now also presents with an irregular and rapid heartbeat. Which of the following pharmacologic options would treat the patient's new, and most likely condition?a) Enalaprilb) Benazeprilc) Thiazide diureticd) Anticoagulants
Ans: D AnticoagulantsThis patient has Atrial Fib and the treatment is anticoags
463
Among men with no symptoms of prostate cancer, the USPSTF recommends:a) Annual PSA based screening starting at age 40b) Biennial PSA based screening starting at age 45c) Annual PSA based screening beginning at age 50d) Against PSA based screening for prostate cancer
Ans: CAgainst PSA-based screening for prostate cancerGrade D recommendation suggests that there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. These recommendations apply to men with no symptoms of prostate cancer regardless of age, race, or family history.
464
A 30 year old female comes to clinic with a red and very swollen knee. She is in pain and struggles to walk. She says that she was playing hockey the day before and took a hit to her knee. She says the same thing happened a few months ago and that she already knows it is bursitis. Initially, she had been treated with a steroid injection. At most, how many additional steroid injections should she be allowed this year?a) 5b) 2c) 3d) 4
Ans: B2 MORE in this yearthree total but dumb shit me didn't see the "how many more" so the answer is 1 + 2 =3
465
A mom comes to the ED with a very ill 9 month old son. The baby is pale and he has a 3 day history of jelly like stools, vomiting, and inconsolable crying. On exam, the NP notes abdominal distention, a sausage-shaped mass in the RUQ, and blood in the child's rectum. Which of the following tests should you order to confirm the suspected diagnosis?a) X-Rayb) Abdominal USc) MRId) CT Scan
Ans: A X-rayThe findings point to intussusception and Radiography and a barium enema are the most definitive tools for confirmation. Barium might gunk up a possible surgical field, so an Xray would be my choice. Abd US are most useful in the diagnosis of solid organs of the abdomen such as the liver and pancreas. MRI and CT are more advanced diagnostic tools and not necessary to make this diagnosis
466
A mom brings her 2 month old girl because the baby's legs spasm from time to time, and there is swelling in her hip area. You decide to conduct the Ortolani test. Which of the following is the diagnostic use of this test?a) Dislocates the head of the femur from the hip jointb) Reduces hip joint dislocationc) Screens for unequal knee heightd) Screens for unequal leg length
Ans: B Ortolani maneuver reduces hip joint dislocation that is often caused when doing the Barlow test which pops the hip out. Barlow diagnoses hip dysplasia by popping the hip out of the joint. Allis is leg length and Galeazzi is knee height. Inequality suggests hip displacement
467
Which of the following is responsible for determining how the goals set forth by the Healthy People 2020 initiative are met?a) Patient safety organizationsb) State governmentsc) Communitiesd) Health insurance companies
Ans: C CommunitiesCommunities as well as individuals and organizations are responsible for determining how the goals of Health People 2020 are met.
468
A 59-year-old male is having a follow up evaluation 2 years after the successful completion of chemo for leukemia. He says taht he has been feeling run down and reports unexplained weight loss, pain below the ribs on his left side as well as night sweats. You examine him and determine that he also has a fever. You consider Chronic Myelogenous leukemia. Which of the following results is considered the hallmark of this disease?a) Non-circulating blast cells in the bone marrowb) Lymphocytosisc) Philadelphia chromosome in leukemic cellsd) Pancytopenia with circulating blasts.
Ans: C Philadelphia chromosome is hallmark in the diagnosis of CML
469
A 65-year old fashion designer has in recent months, noticed persistent, sharp, and painful spasms in her left cheek. These incidents occur primarily when she is applying makeup and do not occur on the other side of her face. She describes the pain as feeling like an "electric shock". Which of the following would be the least appropriate treatment for this condition:a) Anti-seizure drugsb) Tricyclic antidepressantsc) Calcium-channel blockersd) Muscle relaxants
Ans: CThe sharp, painful spasms occurring on one side of the face are classic presentation of trigeminal neuralgia and a calcium channel blocker (CCB) does not treat this condition. CCB are most often used to treat HTN. Anti-seizure meds, muscle relaxants, and TCAs are commonly prescribed to diminish or prevent future spasmodic episodes.
470
According to the ARIA guidelines and the JTForce on practice parameters for Rhinitis, first line therapy for patients with moderate to severe persistent allergic rhinitis symptoms is a(n):a) Antihistamineb) Mast cell stabilizerc) Intranasal corticosteroidd) Decongestant
Ans: C Intranasal corticosteroidAllergic rhinitis is a consequence of inappropriate release of inflammatory mediators. Proper management of allergic rhinitis must include a primary strategy for LT control of inflammatory mediators, and intranasal corticosteroids are identified to be superior in terms of clinical outcomes.
471
Which of the following best describes a II/VI heart murmur?a) Moderately loud; easily heardb) Barely audiblec) Audible but faintd) Loud; associated with a thrill
Ans: C Audible but faintIII is louder and IV has a thrill
472
A patient presents with a moderate cough and reports experiencing chest tightness as well. The NP notes that the patient has some difficulty breathing. Upon interview, the NP learns that the patient recently moved into a new apartment building that may have cockroaches. Which of the following is the patient most likely experiencing?a) Acute bronchitisb) Asthmac) Pneumoniad) Chronic Bronchitis
Ans: B Asthma
473
A 25-year-old male who just finished a four-day camping trip with his parents complains of having been abnormally hungry the past few months. The 6'1" man is especially concerned because his weight has dropped to 140 pounds as well. Lab results reveal two significant findings: hyperglycemia and ketonuria. What is the most likely diagnosis?a) Hyperthyroidismb) Hypothyroidismc) DM type 2d) DM type 1
Ans: D Diabetes Mellitus type 1
474
Alison comes in for a check-up. She knows "mama and Dada" and sits independently to play. She cannot yet walk or speak many other words but communicates by reaching and pointing. Ali recognizes you, her NP, from previous visits, and she smiles at seeing you. She sees the pen in your coat and reaches for it. What would you estimate Alison's age to be?a) 13-18 monthsb) 6-9 monthsc) 19-24 monthsd) 10-13 months
Ans: D 10-13 monthsSaying Mama and Dada, recognize people, and move purposefully to get desired objects suggest that Ali is 10-12 months. 19-24 months can walk up and down stairs6-9 months is babbling and newly sitting alone but responds to her name13-18 months has 4-10 word vocabulary and can scribble with a crayon, walk alone, and speak in long jabbering sentences.
475
Ty, a 17 year old amateur boxer, is rushed to the ED with a 40 hour history of abdominal pain. Despite the pain, he continued to train for an upcoming boxing match. Last night however, the pain became so severe that it forced him to stop. On exam, you note that there is right lower quadrant guarding with rebound tenderness, pain with his right thigh extension, and pain with rotation of his flexed right thigh. The patient says he has been experiencing nausea. Considering the length of time since the signs began, which of the following should the NP be most concerned about?a) High feverb) Perforationc) Peritonitisd) Appendiceal abscess
Ans: BPerforation
476
An 18 year old college student presents for an athletic physical. When asked about current medications, she mentions that she takes "some herb" she bought at the health food store for migraines and menstrual cramping. Which of the following herbal remedies has been commonly used for these conditions?a) Ephedrab) Echinaceac) Feverfewd) Ginkgo Biloba
Ans: C FeverfewEphedra is for appetite controlEchinacea is for immune strengthGinkgo Biloba is for enhanced memory
477
During a 12 month well child visit, the NP notices that the child is not walking independently. The mother is very concerned and insists that her other three children were all walking by the age of 1. The most appropriate action would be to:a) Tell the mother that while, on average, many children are walking by age 1, many children do so later; schedule a follow up appointment in 1-2 months to assess progressb) Reassure the mother that children with older siblings often do not start walking until later; schedule the next routine well child checkup in 3 monthsc) Counsel the mother that while there is no need to panic, this does represent a developmental delay and the child should see a pediatric orthopedic specialistd) Request a radiographic assessment of the spinal cord, pelvis, and femurs to rule out structural bony anomalies that frequently delay walking.
Ans: Tough call between A and BI would go with B because at the age of 12 months, normal visits are scheduled for every 3 months. This is not a dev. red flag so why ask for an extra office visit.What do you think?
478
Initial therapy for a 3-week old infant with uncomplicated symptoms of GI reflux disease includes which of the following?a) Prone position and rotate formulas in order to find one that causes less refluxb) Erect position and start pre-thickened formula in smaller amountsc) Semi-supine position and offer more ounces of formula less frequentlyd) Lateral position and start small amounts of solid food with formula
Ans: BErect position and start pre-thickened formula in smaller amounts
479
Carl, 38, has been diagnosed with hypothyroidism and was prescribed Levothyroxine 3 weeks ago. Today, he presents to clinic with weakness, fatigue, and puffy eyes. His lab findings show an elevated thyroid stimulating hormone level, decreased thyroxine, increased serum cholesterol, and hypoglycemia. Which of the following is the best action to take next concerning Carl's treatment?a) Change his medication to Methimazoleb) Continue his current medication regimen without changec) Increase the oral levothyroxine dosaged) Change his medication to propylthiouracil
Ans: CHe needs his levothyroxine dose increased by 25mcg because he is highly symptomatic for hypothyroidism.Methimazole is a medication used to decrease the production of thyroid in HYPERthyroidism
480
A 52 year old with a 40 pack year history of smoking had a 3-day hospitalization for the treatment of CAP. He is now being seen 2 days post hospital discharge. He is without fever, well hydrated, less short of breath, and feeling better. Chest auscultation reveals bilateral crackles. The NP considers ordering a chest X-ray:a) Todayb) In about 6 weeksc) In about 2 weeksd) In 3-5 days
Ans: B in 6 weeksThis patient is recovering. An X-ray is to evaluate for the presence of an underlying abnormality such as lung cancer that could have precipitated the case of acute pneumonia. It takes at least 6 weeks for complete radiographic resolution of the acute infectious process so that baseline structures can be visualized.
481
According to USPSTF, screening adults for depression should occur:a) Annuallyb) Immediately following significant life events (unemployment, loss, illness)c) When staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-upd) Only for patients with multiple risk factors for depression
Ans: CWhen staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up
482
Which of the following leukemia types represent 80% of acute leukemia in adults?a) Chronic myelogenous leukemiab) Chronic lymphocytic leukemiac) Acute non lymphocytic leukemiad) Acute lymphocytic leukemia
Ans: CAcute non-lymphocytic leukemiaBe careful. The question asks for "acute leukemia" two of the answers are "chronic"
483
During a routine PAP smear, 37 year old Angelica requests a birth control prescription and adamantly states that she does not want to conceive at her age. However, during your exam, you note that her blood pressure is at a prehypertensive level. Based on her medical status, which of the following is the safest and most effective birth control option for her?a) Ortho Evrab) ParaGardc) NuvaRingd) Natural family planning
Ans: B ParaGard
484
The NP is counseling a female patient who is trying to become pregnant. The patient should be encouraged to increase her intake of:a) Vitamin Cb) Folic Acidc) Irond) Vitamin E
Ans: B Folic acidFolic acid deficiency leads to neural tube defects
485
A 24 year old woman comes to clinic concerned that she has acquired a sexually transmitted disease. Her complaints include lower abdominal pain, painful intercourse, painful urination, and other symptoms consistent with gonorrhea. Of the following treatments, which one would be best for her?a) Doxycyclineb) Ceftriaxonec) Acyclovird) Podophyllin
Ans: B Ceftriaxone
486
A patient comes to clinic and says, "I feel so nervous that I think I am going out of my mind. I also can't stop shaking, and my heart races all the time". You learn that she smokes cigarettes, but the patient denies any previous health problems including HTN or diabetes. Of the choices, what would be the most reasonable diagnosis in this situation?a) Hashimoto’s Thyroiditisb) Grave’s Diseasec) Hypothalamic deficiency of Thyrotropin-releasing hormoned) Pituitary deficiency of thyroid stimulating hormone
Ans: BGrave's Disease: Hyperthyroid disorder
487
A new patient presents for a check up. He has no complaints but admits that he has been smoking 2 packs per day for 40 years. Spirometric assessment reveals an FEV1/FVC ratio of 67%. Which additional finding would be consistent with a diagnosis of chronic bronchitis:a) Markedly increased chest AP diameterb) Pleuritic chest painc) Excessive mucus productiond) FEV1 improving by 20% after albuterol treatment
Ans: C Excessive mucus productionFocus on the diagnosis of Bronchitisthe rest are COPD changes
488
Which of the following is the most accurate description of the Dubowitz tool?a) The Dubowitz tool is a gestational assessment tool that evaluates an infant’s reflexes, including Moro, tonic neck, grasping, rooting, and sucking.b) The Dubowitz tool is used to estimate gestational age by examining the physical characteristics and neuromuscular development of a newborn.c) The Dubowitz tool is used to assess the physical condition of a newborn at birth.d) The criteria evaluated with the Dubowitz tool are influenced by labor and birth, therefore, a second exam may be needed to pick up any changes in a newborn.
Ans: BThe Dubowitz tool is used to estimate gestational age by examining the physical characteristics and neuromuscular development of a newborn.
489
A Patient presents for evaluation of a fever. She reports that 3 days ago, she went to the urgent care and was diagnosed with acute bacterial rhinosinusitis (ABRS). She was given a prescription for antibiotics which she is taking as ordered, but is concerned because she has a fever today. Which of the following finding suggests a serious complication of ABRS?a) Tender preauricular lymph nodesb) Foul tasting post nasal dripc) Facial tendernessd) Eyelid erythema and edema
Ans: D Eyelid erythema and edemaABRS is an infection of the sinuses and parasinuses usually following a viral URI.
490
A 15 week old infant presents with a fever of 100.5F, bilateral erythematous TMs. The infant is alert with excellent skin turgor, no evidence of difficulty breathing, acknowledges her mother's face, and is wearing a wet diaper. Her parents report that she is vigorously nursing every 3 hours without vomiting or excessive stooling. The appropriate management would be to:a) Counsel the mother to observe for 72 hours and return to clinic if there is no improvementb) Start topical therapy with otic antibiotic dropsc) Initiate a sepsis workupd) Begin a systemic antibiotic regimen
Ans: CInitiate antibiotics because of the fever.I think I would have given this kid tylenol and watched him.....what do you think?
491
A mom brings in her 10 year old son who has begun eating and drinking excessively but not gaining weight. During the interview, the NP learns that Wendell has also been urinating excessively. Based on these symptoms, the NP suspects a diagnosis of T1DM which is confirmed by fasting blood tests. What should the NP do first?a) Check for the presence of ketones and then give 70/30 mix of insulinb) Assess hemoglobin count and then give 60/40 mix of insulinc) Weigh the patient and then give 70/30 mix of insulind) Refer the patient to an endocrinologist
Ans: Dpediatric T1DM need to be managed by a specialist and establishing treatment for new pedi T1DM is outside the scope of NP primary care practice.
492
The parent of a 13 year old diagnosed with seizure disorder call to report that the child is exhibiting symptoms of a cold but has no fever. The NP should advise the parent that the development of fever may:a) Have no effect on the seizure thresholdb) Lower the seizure thresholdc) Make the seizure medication less effectived) Increase the seizure threshold
Ans: B Lower the seizure thresholdFevers make this patient MORE susceptible to having a seizure: therefore the threshold is LOWERED
493
A woman in her 28th week of pregnancy comes to clinic with frequent headaches, which she feels are causing vision problems. You also observe that her weight gain, 15 pounds in 30 days, is sudden and substantial. Her symptoms are most consistent with which of the following conditions?a) Hemolysis, elevated liver enzymes, and low platelet syndromeb) Pregnancy induced hypertensionc) Preeclampsiad) Eclampsia
Ans: Cthese symptoms are most consistent with Preeclampsia
494
Lily, 45 complains of some recent findings that she suspects may be caused by a sexually transmitted disease. She has been urinating frequently and painfully. There has been pain and swelling in her labia and most notably, some green-colored discharge. Which of the following is the best treatment to administer to Lily?a) Ceftriaxoneb) Cervarixc) Valacyclovird) Azithromycin
Ans: ALily most probably has Gonorrhea. The treatment for GC is Ceftriaxone.Cervarix is a vaccine given at age 9-11 for prevention of HPVValcyclovir is given for HerpesAzithromycin is given for the treatment of Chlamydia
495
Of the following, which is a necessary guideline for interviewing adolescents in a clinical setting?a) Have the parents and the adolescent in your office for a meetingb) Having the adolescent fill out a questionnaire to save timec) Advising the adolescent that his or her parents are privy to what was discussed in the interviewd) Excluding the parents from some of the interview with the adolescent
Ans: D Excluding the parents from some of the interview with the adolescent
496
For patients with inadequate iron intake, most of what composes a patient's blood will be lower than normal in lab findings. What aspect of blood however may actually be found to increase?a) Red cell distributionb) Mean corpuscular hemoglobin concentrationc) Mean corpuscular volumed) Serum iron
Ans: A RDW
497
Unless contraindicated or other concomitant conditions present, antiretroviral therapy should be initiated in all patients with documented HIV infection and CD4 counts of:a) 250c)
Ans: DThe CDC recommends that all patients should be on Active Antiretroviral Therapy (AART by the time the CD4 reaches 350
498
Alison, 15, has gone from having many close friends at school to being virtually friendless. She does not talk to anyone in the family about it. Her school performance, once stellar, has also declined as she faces difficulty organizing her homework assignments. Upon interview, the NP learns that Kim is aware of the changes but does not believe it to be a problem. She seems only concerned with a boy at school, for whom she has strong feelings. Of these behaviors, which one is NOT considered a developmental warning sign?a) Poor adjustment to schoolb) Difficulty accepting failurec) Apparent personality changed) Withdrawal from friends and family
Answer: A Poor adjustment to school
499
A couple brings their 3 year old boy to you for evaluation because he has been irritable and feverish. Three days prior, they brought him in and were sent home with instructions to give the child acetaminophen. However, his temperature has remained at or slightly above 102F. The parents are also worried about skin rashes found on the child's trunk and his reddened palms and soles, and point out how red the child's eyes are "from all the crying". Your exam reveals a whitish coat on the child's tongue and very chapped lips. You also see that the skin of the palms and soles is starting to peel. Which of the following is the most appropriate treatment plan for this child's likely condition?a) Oral Penicillin; aspirinb) Admit to hospital for IV gamma globulin and high dose aspirinc) Acyclovir and acetaminophend) Corticosteroids and ibuprofen
Ans: B Admit to the hospital for IV gamma globulin and high dose aspirin. This child has Kawasaki's disease
500
You are seeing a 4 year boy who appears pale and listless. His parents have brought him in with a two day history of fever and painful limbs. Upon exam, you notice petechiae on the legs and abdomen as well as a bulging and immobile tympanic membrane. The painful limbs appear to be due to joint pains. After the exam, what should be your next step?a) Start the patient on antibioticsb) Order a complete blood countc) Encourage fluids and start the patient on NSAIDsd) Order a prothrombin time and partial thromboplastin time test
Ans: BWe need more information before we choose a treatment.
