Final !!!!! Flashcards
serum iron measures iron in the
circulation
serum ferritin measures what
iron in storage
Total iron binding capacity (TIBC)
measures iron in storage
Hodgkins lymphoma presents with what type of lymph nodes
nontender swollen
normal lead levels are less than what
5
preauricular lymph node is located
in front of the ear
Tonsillar lymph node is located
at the angle of the mandible
Patients who have been dlagnosed with malignant melanoma should be taught that:
* A - raised moles have the highest rate of malignancy.
* B - wearing SPF 15 sunscreen will prevent further lesions.
* c - patients with a history of malignant melanoma should perform monthly skin self-examinations.
* D - a topical antineoplastic agent is the treatment of choice.
patients with a history of malignant melanoma should perform monthly skin self-examinations.
An obese 43-year-old patient has experienced recurrent superficial fungal skin Infections over the past 2 years. Today, the patient presents with intertriginous Candida infection. The patient’s skin is macerated from frequent rubbing and scratching. The plan of care for this patient should include:
* A - recommended screening for diabetes mellitus and HIV infection.
* B - the application of cornstarch or body powder to finger webs, toe webs, and skinfolds to absorb moisture.
* c - the liberal application of a moisturizing cream to the affected areas.
* D - application of a topical antiblotic for 7 to 10 days.
A - recommended screening for diabetes mellitus and HIV infection.
What prophylaxis medication is recommended for a patient who is younger than 35 years and has a positive PPD test?
* A - Tenofovir and emtricitabine (Truvada)
* B - Bacille Calmette-Guerin (BCG)
C - Pyrazinamide (Tebrazid)
D - Isoniazid (INH)
Isoniazid (INH)
Which oral hypoglycemic agent would be safest for a patient in whom hypoglycemia is a major concern?
* A - Tolbutamide (Orinase)
* B - Glipizide (Glucotrol XL)
* C - Metformin (Glucophage -XR)
* D - Glimepiride (Amaryl)
- Metformin (Glucophage -XR)
The caregiver for a 75-year-old patient reports that the patient has trouble falling asleep and roams the house at night. The patient has fallen twice. According to the Beers Criteria, which of the following medications would be the most effective and safe to treat insomnia in an older adult patient?
* A - Doxepin (Silenor)
* B - Diphenhydramine (Benadryl)
O c - Lorazepam (Ativan)
* D - Zolpidem (Ambien)
Doxepin (Silenor)
Trophic changes assoclated with chronic arterial insufficiency include all of the following lower extremity characteristics EXCEPT:
* A - dry ulcerations with round smooth edges.
* B - edema and weeping ulcerations.
* c - sparse or absent hair.
* D - pronounced malleoli and MTP Joints.
edema and weeping ulcerations.
Ideally, antepartum care should begin:
* A - as soon as the pregnancy is Identified.
* B - at 6 weeks’ gestation.
C - with preconception counseling.
D - in the first trimester.
with preconception counseling.
Which of the following is a medication or medication class that does NOT have dizziness or vertigo as potential side effects?
* A - Aminoglycoside antibiotics
* B - High-dose salloylates
* c - Central-acting antihypertensives
D - Meclizine (Antivert)
Meclizine (Antivert)
The nurse practitioner wants to assess a patient’s cerebellar function. Which of the following clinical tests provide information on whether this functioning is intact?
* A - Kinesthesia assessment
* B - DIx-Hallpike maneuver.
* C - Tandem walking test
* D - Graphesthesia testing
Tandem walking test
Criteria for the diagnosis of Alzheimer’s disease include:
* A - cerebral atrophy documented by CT scan.
B - Impaired fine motor sklls.
- insidious, progressive decline in cognitive functions.
D - speech Impediments.
insidious, progressive decline in cognitive functions.
A patient presents with symptoms that lead the nurse practitioner to suspect perimenopause. Findings may include:
A - normal to high follicle-stimulating hormone (FSH) level and lengthening of the intermenstrual interval.
* B - low follicle-stimulating hormone (FSH) level and shortened intervals in between menses.
* C - elevated human chorionic gonadotropin (hCG) level and vasomotor symptoms.
* D - low human chorionic gonadotropin (hCG) level and breast tenderness.
A - normal to high follicle-stimulating hormone (FSH) level and lengthening of the intermenstrual interval.
A 45-year-old female in good health reports “pink-tinged” urine. Urinalysis demonstrates alkaline urine that is positive for nitrites and leukocyte esterase. The most likely diagnosis is:
* A - renal calcull.
* B - Interstitial cystitis.
* c - bladder neoplasm.
D - urinary tract infection.
urinary tract infection.
Swan neck and boutonniere deformitles are typical clinical findings in the later presentation of:
* A - systemic lupus erythematosus.
* B - rheumatold arthritis.
* c - Turner’s syndrome.
* D - osteoarthritls.
rheumatold arthritis.
Which of the following clinical findings is consistent with a diagnosis of hypoparathyroldism?
* A - Headaches and diplopla
B - Positive Chostek’s sign
* C - Polyuria with hypercalciuria
* D - Hypotonic deep tendon reflexes
Positive Chostek’s sign
A 2-month-old Infant presents with a history of elevated temperature for the past 8 hours despite the administration of acetaminophen. The infant is ill-appearing, but has nonspecific symptoms. The most appropriate intervention by the nurse practitioner Is to:
* A - prescribe an oral broad-spectrum antimicrobial.
* B - hospitalize the infant for sepsis workup and evaluation.
* C - recommend that the parent alternate acetaminophen with Ibuprofen and return to the clinic for reevaluation the next day.
* D - order a CBC, test for respiratory syncytial virus, and advise the parents to continue acetaminophen.
B - hospitalize the infant for sepsis workup and evaluation.
A - refer the infant to a pediatric dermatologist.
B - refer the Infant to a peddlatric geneticist.
C inform the guardians that these lesions are precursors to melanomas.
D - inform the guardians that surgical removal of the lesions will be necessary as the infant grows.
refer the Infant to a peddlatric geneticist.
The LEAST likely physical finding in a 2-week-old infant diagnosed with tetralogy of Fallot Is:
A - a systolic ejection murmur that is best heard at the upper left sternal boarder.
B - an absence of pedal pulses.
O c - cyanotic episodes.
D - central cyanosis.
B - an absence of pedal pulses.
A adolescent is sent home from school due to a mucopurulent discharge from the eye. What is the most appropriate intervention for the nurse practitioner to suggest?
* A - Cromolyn sodium (Opticrom, Nalcrom) ophthalmic solution for 4 days
* B - Doxycycline (Vibramycin) orally for 10 days
C - Bacitracin/polymyxin (Polysporin) ophthalmic solution for 7 to 10 days
D - No pharmacologic intervention
Bacitracin/polymyxin (Polysporin) ophthalmic solution for 7 to 10 days
Common symptoms of focal brain ischemia without infarction include:
* A - nausea and vomiting, unequal pupils, loss of consciousness, dizziness.
* B - weakness in an extremity, abruptly slurred speech, partial loss of vision, and sudden gait changes.
* c - headache and visual symptoms such as bright spots or sparkles crossing the visual fleld.
* D - isolated ataxia, vertigo, generalized weakness, and lightheadedness.
weakness in an extremity, abruptly slurred speech, partial loss of vision, and sudden gait changes.
A patient presents with testicular pain and swelling on the right side. In determining the differential diagnosis for a patient with scrotal pain, the nurse practitioner elicits a cremasterle reflex. Epididymitis should be considered if the patient’s cremasteric reflex Is:
* A - positive on the left side.
* B - absent on the left side.
* C - positive on the right side.
* D - absent on the right side.
positive on the right side.
A characteristic of dellrium that is typically absent In dementia ISa
* A - acute onset of temporary confusion.
* B - Irritability and depression.
* c - loss of language skills.
* D - long-term memory gaps and confabulation.
acute onset of temporary confusion.
An 18-year-old nonpregnant patent has Irregular menstrual cycles that vary in volume and duration. What should be included in the differential diagnosis?
A - Adenomyosis
* B - Uterine lelomyoma
* C - Polycystic ovarian syndrome
* D - Endometrial polyp
Polycystic ovarian syndrome
Which lymph node characteristics should raise concern if palpated by the examiner?
O A - Enlarged and mobile
* B - Tender and 0.5 cm in diameter
* C - Firm and nontender
D - Warm and 1.0 cm
Firm and nontender
When auscultating the heart of a patient with chronic emphysema, the nurse practitioner hears a murmur over the fourth and fifth intercostal spaces along the left sternal edge. The nurse practitioner suspects:
* A - tricuspid regurgitation.
* B - mitral regurgitation.
*c- aortic regurgitation.
* D - pulmonic regurgitation.
- mitral regurgitation.
A patient reports waking frequently each night with a sensation of bladder fullness but being unable to make it to the bathroom without involuntarily voiding. This type of urinary incontinence is termed:
* A - overflow Incontinence.
* B - stress incontinence.
* c - functional Incontinence.
* D - urge Incontinence.
urge Incontinence.
A patient seeks advice from the nurse practitioner about becoming pregnant. The patient Is currently taking an oral contraceptive. The patlent has a history of hydatidiform molar pregnancy 2 years ago with uterine evacuation, but no need for chemotherapy. An appropriate plan of care for this patient at this time includes:
* A - delaying pregnancy for 1 more year.
B - measuring the serum chorionic gonadotropin level.
* c - discontinuing oral contraceptives.
* D - recommending permanent sterilization.
measuring the serum chorionic gonadotropin level.
Which of the following adolescents has risk factors that have been associated with high-risk sexual behaviors?
* A - A 14-year-old patient with early development of secondary sex characteristics, living In an urban area
* B - A 13-year-old patient with lower socioeconomic status, alcohol use, and a single-parent household
* c - A 16-year-old patient who is in a relationship with another student
* D - A 15-year-old patient who has had exposure to sex education
Information at school
- A 13-year-old patient with lower socioeconomic status, alcohol use, and a single-parent household
A healthy 4-week-old Infant has experienced continuous ipsilateral eye tearing for the past 3 days. On exam, no evidence of purulence, erythema, or swelling is present. The most appropriate recommendation by the NP is:
* A - regular nasolacrimal duct massage.
* 8 - an ophthalmic antibacterial agent.
* c - an ophthalmic steroid combination.
* D - a referral to a pediatric ophthalmologist.
regular nasolacrimal duct massage.
According to Erikson, the developmental task of the older adult is:
* A - intimacy vs. isolation.
* B - ego integrity vs. despair.
* C - generativity vs. stagnation.
* D - initlative vs. gullt.
ego integrity vs. despair.
When documenting the intensity of heart murmurs, the nurse practitioner knows that the intensity depends on:
* A - when the murmur is best heard during the cardiac cycle.
* B - where the murmur is best heard the loudest.
* C - the volume of blood flow across the valve and the pressure gradient across which the blood flow occurs.
* D - the frequency and quality of the murmur and whether the heart sound radiates or not.
the volume of blood flow across the valve and the pressure gradient across which the blood flow occurs.
Which of the following statements about asymptomatic bacteriuria (ABU) is true?
* A - High-risk patients should be screened perlodically for ABU.
OB - ABU may be caused by increased uropathogens in the postmenopausal vagina and introitus.
O C Untreated ABU Increases morbidity and mortality.
QD - Antibiotic treatment of ABU reduces the frequency
ABU may be caused by increased uropathogens in the postmenopausal vagina and introitus.
Which case of epistaxis is the most concerning?
* A - A child younger than 2 years
* B - An 8-year-old child with a history of allergies
* C - A child with fresh clots in one naris
* D - A teenager who uses a nasal decongestant
A child younger than 2 years
The nurse practitioner diagnoses epididymitis in a 24-vear-old sexually active patient. The empirical antibiotic treatment of choice for this patient is:
* A - oral ciprofloxacin (Cipro).
* B - oral doxycycline (Vibramycin) plus intramuscular ceftriaxone.
* C - oral trimethoprim-sulfarethoxazole (Bactrim).
* D - intramuscular penicillin.
B - oral doxycycline (Vibramycin) plus intramuscular ceftriaxone.
An early indication of diabetic nephropathy is elevated:
A - serum creatinine.
O, B - serum albumin.
* c - urinary microalbumin.
* D - urinary protein.
urinary microalbumin.
Which of the following is LEAST likely to contribute to vitamin B12 deficiency and pernicious anemia?
* A - Administration of proton pump inhibitors
B - Hellcobacter pylori infection
C - Strict vegan diet
D - Chronic laxative use
Chronic laxative use
When considering a diagnosis of hypoperathyroldism, diagnostic studies should
O A - serum magnesium and a complete blood count.
* B - vitamin D and thyroid- stimulating hormone measurement.
c - total calcium levels with total protein or albumin levels.
* D - serum phosphorus and sodium levels.
total calcium levels with total protein or albumin levels.
An 8-year-old female presents with severe injuries that are inconsistent with the explanation given by the child’s caregiver. Upon further questioning, the caregiver states that the child’s other guardian caused the injuries. Once the child’s condition Is stabilized, the nurse practitioner should:
* A - report the incident to local child protection authorities.
* B - Isolate the child from all caregivers until authoritles arrive.
* C - ask whether the guardian who is present has also been abused.
* D - separate the guardian from the child and question the child alone.
A - report the incident to local child protection authorities.
Which of the following screening scenarios is appropriate when screening a patient for diabetes mellitus?
* A - Screen all adults who are physically Inactive and have a body mass index >25 kg/m2 using a fasting serum glucose.
* B - Screen a 35-year-old patlent with dizziness using a hemoglobin
A1C.
* c - Screen a 28-year-old nonpregnant patient with a family history of gestational diabetes using an oral glucose tolerance test.
D - Screen a 40-year-old patient with a history of alcohol abuse and three cousins with Type 2 diabetes mellitus using a urine glucose test.
A - Screen all adults who are physically Inactive and have a body mass index >25 kg/m2 using a fasting serum glucose
A patient presents with fluid in the scrotum. The patient reports that the size of the scrotum does not fluctuate during the course of a day. A likely historical finding is:
O A - recent traumatic injury.
* B - history of testicular torsion.
* c - recent urinary tract infection.
* D - frequent nocturia.
recent traumatic injury.
A 3-year-old child presents with fever, anemia, and a palpable mass in the right upper quadrant of the abdomen. During the abdominal examination, the NP Identifies mild pain on palpation. A urine specimen shows hematurla. The child’s body temperature is 100*F. The most likely diagnosis is:
O A - urinary tract infection (UTI).
* B - pediatric functional abdominal pain.
* c - a Wilms tumor.
* D - vesicoureteral reflux.
a Wilms tumor.
The goals of treatment for patients with alcohol dependence syndrome are:
* A - reduction in withdrawal symptoms and reduction in desire for alcohol.
* B - psychotherapeutic and pharmacologic interventions to decrease desire for, and the effects of, alcohol.
* C - abstinence or reduction in use, relapse prevention, and rehabilitation.
* D - improved social and vocational functioning.
abstinence or reduction in use, relapse prevention, and rehabilitation.
During an ophthalmic examination of a 3-week-old Infant, the NP found that the red reflex was present and clear in the left eye but was absent in the right eye. The remainder of the exam was unremarkable. This finding is MOST suggestive of:
* A - primary congenital glaucoma.
* B - a unilateral congenital cataract.
* c - the presence of an ocular foreign object In the right eye.
* D - a unilateral corneal abrasion.
a unilateral congenital cataract.
Which of the following is an extraintestinal condition commonly assoclated with ulcerative colitis?
O A - Bile duct carcinoma
* B - Retinopathy
© C Liver cirrhosis
O D - Fatty liver disease
fatty liver
An adult patient with diabetes has perlorbital cellulitis secondary to a sinus Infection. What course of action should the nurse practitioner take?
* A - Dilate the eye to assess for increased intracular pressure.
* B - Refer the patient to an ophthalmologist.
* C - Initiate amoxicillin clavulanate (Augmentin) 875 mg orally twice a day for 14 days.
* D - Have the patient transported to the emergency department.
Have the patient transported to the emergency department.
Which of the following is true about cognitive abilities in older adults?
* A - The most significant decline in cognition occurs in the sixth decade.
* B - Skills training and motivational incentives have no effect on memory.
* c - Older adults perform poorly In comparison to young adults on tests of verbal skills.
* D - Apprehension
The most significant decline in cognition occurs in the sixth decade.
To open an independently owned and operated nurse practitioner clinic, It is necessary to:
* A - be in a state with full practice authority for NPs.
O B - have a clean practice record (no malpractice claims).
* C - have the skill and confidence to pursue business ownership.
be in a state with full practice authority for NPs.
Which of the following is not included In the Beers Criterla as a category for the safe administration of medication in older adults?
* A - Potentially Inappropriate medications for older/frall adults
* B - Specific prescribing guidelines for older/frail adults
* c - Medication combinations that may lead to harmful interactions
* D - Medications to avold or alter dosing in the presence of poor renal function
Specific prescribing guidelines for older/frail adults
The physical exam findings that are most consistent with a diagnosis of benign prostatic hyperplasia (BPH), as detected on digital palpation, are:
A - enlarged, symmetrical, semi-firm, and nontender prostate gland.
* B - enlarged, symmetrical, boggy, and exquisitely tender prostate gland.
* c - asymmetrical and nodular prostate gland.
* D - exquisitely tender prostate gland with absence of median sulcus.
enlarged, symmetrical, semi-firm, and nontender prostate gland.
When assessing heart murmurs, it is important to document the timing of the murmur. The nurse practitioner would document a murmur as diastolic if the murmur were audible:
* A - with S1 and extends up to S2.
O B - after S1 and obscures S2.
* c- after S1 and ends before S2.
* D - after S2 and ends before S1.
Diastolic: audible with or after S2 and ends before S1
Which of the following is the most common presenting sign of substance abuse in adolescents?
O A - Poor school performance
* B - The development of nightmares
* c - Recurring complaints of head and stomach pain
D - Changes in behavior
Changes in behavior
During which developmental stage does the highest risk for development of testicular tumors occur?
O A - Preadolescence
* B - Adolescence through early adulthood
* c - Midlife, ages 40 to 60 years
* D - 65 years and older
adolescence through early adulthood
Symptoms of moderate persistent asthma are most likely to be effectively managed with dally dosing of:
* A - an oral leukotriene receptor antagonist and glucocorticoids.
* B - short- and long-acting bronchodilators.
* C - inhaled corticosteroids and long-acting bronchodilators.
* D - oral steroids and short-acting bronchodilators.
inhaled corticosteroids and long-acting bronchodilators.
An 8-year-old child presents to the health clinic for evaluation of an acute onset of severe sore throat. The patient exhibits tachypnea and has a respiratory rate of 34 breaths/minute. The child’s history is positive for fever and pharyngitis for the past 2 days. The most likely diagnosis is:
* A - mononucleosis.
* B - peritonsillar abscess.
* c - respiratory syncytial virus (RSV).
* D - epiglottitis.
epiglottitis.
A patient states that their elbow aches and burns with activities such as hand shaking or using a screw driver. The pain increases with resisted wrist extension, with the wrist radially deviated and pronated, and with the elbow extended. The most likely diagnosis Is:
O A - radial tunnel syndrome,
OB - ulnar collateral ligament sprain.
C - olecranon bursitis.
D - lateral epicondylitis.
lateral epicondylitis.
Which diabetes complications result from hyperglycemia? 1. Retinopathy 2.
Glaucoma 3. Resistant hypertension 4. Accelerated atherogenesis
0 A - 1,2
0 B - 2,3
0 c-1,4
0 D -2,4
1 and 4
At a routine visit, the examination findings for a 1-month-old infant are unremarkable except for three medium-brown macular lesions on the upper back and the right side of the chest. The lesions appear to have smooth edges and range in size from 0.2 to 0.5 cm in diameter. The nurse practitioner suspects:
* A - neurofibromatosis.
* B - café au lait spots.
* c - dermal melanocytosis (formerly referred to as *Mongolian spots”).
* D - melanoma.
café au lait spots.
Café au lait spots occur on the trunk; borders may be smooth or irregular
Range in size from 0.2 to 4 cm in diameter
The initial step in the management of peptic ulcer disease (PUD):
* A - Is to determine if complications associated with the peptic ulcer are present.
* B - Is to establish the underlying etiology of the peptic ulcer, which will direct treatment.
C - is almed at diminishing prostaglandin synthesis, to allow healing of the stomach mucosa.
* D - is to Instruct the patient In a reflux-reducing diet and the
Is to establish the underlying etiology of the peptic ulcer, which will direct treatment.
Appropriate nutritional guldance for the pregnant patient is to:
* A - maintain usual caloric intake and add a daily multivitamin.
* B - Increase caloric intake by 300 cal/day and add iron and folic acid supplementation.
* c - Increase daily calories by 500 cal/day and add a dally multivitamin.
* D - if the dally diet is nutritious and well-balanced, vitamin supplementation is not necessary,
Increase caloric intake by 300 cal/day and add iron and folic acid supplementation.
A 48-year-old female reports insomnia, night sweats, feeling intensely hot, emotional lability, extreme nervousness, and impatience. The LEAST likely cause of her symptoms is:
* A - thyrotoxicosis.
* B - menopausal vasomotor Instability.
* c - alcohol or other drug withdrawal.
* D - new-onset Type 2 diabetes mellitus.
new-onset Type 2 diabetes mellitus.
A patient is diagnosed with unipolar depression. He is otherwise healthy. An appropriate Initial treatment choice is:
* A - amitriptyline (Elavil).
* B - escitalopram (Lexapro).
* c - mirtazapine (Remeron).
* D - quetiapine (Seroquel).
escitalopram (Lexapro).
A patient with chronic atrial fibrillation takes a generic version of Coumadin (warfarin). The NP should advise the patient about consuming:
OA - carbonated beverages.
* B - green tea.
* c - milk.
* D - caffeine.
green tea.
A prenatal patient is in the tenth week of pregnancy. The patient belleves they were exposed to rubella yesterday and is unsure of their immunization history. Which of the following responses by the nurse practitioner is appropriate?
* A - Rubella is not likely to cross the placenta and infect the fetus.
* B - The outcome of the pregnancy depends on the proximity to and length of time of the exposure.
* C- If the patient is determined to be seronegative, they can receive. the MMR vaccine postpartum.
* D - A rubella titer should be performed. If seronegative, the patlent should be immunized against rubella because Immunization is less teratogenic than the rubella virus.
A rubella titer should be performed. If seronegative, the patlent should be immunized against rubella because Immunization is less teratogenic than the rubella virus.
A 25-year-old female presents for a routine wellness exam. On physical examination, the nurse practitioner notes a scant nipple discharge, absence of a palpable mass, and absence of lymph node enlargement. Which of the following is the most Ilkely diagnosis?
© A - Intraductal papilloma
* B - Breast cancer
* c - Chest wall syndrome
* D - Fibrocystic breast disease
- Intraductal papilloma
Tricyclic antidepressants (TCAs) should be avoided in older adult patients because they have potentially disabling side effects. Which of the following is LEAST likely to be a side effect of TCAs?
* A - Nausea and urinary retention
* B - Confusion, sedation, and memory impairment
* c - Unsteady gait and orthostatic hypotension
* D - Potentiation of seizures
Potentiation of seizures
The antibiotic proven to be the most effective treatment for community-acquired pneumonia (CAP) In a healthy adult without any comorbid conditions is:
* A - sulflsoxazole (Gantrisin).
B - clarithromycin (Blaxin).
* c - cefuroxime (Ceftin).
* D - penicillin.
clarithromycin (Blaxin).
A 37-year-old female is being treated for hypothyroidism. Today, the patient complains of frequent premenstrual symptoms, poor concentration, and fatigue.
The patient has a past history of depression that was successfully treated. The first step by the NP Is to:
* A - provide more information to the patient about premenstrual syndrome.
* B - order serum lab tests, including a thyroid-stimulating hormone level.
* C - resume the patient’s antidepressant medication.
* D - perform a more comprehensive history and physical exam.
perform a more comprehensive history and physical exam.
A 3½-year-old healthy male presents with a history of continuous unsuccessful attempts at toilet training. The child experlences urinary incontinence at least once daily and a few nights weekly. The child has been continent of stool for the past 2 months. Urine dipstick results are within normal limits. The nurse practitioner correctly documents a diagnosis of:
* A - age-appropriate bladder control.
* B - primary enuresis.
* c - secondary enuresis.
* D - nocturnal enuresis.
Age appropriate
A patient reports having “panic attacks.” The NP knows that panic attacks are characterized by:
O A - headache onset in stressful situations.
* B - excessive and consistent worry about specific situations.
* c - impairment in soclal or occupational functioning.
* D - abrupt onset of intense fear or discomfort.
abrupt onset of intense fear or discomfort.
A breastfeeding infant has oral thrush. What should the nurse practitioner advise?
* A - The breastfeeding parent can take oral nystatin to treat the infant’s thrush.
* B - Stop breastfeeding until the thrush has resolved.
* C - Administer antifungal medication to the infant prior to feedings.
* D - Sterilize pacifiers and bottle nipples.
Sterilize
A patient is taking a combined hormonal oral contraceptive to prevent pregnancy.
The patient should be instructed that a backup method of contraception should be used:
* A - if they experience symptoms of pelvic inflammatory disease.
* B - if irregular menses occurs.
* c - if amoxicillin-clavulanate (Augmentin) is prescribed for a sinus Infection.
© D - if two consecutive doses of the oral contraceptive are missed.
if two consecutive doses of the oral contraceptive are missed.
The side effect of medroxyprogesterone (Depo-Provera) that often leads patients to discontinue use is:
* A - pain at the Injection site.
* B - weight gain.
C - heavy menstrual bleeding.
D - nausea and vomiting.
weight gain.
When making decisions about the treatment of syphilis with parenterally penicillin
G, the preparation, dosage, and length of treatment depend on the:
A - patient’s other comorbidities.
* B - level of the nontreponemal titers.
* c - stage of syphilis.
* D - patient’s risk factors.
stage of syphilis.
Which of the following statements about ankle sprain is true?
* A - Acetaminophen Is the preferred choice for managing pain assoclated with ankle sprains.
* B - Immoblization for 4 weeks is recommended for all grades of ankle sprain.
* C - Once pain and swelling subside, range of motion exercises should be initlated.
* D - The treatment of cholce for ankle sprains is Ice, 3-4 weeks without weightbearing, and compression.
Once pain and swelling subside, range of motion exercises should be initlated.
Which refractive error is commonly associated with the normal aging process?
O A - Myopia
* B - Astigmatism
C - Presbyopia
* D - Hyperopia
Presbyopia
Routine monitoring of a patient receiving isotretinoin does NOT include:
A - Iver function tests.
* B - serum cholesterol checks.
* C- complete blood call count
* D - triglyceride measurement.
Cbc
A 4-month-old Infant presents with several blue-black macular lesions over the buttocks and lower back area. The nurse practitioner suspects congenital dermal melanocytosis (formerly referred to as “Mongolian spots”) but should include in the differential dlagnosis:
* A - café au lait spots.
* B - Idiopathic thrombocytopenic purpura.
* C - child abuse.
* D - hemangloma,
child abuse.
The nurse practitioner is discussing contraception options during lactation with a pregnant patent. Which of the following methods of contraception would NOT be appropriate for use while breastfeeding?
* A - Levonorgestrel
* B - A low-dose oral contraceptive
C- An Intrauterine device
* D - A diaphragm and spermicide
A low-dose oral contraceptive
Which of the following medicatons should be used with cautlon In patlents who are taking antidiabetic medications, because they may further predispose the patient to hypoglycemla?
O A - Beta blockers
* B - Thlazide diuretics
* c - Phenytoin (Dilantin)
* D - Glucocorticosteroids
Beta blockers
According to the American Nurses Association, the role of the nurse practitioner who provides primary healthcare Is the:
* A - nurse educator.
* B - direct nursing care role.
* c - indirect nursing care role.
* D - administrator.
direct nursing care role.
A patient complains of urinary incontinence. Which characteristic supports a diagnosis of stress Incontinence?
* A - Frequent small-volume voids
* B - Strong urge to urinate and an Inability to make it to bathroom
* C - No urge to void, but urine leakage with laughing or sneezing
* D - Urinary frequency and involuntary loss of urine without warning
No urge to void, but urine leakage with laughing or sneezing
Acute complicated urinary tract infection may be differentiated from an uncomplicated urinary tract infection by the presence of:
*A - urinary frequency or urgency.
* B - pelvic pain.
* c - pyuria.
* D - flank pain.
- D - flank pain.
The AUDIT-C is a questionnaire containing three questions. It is used in primary care to assess:
* A - alcohol use disorders.
* B - types of headaches.
* C - dementia as differentiated from depression.
* D - cognitive dysfunction.
A - alcohol use disorders.
A child with type 1 diabetes mellitus brings in a glucose diary indicating consistent morning hyperglycemia. How can the nurse practitioner differentiate the Somogyl effect from dawn phenomenon?
* A - Experiment with a smaller Insulin dose In the evenings.
* B - Increase the insulin dose and liberalize the child’s diet.
* c - Check HbA1C today and again in 3 months.
* D - Instruct the parent to monitor the blood glucose at 3:00 am.
- Instruct the parent to monitor the blood glucose at 3:00 am.
A 4-year-old child complains of nighttime leg pain that resolves by morning. This has occurred for the past 4 months. The nurse practitioner should tell the patient’s guardlans that:
* A - these are growing pains that last from 1 to 2 years. This is a common complaint in this age group.
* B - this complaint is typical of Legg-Calve-Perthes disease. However, it is a disease that is NOT common in this age group.
* C - this pain is typical in assoclation with juvenile arthritis. Blood work will confirm the diagnosis.
* D - the pain is likely secondary to excessive leg movements caused by night terrors.
- these are growing pains that last from 1 to 2 years. This is a common complaint in this age group.
The greatest known risk factor for hepatitis B infection among adolescents in the United States Is:
* A - alcohol use.
* B - Intravenous drug use.
* C - tattooing and plercings.
* D - unprotected sexual activity.
unprotected sexual activity.
A patient reports right flank pain that began 2 days ago and has progressively worsened. On examination of the area, the nurse practitioner Identifies papular fluid-filled lesions that are confluent and linear. The nurse practitioner would appropriately order an):
* A - narcotic medication.
©B - topical analgesic.
* C - oral antiviral.
* D - topical steroid cream.
oral antiviral.
A nurse practitioner has been accused of deviating from the standard of care and causing harm/injury to a patient. The next step in a medical malpractice case against the NPs for the attorneys for both sides to:
© A - review the medical records to gather information.
* B - call in the defendant and plaintiff for depositions.
* C - present the case for review by peers.
* D - notify the state board of nursing, so that it can begin an
Investigation.
A - review the medical records to gather information.
Which of the following is NOT covered by Medicare Part B?
O A - Outpatient services
* B - Services in short-stay skilled nursing care facilities
* c - Physiclan and/or APRN services
* D - Lab and X-ray services
Services in short-stay skilled nursing care facilities
All of the following agents/medication classes are generally contraindicated in pregnancy EXCEPT:
* A - angiotensin-converting enzyme inhibitors, angiotensin Il receptor blockers (ARB), warfarin.
* B - oral antiseizure medications, oral diabetic agents, oral estrogen.
* C- fluoroquinolones, tetracyclines, ibuprofen.
* D - cephalosporins, parenteral insulin, parenteral heparin.
cephalosporins, parenteral insulin, parenteral heparin.
A patient was diagnosed with hypertension during the second trimester of pregnancy. If elevated blood pressure persists postpartum, at what point is it considered chronle hypertension?
* A - 2 weeks
* B - 6 weeks
* c - 12 weeks
* D - 16 weeks
12 weels
The live attenuated influenza vaccine would be appropriate to administer to:
O A - a 3-year-old patient with asthma.
* B - an immunocompetent 13-year-old patient.
O C - a 20-year-old pregnant patient at 32 weeks’ gestation.
* D - a 55-year-old patient with insulin-dependent Type 2 diabetes.
an immunocompetent 13-year-old patient.
Diagnostic radiologic studles are indicated for low back pain:
* A - routinely after 3 weeks of low back pain symptoms.
OB - to screen for spondylolisthesis in patients younger than 20 years old who experience low back pain lasting 2 weeks or more.
* c - when the presentation is suspicious for a space-occupying lesion, fracture, cauda equina, or infection.
* D - when pain radiates down both legs immediately after a fall.
when the presentation is suspicious for a space-occupying lesion, fracture, cauda equina, or infection.
The assignment of a diagnosis to a patient utilizing the International Classification of Diseases (CD) codes involves a variety of measures, but does NOT include:
O A - tracking of healthcare statistics and disease burden.
*B - measures of quality outcomes.
* C - establishing reimbursement and payment rates.
* D - tracking of morbidity and mortality statistics.
measure of quality outcomes
A 23-year-old patlent is boing evaluated by the nurse practtioner for immunization
status. The patient has documentation of completion of IPy, DTaP, and MMR series.
The patient states, “I got a shot when I was 12 years old, but none since.” Which vaccine(s) should the patient receive today?
DA - Td
* B - HBV and Hib.
* C - Hib and Td
* D - Td and HBv
Td and HBv
Which of the following statements is NOT accurate when educating a nonpregnant patient about folic acid deficiency anemia?
* A - Follc acid is the synthetic form of vitamin B2.
* B - Foods high In folate include broccoll and eggs.
OC - Oral folic acid of 1-5 mg dally is recommended to treat deficiency.
* D - Folic acid replacement may be given orally or parenterally.
A - Follc acid is the synthetic form of vitamin B2.
Developmental screening Is designed to Identify problems or delays during normal childhood development. Of the following children, which one should alert the nurse practitioner that further evaluation is warranted?
O A - A 5-month-old infant is unable to roll from supine to prone.
* B - A 16-month-old Infant is unable to walk backward.
* C - A 2½-year-old toddler does not have voluntary bladder and bowel control.
* D - A 36-month-old child has a 50-word vocabulary and 50% of speech is intelligible.
A 36-month-old child has a 50-word vocabulary and 50% of speech is intelligible.
The most effective intervention(s) to prevent stroke is (are):
* A - daily low-dose aspirin and cardiovascular exercise.
* B - weight loss and treatment of diabetes.
* c - daily cardiovascular exercise and weight loss.
* D - smoking cessation and treatment of hypertension.
smoking cessation and treatment of hypertension.
A patient is receiving timolol maleate (Timoptic) for chronic open-angle glaucoma.
When prescribing propranolol (Inderal), the nurse practitioner should educate the patient about which risk factor?
O A - Blurred vision
OB - Elevated Intraocular pressure
O C - Bradycardia
* D - Exacerbation of prostate hyperplasia
Bradycardia
At what age is it appropriate to begin administering the pneumococcal conjugate vaccine (PCV13 or Prevnar 13)?
O A - 2 months as a routinely scheduled vaccine
* B - 12 years If immunocompetent
O c - 20 years if a healthcare
A - 2 months as a routinely scheduled vaccine
A 16-year-old patient presents for a preparticipation physical to play football. The nurse practitioner auscultates a diastolic murmur. It is a grade II/VI. The patient has no history of a murmur and denies symptoms. What is the most appropriate action Dy the NP?
* A - Refer this patient to a cardiologist.
O B - Consider this a normal finding and complete the physical exam.
* C - Have the patient return in 8-12 weeks and reassess the murmur.
* D - Complete the physical exam and order an ECG.
Refer this patient to a cardiologist.
A 17-year-old patent is brought into the clinic by their guardian, who has consented to allowing the adolescent to get a tattoo if the nurse practitioner Identifies no medical concerns or consequences. The NP should:
* A - advise against getting a tattoo due a history of congenital heart disease.
* B - determine the patient’s Immunization status against hepatitis B.
* C - confirm that the patient has received their tetanus vaccine.
* D - test for sexually transmitted diseases, including a hepatitis panel.
determine the patient’s Immunization status against hepatitis B.
Which of the following is an example of secondary prevention?
* A - Annual mammography for females age 40 years and older
* B - Educating guardians about immunizations for children
Oc - Introducing the subject of “safe sex” during an adolescent exam
* D - Annual influenza vaccination.
Annual mammography for females age 40 years and older
Which of the following is an example of secondary prevention?
* A - Annual mammography for females age 40 years and older
* B - Educating guardians about immunizations for children
Oc - Introducing the subject of “safe sex” during an adolescent exam
* D - Annual influenza vaccination.
Annual mammography for females age 40 years and older
A 2-year-old child is being evaluated by the nurse practitioner. His clinical appearance and history are consistent with sickle cell anemia. What is the most appropriate laboratory test to diagnose sickle cell anemia?
* A - Hemoglobin electrophoresis
* B - CBC with peripheral smear
* C - Hemoglobin S solubility testing
* D - Haptoglobin level
Hemoglobin electrophoresis
An adolescent patient presents with tender lymph nodes in the posterlor cervical region of the neck. This finding could be consistent with:
* A - allergic rhinitis.
* B - streptococcal pharyngitis.
C - mononucleosis.
* D - conjunctivitis.
mononucleosis.
A premenopausal female with obesity complains of indigestion, flatulence, right upper gastric pain and epigastric “crampy pain” that radiates to the right scapula.
Symptoms are exacerbated by a high-fat meal. What is the most likely diagnosis?
O A - Fatty liver disease
* B - Chronic cholecystitis
O C - Acute pancreatitis
D - Peptic ulcer disease
Chronic cholecystitis
The most appropriate medications for older adults:
* A - are highly protein bound.
B - may be dosed once a day.
* C - can be given with meals.
* D - have a narrow therapeutic index.
may be dosed once a day.
Smoking during pregnancy increases the risks that the infant will experience:
CHA - macrosomia.
* B - Infant respiratory distress.
C - low birth weight.
* D - nicotine withdrawal symptoms.
- low birth weight.
Combined oral contraceptives should not be initiated within the first 21 days postpartum because:
* A - they may interfere with lactation.
* B - they may delay uterine shrinkage.
* c - their use is associated with an Increased risk of venous thromboembolism.
* D - they may potentially worsen postpartum depression.
their use is associated with an Increased risk of venous thromboembolism.
Which disease process is most commonly associated with Bouchard’s nodes?
* A - Rheumatoid arthritis
* B - Systemic lupus erythematosus
C - Osteoarthritis
* D - Gouty arthritis
Osteoarthritis
Nurse practitioner services are filed with Medicare for reimbursement:
* A - and paid by Medicare Part B.
B - using speclal procedure codes specific to nurse practitioner services.
O C- only as incident to the services of the physiclan.
* D - by the patient, using the nurse practitioner’s modifier.
C- only as incident to the services of the physiclan.
A patient with shortness of breath has suspected heart failure (HF). The initial diagnostic measure that will best help In confirming this suspicion is a(n):
A - brain natriuretic peptide (BNP).
* B - electrocardiogram (ECG).
© C - CPK (creatine phosphokinase),
* D - chest X-ray (CXR).
brain natriuretic peptide (BNP).
Inclusion of CAGE questions in the patient interview may yield information about:
A - problems related to alcohol use.
* B - confusion and memory impairment.
* C - depression and suicidal ideation.
* D - motivating factors for smoking cessation.
problems related to alcohol use.
When considering catch-up vaccinations for a child who has never received any vaccinations, the initial step is to determine which vaccinations are needed based on:
* A - risk factors.
* B - age.
* C - number of vaccinations missed.
D - immune status.
age.
A patient complains of intermittent “stomach pains” for the past month. When distinguishing between a gastrio ulcer and a duodenal ulcer, what question is LEAST important to ask?
A - Does your abdominal pain radiate to your shoulder blade?
*B - Have you had diarrhea or blood in your stool?
* c- Is your stomach pain made worse by eating?
D - Does your stomach pain wake you up in the early morning?
Does your abdominal pain radiate to your shoulder blade?
During a routine annual evaluation, a 49-year-old patient has a blood pressure of 145/95 mm Hg. The patient has no previous history of hypertension. The patient takes a statin for dyslipidemia. The patient’s 10-year risk for first atherosclerotic cardiovascular disease (ASCVD) event is less than 7.5% (low risk). How should the NP proceed?
* A - Consider home blood pressure monitoring, especially if the NP suspects white coat hypertension.
* B - The patient should be started on 25 mg HCTZ (hydrochlorothiazide) once daily In the morning.
* C - The patient should be diagnosed with hypertension today and lifestyle modifications should be initiated.
* D - Due to age and comorbidity, the patient should be started on an angiotensin-converting enzyme (ACE) inhibitor.
Consider home blood pressure monitoring, especially if the NP suspects white coat hypertension.
A 12-year-old male presents for a routine exam. Examination reveals that the patient grew approximately 3 inches in the past 2 years. On the genital exam, the patient’s testes measure 8.6 cm and the pubic hairs are coarse and curled over the pubis. The nurse practitioner documents that he is in Tanner Stage:
*A- two.
* B - three.
* c- four.
* D - five.
SUBMIT
3
Evaluation of a heart murmur’s pitch should be made by classifying its frequency.
Using the diaphragm of the stethoscope, the nurse practitioner auscultates a mild to moderate-pitched systolic ejection murmur audible over the upper left sternal border (ULSB) and radiating to the back. These findings are MOST consistent with:
* A - pulmonary stenosis.
* B - mitral valve insufficlency.
* C - aortic stenosis.
* D - tricuspid regurgitation.
pulmonary stenosis.
When examining a pregnant patient, where should the fundal height be at 22 weeks?
* A - Slightly above the symphysis pubis
OB - At the level of the umbilicus
* C - Midway between the symphysis pubis and umbilicus
* D - Above the umbilicus
D
The process by which the nurse practitioner requests to be reimbursed for services provided is known as:
* A - empaneling.
* B - certification.
C - credentialing.
* D - privileging.
credentialing.
Which of the following conditions is considered curable?
* A - Chronic hepatitis C
* B - Celiac disease
* c - Grohn’s disease
* D - Inflammatory bowel disease.
Chronic hep C
Screening for increased Intraocular pressure or early glaucoma is:
* A - performed with tonometry on y.
* B - Indicated only if symptoms such as eye pain or vision are noted.
* C - recommended every 1-3 years starting at age 40.
* D - part of the routine physical examination of an adult.
C
In children diagnosed with hand-foot-mouth disease, the nurse practitioner informs the caregivers of the child that the cutaneous and mucosal lesions resolve in 7-10 days. However, the caregivers should also be told that the virus continues to shed In the stool for:
* A - 2-3 days.
* B - 7 days.
* c - 10 days.
D - a few weeks.
a few weeks.
Which of the following is NOT a component of the diagnostic criteria for Meniere’s disease?
* A - At least two episodes of vertigo lasting 20 minutes to 12 hours
* B - Symptoms of high-frequency hearing loss, tinnitus or bilateral ear fullness
* c - Fluctuating symptoms of reduced or distorted hearing, tinnitus, or fullness in the affected ear
* D - Audiometrically documented low- to mid-frequency sensorineural hearing loss in the affected ear
Symptoms of high-frequency hearing loss, tinnitus or bilateral ear fullness
Which assessment finding is NOT typical in a patient with psoriasis?
O A - Pruritus
* B - Positive Auspitz sign
* c - Pitted nails
D - Satellite lesions
Satellite lesions
Which of these behaviors should the nurse practitioner recognize as most typical of sexual abuse in an adolescent?
* A - Substance abuse, indiscriminate sexual activity, and decreased personal boundaries
* B - Anorexla, generalized anxlety, and shyness during exam
* C - Academic overachievement, social isolation, and obsessive-compulsive symptoms
* D - Frequent clinic visits for insignificant medical problems and apathetic or bored affect
Substance abuse, indiscriminate sexual activity, and decreased personal boundaries
An otherwise healthy pregnant patient at 12 weeks’ gestation complains of feeling dizzy upon standing. This is the patent’s first pregnancy. The nurse practitioner knows that:
* A - the most likely cause is orthostasis due to systemic vasodilation in the first trimester.
* B - lightheadedness in pregnancy is a concern, and an electrocardiogram should be ordered.
* C - this is likely related to an abnormal elevation in blood pressure, which is common during pregnancy.
* D - low blood glucose may be causing this problem, and an oral giucose tolerance test is indicated.
the most likely cause is orthostasis due to systemic vasodilation in the first trimester.
A 35-year-old adult presents with radicular pain followed by the appearance of grouped vesicles consisting of about 20 lesions across three thoracic dermatomes.
The patient complains of pain, burning, and itching. The nurse practitioner:
* A - considers this a common case of shingles and prescribes an analgesic and an antipruritic agent.
* B - knows that this is a typical case of shingles and prescribes acyclovir (Zovirax), an analgesic and an ant/pruritic agent.
* C - suspects that this patient is Immunccompromised due to the dissemination of the herpes zoster.
* D - thinks that this is likely a recurrence of chickenpox due to age and the dissemination of the lesions.
knows that this is a typical case of shingles and prescribes acyclovir (Zovirax), an analgesic and an ant/pruritic agent.
A 28-year-old pregnant patient reports a history of smoking one pack of cigarettes per day (1PPD). The nurse practitioner is correct when explaining to the patient that cigarette smoking could be associated with fetal:
* A - macrosomia.
* B - hyperbillrubinemia.
* C - cleft palate.
* D - hypoglycemia.
cleft palate.
A 55-year-old male patient presents with dysurla, urgency, perineal pain, and temperature 101 degree F (38.3C), What is the most likely diagnosis?
* A - Cystitis
* B - Epididymitis
* C - Urethritis
D - Prostatitls
Prostatitls
A patient presents with a diffuse, symmetric maculopapular eruption Involving the entire trunk and extremities. The patient reports multiple sex partners over the past year. No other symptoms are present. The patient is most likely exhibiting symptoms of:
* A - disseminated human papillomavlrus.
* B - human Immunodeficiency virus.
* c - secondary syphills.
* D - disseminated trichomonas.
secondary syphills.
A 52-year-old female presents with a firm, nontender 1-cm mass in the right breast.
No palpable axillary lymph nodes or nipple discharge Is present. The patient had a screening mammogram 6 months ago, and no suspicious masses were noted. The most appropriate action today is to:
* A - order a bilateral diagnostic mammogram.
* B - repeat a bilateral screening mammogram.
* c - schedule an ultrasound of the breast.
D - plan a repeat mammogram in 6 months.
order a bilateral diagnostic mammogram.
The U.S. Preventive Services Task Force (USPSTF) recommends routine screening for asymptomatic bacteriurla in:
* A - pregnant women between 12 and 16 weeks’ gestation.
*B - men with a history of prostate enlargement.
* c - adolescents with diabetes insipidus.
* D - frail older adults.
- pregnant women between 12 and 16 weeks’ gestation.
Which activitles are NOT characteristic of preschool children in their current developmental stage?
* A - Social, cooperative, and shared play
* B - Independent toileting with occasional accidents
* C - Always following rules during playground games
* D - Use of security objects
Always following rules during playground games
A nonsmoking adult is diagnosed with acute bronchitis. The nurse practitioner advises the patient to take guaifenesin for the cough. The patlent should be Instructed to return to clinic if:
* A - fatigue develops.
* B - the cough becomes productive.
* c - the cough persists longer than 3 weeks.
* D - the patient develops substernal musculoskeletal pain.
- the cough persists longer than 3 weeks.
When Interpreting the results of a complete blood count obtained on an adolescent with signs and symptoms of scarlet fever, the nurse practitioner should expect:
* A - an elevated platelet count.
* B - leukocytosis.
* C - elevated hemoglobin.
D - decreased red blood cells.
leukocytosis.
A 65-year-old patent presents with a history of alcoholism, hemoglobin 10 g/dL (100 g/L), and mean corpuscular volume (MCV) 110 fL. These laboratory values are most consistent with which of the following?
* A - Thalassemia major
* B - Anemia of chronic disease
* c - Iron deficlency anemia
* D - Folic acid deficiency anemia.
FOlic
Which activity during the first trimester could be deleterlous to the fetus?
O A - Sexual Intercourse
O B - Jogging
* C - Dieting
* D - Airplane flight
Dieting
The nurse practitioner receives culture results for a patient with pelvic inflammatory disease (PID). The results are positive for Neisseria gonorrhea infection. The patient was empirically treated for this pathogen at the last visit. The next step for the nurse practitioner is to:
* A - perform a test of cure at 3 months.
* B - perform a test of cure only if sexual partners were not treated.
* c - advise the patient to follow up only if symptoms reoccur.
* D - schedule the patient for a yearly follow-up with testing at that time.
perform a test of cure at 3 months.
The LEAST likely assessment finding in a patient with acute epididymitis is:
* A - a reactive hydrocele.
* B - testicular pain.
C - negative cremasteric reflex.
* D - positive Prehn sign.
negative cremasteric reflex.
The management style that motivates employees to take ownership for their roles and perform beyond expectations is known as
* A - democratic leadership.
* B - transformational leadership.
* c - laissez faire leadership.
* D - autocratic leadership.
transformational leadership.
Health maintenance organizations (HMOs) and preferred provider organizatio (PPOs) are:
© A - managed care systems.-
OB - regulated by state law.
* c- cooperatives of fee-for-service providers.
* D - networks of hospitals and clinics.
managed care system
The medication that is safe and effective for the Initial treatment of low back paln is
A - nonsteroidal anti-inflammatory drug.
* B - muscle relaxant.
* c - oral corticosteroid.
* D - oploid analgesic.
nonsteroidal anti-inflammatory drug.
Soclal determinants of health include:
A - physical barriers, especlally for people with disabilities.
B - exposure to toxic substances.
C - safe housing.
D - access to healthcare services.
access to healthcare services.
Classic features of ulcerative colitis include:
* A - fever, right lower quadrant pain, and in many cases, a palpable
mass.
* B - bloating, vitamin B12 deficiency, anal fissures, and fistulas.
OC - postprandial urgency, alternating constipation and diarrhea, and diffuse lower abdominal pain.
* D - colicky abdominal pain, fecal incontinence, diarrhea, and tenesmus.
colicky abdominal pain, fecal incontinence, diarrhea, and tenesmus.
A patient complains of fever and throat pain. Bilateral exudate is present on the tonsils. The patient describes having an anaphylactic reaction to penicillin in the past. Which antibiotic should the nurse practitioner prescribe if she belleves the causative agent is bacterial?
* A - Amoxicillin-clavulanate (Augmentin)
B - Erythromycin
* c - Cefadroxil monohydrate (Duricet)
* D - Ceftriaxone (Rocephin)
Erythromycin
A patient complains of lower extremity edema. The patient reports that the swelling began 3 months ago after starting a new medication. Physiologic causes of this condition have been excluded. Which medication is MOST likely causing the edema?
A - Nifedipine (Procardia)
* B - Losartan (Cozaar)
* C - Enalaprl (Vasotec)
D - Metoprolol (Toprol)
Nifedipine (Procardia)
A short-acting beta agonist (e.g., albuterol) is initlated in a patient with intermittent chronic obstructive pulmonary disease (COPD). The nurse practitioner should Instruct the patient to avold overuse of the inhaler because it may cause:
* A - headaches.
* B - pharyngitis.
O c - reflex tachycardia.
* D - seizures.
O c - reflex tachycardia
Which physical modality recommended in the treatment of rheumatoid arthritis provides the most effective long-term pain relief?
* A - Superficial and deep heat
O B-Massage
© c - Transcutaneous electrical nerve stimulation (TENS)
D - Exercise
Exercise
A patient was diagnosed with hypertension during the second trimester of pregnancy. If elevated blood pressure persists postpartum, at what point is it considered chronic hypertension?
A - 2 weeks
B - 6 weeks
C - 12 weeks
D - 15 weeks
12 weeks
While obtaining the history from a patient with an ankle injury, the patient will likely report:
* A - a popping sound.
* B - a clicking sound.
* c - ankle eversion.
D - ankle inversion.
ankle inversion.
The nurse practitioner wants to assess a patient’s cerebellar function. Which of the following clinical tests provide information on whether this functioning is intact?
O A - Kinesthesia assessment
* B - Dix-Hallpike maneuver
C - Tandem walking test
* D - Graphesthesia testing
- Tandem walking test
Which drug class is most effective in the treatment of very high triglyceride levels (hypertriglycer/demia) of >650 mg/dL?
* A - Bile acid sequestrants
* B - Nicotinic acid
C - Fibrates
* D - HMG-CoA reductase Inhibitors
Fibrates
A 48-year-old patient reports pain and stiffness in the right hip and knee. The pain Is worse in the morning and at the end of the day. During the physical exam, the NP Identifies crepitus with active range of motion of the knee. What is the most likely diagnosis?
* A - Rheumatoid arthritis
* B - Bursitis
* C - Osteoarthritis
* D - Tendinitis
- Osteoarthritis
The most appropriate therapy for an older adult patient with pernicious anemia is:
* A - increased dietary Intake of vitamin B12.
* B - oral vitamin B12 supplementation.
* c - intramuscular injections of vitamin B12.
* D - oral multivitamin supplementation.
intramuscular injections of vitamin B12.
A college student was exposed to varicella yesterday and is scheduled to take final exams In 2 days. The patient did not have varicella during childhood and asks the nurse practitioner if any medication would prevent them from contracting the disease. The nurse practitioner informs the patient that:
* A - nothing can be done to prevent the disease after exposure, and the patient should expect the first symptoms within the next 7-10 days.
* B - the patient should receive the Varivax immunization to prevent the onset of the disease.
* c - varicella zoster Immune globulin (VariZIG) may be beneficial if it is administered immediately.
* D - intravenous immune globulin (VIC) will prevent the illness.
varicella zoster Immune globulin (VariZIG) may be beneficial if it is administered immediately.
The guardian of a 3-month-old Infant diagnosed with tetralogy of Fallot seeks advice on how to assist the infant during cyanotic episodes. The initial and most appropriate Intervention would be to Instruct the guardian to:
* A - provide oxygen via face mask when the episode begins and for 15 minutes after it ends.
O B - place the child in a knee-chest position until the cyanotic episode resolves.
* C - administer intranasal fentanyl every 6 hours as needed.
* D - administer acetaminophen orally every 4 hours as needed.
- place the child in a knee-chest position until the cyanotic episode resolves.
A patient presents with testicular pain and swelling on the right side. In determining the differentlal diagnosis for a patient with scrotal pain, the nurse practitioner elicits a cremasteric reflex. Epldidymitis should be considered if the patient’s cremasteric reflex is:
* A - positive on the left side.
* B - absent on the left side.
* c - positive on the right side.
* D - absent on the right side.
- positive on the right side.
The goals of treatment for patients with alcohol dependence syndrome are:
* A - reduction in withdrawal symptoms and reduction in desire for alcohol.
* B - psychotherapeutic and pharmacologic interventions to decrease desire for, and the effects of, alcohol.
* C - abstinence or reduction in use, relapse prevention, and rehabilitation.
* D - improved social and vocational functioning.
bstinence or reduction in use, relapse prevention, and rehabilitation.
Why Is it Important that a postmenopausal patient with an Intact uterus receive combined estrogen-progestin hormone replacement therapy rather than estrogen
alone?
* A - When taken without progestin, estrogen Is less effective in relleving vulvovaginal atrophy.
* B - The beneficial effect of estrogen on high-density lipoprotein cholesterol levels is increased by the addition of progestin.
* C - Prolonged use of unopposed estrogens increases the risk of endometrial cancer.
* D - Breast cancer risk is increased In female patients who take unopposed estrogen.
Prolonged use of unopposed estrogens increases the risk of endometrial cancer.
Which Immunization(s) is(are) contraindicated in a patient who is immunodeficient?
1. Varicella 2. Inactivated polio vaccine (IPV) 3. Measles, mumps, rubella (MMR) 4.
Hepatitis B (HBV)
* A-4
О в - 1,3
* с - 1,3,4
D - All of the above
one and three
The nurse practitioner is conducting a routine health assessment on a marathon runner. Which urinalysis finding would be consistent with increased exercise?
* A - Ketones and glucose
* B - Protein and hyaline casts
* c - Albumin and Increased pHi
* D - Urobilinogen and calcium oxalates
B
At what age is it appropriate to begin administering the pneumococcal conjugate vaccine (PCV13 or Prevnar 13)?
* A - 2 months as a routinely scheduled vaccine
* B - 12 years If immunocompetent
* c - 20 years if a healthcare worker
* D - 50 years
- A - 2 months as a routinely scheduled vaccine
A patient presents with complaints of lower extremity pain that is suggestive of severe peripheral arterial disease. The diagnostic test that is most beneficial in differentiating peripheral artery disease from another vascular etiology is:
* A - abdominal aortic ultrasound.
* .
B - ankle-brachial Index.
* c - computed tomography angiography
D - magnetic resonance angiography.
Mri
A child with type 1 diabetes mellitus brings in a glucose diary indicating consistent morning hyperglycemia. How can the nurse practitioner differentiate the Somogy! effect from dawn phenomenon?
* A - Experiment with a smaller insulin dose In the evenings.
© B- Increase the insulin dose and liberalize the child’s diet.
* C - Check HbA1C today and again in 3 months.
D - Instruct the parent to monitor the blood glucose at 3:00 am.
Instruct the parent to monitor the blood glucose at 3:00 am.
A 37-year-old female is being treated for hypothyroidism. Today, the patient complains of frequent premenstrual symptoms, poor concentration, and fatigue.
The patient has a past history of depression that was successfully treated. The first step by the NP Is to:
* A - provide more information to the patient about premenstrual syndrome.
* B - order serum lab tests, including a thyrold-stimulating hormone level.
* C- resume the patient’s antidepressant medication.
D - perform a more comprehensive history and physical exam.
perform a more comprehensive history and physical exam.
A breastfeeding infant has oral thrush. What should the nurse practitioner advise?
* A - The breastfeeding parent can take oral nystatin to treat the infant’s thrush.
* B - Stop breastfeeding until the thrush has resolved.
* C - Administer antifungal medication to the infant prior to feedings.
* D - Sterilize pacifiers and bottle nipples.
D
The most effective intervention(s) to prevent stroke is (are):
* A - daily low-dose aspirin and cardiovascular exercise.
* B - weight loss and treatment of diabetes,
* C - daily cardiovascular exercise and weight loss.
* D - smoking cessation and treatment of hypertension.
smoking cessation and treatment of hypertension.
The most effective strategy in the management of an adult with resistant nypertension is to:
* A - re-educate and reinforce the need for lifestyle modifications (I.e., diet, exercise, smoking cessation).
* B - add a fourth medication to the current regimen to achieve control of the blood pressure.
* c - perform a comprehensive evaluation to identify a secondary cause of the hypertension.
* D - assure that the patient is taking their medication appropriately.
c - perform a comprehensive evaluation to identify a secondary cause of the hypertension.
A 66-year-old patient presents to the nurse practitioner’s clinic. The patient reports experiencing chest paln the prior evening. It lasted 20-30 minutes. Which finding most strongly correlates with myocardial infarction?
* A - ST segment depression on ECG
* B - Elevated troponin I levels
* C - Elevated creatinine phosphokinase myocardial bands (CK-MB)
* D - Elevated U waves on ECG
Elevated troponin I levels
Which of the following patients is least likely to exhibit secondary hypertension?
* A - A 38-year-old patient with untreated Graves disease
* B - An 18-year-old patient who is addicted to cocaine
* C - A 62-year-old patient with untreated depression
* D - A 29-year-old patient with untreated Cushing syndrome
A 62-year-old patient with untreated depression
An adult female will be started on levothyroxine and the dosing is based on the patient’s Ideal body weight. The patient is 5 feet 7 inches tall. Using the height-
weight formula, what is her ideal body weight (IBW)? Formula: IBW (Ibs) = 100 + 5 x
(Ht - 60 in)
A - 135 pounds
* B - 140 pounds
* c - 145 pounds
* D - 150 pounds
135
What is the standard measurement to diagnose legal blindness using a visual aculty test?
O A - 20/100
* В - 20/150
* C- 20/200
* D - 20/250
20/200
A patient with mild depression symptoms has been treated for those symptoms with sertraline (Zoloft) during the past 6 months. The patient is now contemplating pregnancy. Which statement indicates a lack of knowledge on the provider’s part?
O A - SSRis as a group are not considered major teratogens, and first trimester exposure is assoclated with a low risk of teratogenicity.
* B - If the patient has been euthymic for 6 months, the patient can weigh the risks versus the benefits of continuing medication therapy.
* C - The patient should wean off the SSRI prior to becoming pregnant, because depressive symptoms improve during pregnancy.
* D - Paroxetine (Paxil) is the only SSRI that may be considered less safe than other SSRis for use during pregnancy.
The patient should wean off the SSRI prior to becoming pregnant, because depressive symptoms improve during pregnancy.
A 13-year-old patient experienced a fall while running during football practice. Now, the patient’s knee hurts and sometimes “locks.” The nurse practitioner conducts McMurray’s test. Which of the following is true about this test?
* A - If a palpable “click” is present, the patient most likely has a meniscus tear.
* B - When pressure is applied to the flexed knee, varus stress is suspected.
* C - To perform this test, a straight leg is internally rotated while the patient is lying prone and flat.
* D - Pain with movement indicates a problem with the anterior cruciate ligament.
If a palpable “click” is present, the patient most likely has a meniscus tear.
The LEAST likely physical finding In an adolescent with moderate acne vulgaris is:
* A - blockage of hair follicles and sebaceous glands on the face, back, or chest.
* B - Inflammatory lesions on the face.
* C - erythematous pustules.
* D - scaly patches and fine papules.
scaly patches and fine papules.
The factor that is LEAST Ilkely to contribute to the development of otitis media in a child younger than 3 years Is:
* A - exposure to cigarette smoke.
*B - lack of immunizations.
* C - being born with Down syndrome.
* D - breastfeeding.
breastfeeding.
When Interpreting the results of a complete blood count obtained on an adolescent with signs and symptoms of scarlet fever, the nurse practitioner should expect:
* A - an elevated platelet count.
* B - leukocytosis.
* c - elevated hemoglobin.
* D - decreased red blood cells.
leukocytosis.
A 32-year-old male reports a 3-day history of urinary frequency and burning on urination. Urinalysis reveals bacteriuria and positive nitrites. The empiric first-line treatment should be:
* A - trimethoprim-sulfamethoxazole (Bactrim) for 7 to 10 days.
* B - ciprofloxacin (Cipro) for 3 to 5 days.
* c - trimethoprim-sulfamethoxazole for 3 days.
* D - ceftriaxone (Rocephin) IM x 1 and azithromycin (Zithromax).
trimethoprim-sulfamethoxazole (Bactrim) for 7 to 10 days.
The management style that motivates employees to take ownership for their roles and perform beyond expectations is known as:
O A - democratic leadership.
° B - transformational leadership.
O c - laissez falre leadership.
O D - autocratic leadership.
transformational leadership.
Which of the following patients with gynecomastia does NOT warrant further diagnostic testing?
* A - A prepubertal boy with bilateral breast enlargement, average weight, and Tanner stage 1
OB - A 13-year-old boy with bilateral breast enlargement and normal testicular size and volume
C- A 15-year-old boy with bilateral tender gynecomastia and right
I breast larger than left
O D - An 18-year-old boy with bilateral nipple sensitivity and right breast enlargement >5 cm
A 13-year-old boy with bilateral breast enlargement and normal testicular size and volume
An adolescent or adult patient Is considered to have intermittent asthma If they experience:
* A - symptoms more than twice weekly, but not dally.
O B - three to four nocturnal awakenings per month.
.C- the need for a short-acting beta agonist (SABA) to relleve symptoms more than 2 days of the week.
* D - the ability to participate in normal activities between exacerbations.
SUBMIT
An adolescent or adult patient Is considered to have intermittent asthma If they experience:
A simple case of impetigo and follicultis can be successfully treated with:
* A - systemic antibiotics.
B - topical antiblotics.
* c - antiseptic body wash.
* D - debridement and irrigation.
Topical ABX
Which of the following is NOT a component of the fetal biophysical profile?
A - Gestational age estimate
B - Fetal tone
C - Amniotie fluid volume
* D - Fetal movements
Gestational age estimate
To differentiate testicular torsion from epididymitis, the nurse practitioner should order:
A - a urinalysis.
B - Doppler ultrasound.
C - a urine Gram stain.
* D - a CT scan.
Doppler ultrasound.
Which of the following interventions is NOT appropriate in pediatric patients?
A - Allowing a caregiver to remain with the patient during unpleasant or painful procedures
* B - Providing age-appropriate, honest explanations prior to procedures
* c - Consoling the patient following unpleasant or painful interventions
* D - Premedicating the patient prior to all painful interventions
Premedicating the patient prior to all painful interventions
A 78-year-old patient with diabetes states that when reading, sentences on a page appear wavy or distorted. The nurse practitioner suspects:
O A - glaucoma.
* B - retinal detachment.
* c - diabetic retinopathy.
D - macular degeneration.
macular degeneration.
A pediatric patient presents with honey-colored crusty lesions around the right side of the mouth and extending to the right cheek. The nurse practitioner diagnoses the patient with nonbullous impetigo. The most appropriate intervention would be to:
O A - recommend gentle cleansing to remove the crusts of nonbullous
Impetigo using antibacterial soap and a washcloth.
* B - prescribe a topical antibiotic and instruct the caregiver in providing good wound care with an antibacterial cleanser.
* c - instruct the caregiver on providing good wound care with an antibacterial cleanser and prescribe an oral antihistamine to relieve the Itching.
* D - prescribe an oral antihistamine and a topical steroid.
prescribe a topical antibiotic and instruct the caregiver in providing good wound care with an antibacterial cleanser.
A 54-year-old patient presents to the clinic with severe chest pain. The nurse practitioner places the patient on a cardiac monitor and observes a normal sinus rhythm with elevated ST segments. The patient’s blood pressure is 130/75 mm Hg.
The diagnosis that must be considered in this patient Is:
* A - dehydration.
* B - dyspepsia.
* C - cardiac ischemia.
* D - costochondritis.
cardiac ischemia.
A patient has developed a blood clot in their lower extremity and is receiving warfarin (Coumadin) therapy. Which outpatient serum laboratory test best measures the therapeutic effect of warfarin?
* A - International normalized ratio
* B - Activated clotting time
* c - Prothrombin time (PT)
* D - Partial thromboplastin time (PTD)
- International normalized ratio
A patient presents with symptoms that lead the nurse practitioner to suspect perimenopause. Findings may include:
A - normal to high follicle-stimulating hormone (FSH) level and lengthening of the intermenstrual interval.
B - low follicle-stimulating hormone (FSH) level and shortened Intervals in between menses.
C- elevated human chorionic gonadotropin (hCG) level and vasomotor symptoms.
D - low human chorionic gonadetropin (hCG) level and breast tenderness.
normal to high follicle-stimulating hormone (FSH) level and lengthening of the intermenstrual interval.
Trichomoniasis is LEAST likely to:
* A - increase the risk of being infected with HIV.
B - transfer from vagina to vagina.
C - cause epididymitis.
D - cause symptoms in males.
cause symptoms in males.
A patient’s laboratory studies demonstrate Increased TSH and decreased free T4 and T3. Which symptoms may this patient report?
* A - Intolerance to heat
* B - Thinning hair and nails, soft nalls
* C - Emotional lability
* D - Hair loss
Hair loss
Which of the following statements about domestic abuse is false?
* A - Physical abuse of the female usually stops during pregnancy.
O B - Domestic abuse occurs in same-sex relationships.
* C - The abuser usually humiliates the spouse in front of others.
* D - The abuser often threatens self-harm when angry with the spouse.
Physical abuse of the female usually stops during pregnancy.
A 7-year-old patient presents with a painless, Intermittent lImp, limited range of motion in the right leg, persistent pain, and occasional muscle spasms In the right anterior thigh. Examination reveals a mildly restricted hip abduction with internal rotation, proximal thigh atrophy, and a slightly short stature. The most likely
diagnosis Is:
* A - transient monoarticular synovitis.
O B - slipped capital femoral epiphysis (SCFE).
* c - developmental dysplasia of the hip (DDH).
D - Legg-Calve-Perthes disease (LCPD).
Legg-Calve-Perthes disease (LCPD).
Developmental screening is designed to identify problems or delays during normal childhood development. Of the following children, which one should alert the nurse practitioner that further evaluation is warranted?
O A - A 5-month-old Infant is unable to roll from supine to prone.
O B - A 16-month-old Infant is unable to walk backward.
O C - A 2½-year-old toddler does not have voluntary bladder and bowel control.
* D - A 36-month-old child has a 50-word vocabulary and 50% of speech is intelligible.
A 36-month-old child has a 50-word vocabulary and 50% of speech is intelligible.
The most effective treatment for anemia of chronic disease is:
O A - Iron replacement therapy.
B - treatment of the underlying disease.
@ c - an oral folate supplement.
© D - glucocorticosteroid therapy.
treat underlying cause
The preferred therapeutic regimen for a pregnant patient diagnosed with Chlamydia trachomatis infection is:
O A - doxycycline 100 mg orally twice a day for 7 days.
O B - penicillinG 1.2 million units x 1 dose.
* c - a single IM dose of ceftriaxone (Rocephin) 500 mg.
D - a single dose of azithromycin (Zithromax) 1 gram orally.
a single dose of azithromycin (Zithromax) 1 gram orally.
A 46-year-old patient has hypertension that is well managed with propranolol (Inderal). Which of the following is a beneficial secondary effect of this drug?
* A - Improved peripheral neuropathy
* B - Reduction In elevated lipids
* c - Improved energy levels
* D - Reduction in essential tremor
Reduction in essential tremor
When Interpreting a prostate-specific antigen (PSA) test, the nurse practitioner knows that the results may be lowered by taking:
O A - St. John’s wort daily.
* B - finasteride (Proscar).
* C - metformin (Glucophage).
* D - sildenafil (Viagra) within the last 48 hours.
B - finasteride (Proscar).
A patient presents with acute nausea, vomiting, and severe retrosternal pain that radiates to the back. The nurse practitioner suspects pancreatitis. What is the preferred imaging study for diagnosing pancreatitis?
* A - Ultrasound of the abdomen
B - CT scan of the abdomen without IV contrast
* c - Esophagogastroduodenoscopy (EGD)
* D - flat and upright abdominal X-rays
US
A valvular heart condition that may cause a diastolic murmur is:
* A - pulmonary stenosis.
* B - mitral valve prolapse.
C - mitral stenosis.
* D - aortie stenosis.
Mitral stenosis
An adult presents with tinea corporis. What comment by the patient would be the LEAST likely explanation for how the patient acquired this disease?
O A - “I trap animals.”
* B - My spouse has this also.”
O C-“I have diabetes.”
O D - L live in the northern United States.”
I have Diabetes
A 2-month-old Infant presents with a history of elevated temperature for the past 8 hours despite the administration of acetaminophen. The infant is ill-appearing, but has nonspecific symptoms. The most appropriate Intervention by the nurse practitioner is to:
O A - prescribe an oral broad-spectrum antimicrobial.
* B - hospitalize the infant for sepsis workup and evaluation.
c - recommend that the parent alternate acetaminophen with Ibuprofen and return to the clinic for reevaluation the next day.
* D - order a CBC, test for respiratory syncytial virus, and advise the
vorons t conunue decreminannen
- B - hospitalize the infant for sepsis workup and evaluation.
Which symptom is NOT typical In a patient during the perimenopausal perlod?
A - Vasomotor Instability
O B - Irregular menses
C - Complete cessation of menses
* D - Sleep disturbances
Complete cessation of menses
The guardian of a 5-month-old Infant asks when and how to Introduce solld foods.
The nurse practitioner explains that the guardian should begin offering solld foods:
* A - now, and then Introduce a new food every other week.
B - now, and then introduce no more than three different foods each week.
C - when the infant is 6 months old. A new food should be Introduced every 3 to 5 days.
* D - when the infant is 6 months old. A new food should be introduced every other week.
when the infant is 6 months old. A new food should be Introduced every 3 to 5 days.
Which of the following adolescents has risk factors that have been associated with high-risk sexual behaviors?
O A - A 14-year-old patient with early development of secondary sex characteristics, living In an urban area
* B - A 13-year-old patient with lower socioeconomic status, alcohol use, and a single-parent household
* c - A 16-year-old patient who is in a relationship with another student
* D - A 15-year-old patient who has had exposure to sex education
Information at school
- A 13-year-old patient with lower socioeconomic status, alcohol use, and a single-parent household
An adolescent has been treated for nonbullous impetigo with mupirocin (Bactroban) for the past 3 days. The patient returns for a follow-up visit and the nurse practitioner notes that the lesion has worsened; the NP suspects cellulitis. The most appropriate treatment approach would be to prescribe:
* A - retapamulin (Altabax) and discontinue mupirocin (Bactroban).
* B - an oral corticosteroid to reduce the inflammation and continue the mupirocin (Bactroban).
*C- amoxicillin-clavulanate (Augmentin) and discontinue mupirocin.
P. D - oral clindamycin and continue mupirocin.
- oral clindamycin and continue mupirocin.
A patient with heart failure (HF) presents with symptoms of mild heart failure exacerbation. The patient takes Prinivil (isinopril), metoprolol (Lopressor), ASA, and low-dose furosemide every morning. The LEAST likely cause of this patient’s exacerbation is:
* A - three skipped doses of Prinivil.
* B - dally Ibuprofen dosing to manage pain associated with knee arthritis.
* c - atrial fibrillation.
* D - taking three doses of calcium carbonate the day before.
taking three doses of calcium carbonate the day before.
The most appropriate medications for older adults:
* A - are highly protein bound.
* B - may be dosed once a day.
* C - can be glven with meals.
* D - have a narrow therapeutic Index.
once a day
After a thorough examination, a 2-month-old breastfed infant is diagnosed with Infantile colic. What should be included In the initial education of the child’s guardian about this condition?
* A - Encourage a maternal diet that is low in dairy and wheat and high In soy and shellfish.
* B - Offer 3 ounces of an oral hypotonic glucose and water solution during colic events.
C - During a colic episode, position the infant so their stomach rests on the guardian’s forearm and they support the infant’s head in the palm of their hand.
* D - Restrict breast and bottle feeding to every 3 hours in frequency and 15 minutes in duration.
- During a colic episode, position the infant so their stomach rests on the guardian’s forearm and they support the infant’s head in the palm of their hand.
The most accepted recommendation for skin cancer prevention is:
* A - monthly skin self-examination.
* B - the use of sunscreen, even at low SPF, to prevent UV exposure.
* C - avoldance of excessive sun exposure.
© D - avoldance of tanning devices.
avoldance of excessive sun exposure.
A 50-year-old male presents to the clinic for a routine physical examination. He has
no significant personal or family history of clinical heart disease and prior
cardiovascular disease risk assessment has determined he is at low risk. The best
screening approach for this patient is to:
- A - measure blood pressure at this visit and annually.
- B - order a screening exercise stress test and a low-dose aspirin daily.
- c - order a screening ultrasound of the abdomen to assess for aortic
aneurysm and perform a carotid auscultation.
D - obtain a baseline electrocardiogram today and then yearly.
A - measure blood pressure at this visit and annually.
During which developmental stage does the highest risk for development of testicular tumors occur?
* A - Preadolescence
* B - Adolescence through early adulthood
* C - Midlife, ages 40 to 60 years
* D - 65 years and older
adolescence to early adulthood
Which of the following tests is used for diagnosis of cystic fibrosis?
* A - Serum amylase
* B - Fecal fat excretion
* c - Pulmonary function study
* D - Sweat test
sweat test
Which of the following statements about nicotine replacement therapy (NRT is true?
* A - The benefits of NRT outweigh the risks because NRT does not contain the harmful chemicals in tobacco products.
B - Nicotine replacement should only be offered to smokers who are unsuccessful after three attempts to stop smoking.
* C - The use of nicotine replacement should be discouraged in smokers with cardiovascular disease.
* D - Dependence on NRT is as much of a concern as tobacco dependence.
SUBMIT
The benefits of NRT outweigh the risks because NRT does not contain the harmful chemicals in tobacco products.
An adult patient has an S4 heart sound and the point of maximal impulse (PMI) Is at the 5th left intercostal space (ICS), left of the midclavicular line. Additional assessment findings Include arteriovenous nicking. What are these findings associated with?
* A - Heart failure (HF)
* B - Mitral insufficiency
* C - Hypertension
* D - Cardiomyopathy
Hypertension
Dog bite
abx with occulisve dressing
The human Immunodeficlency virus (HIV) test with the highest sensitivity and specificity, even in the acute phase of infection, is a(n):
* A - enzyme-linked immunosorbent assay (ELISA) (antibody-only test).
* B - Western Blot (antibody-only test).
* C - HIV-1/HIV-2 antibody differentiation immunoassay (determines
HIV1 versus HIV-2).
D - HIV 1/2 antigen/antibody combination immunoassay.
D - HIV 1/2 antigen/antibody combination immunoassay.
An autosomal recessive disorder such as cystic fibrosis or sickle disease is expressed in the offspring when:
* A - the disease occurs in every generation.
* B - both parents are carriers of the disease.
* C - at least one parent has the disease.
* D - at least one parent, usually the mother, is a carrier.
both parents are carriers of the disease.
The earlest and most sensitive clinical indicator of heart failure (HF) is:
A - shortness of breath.
* B - nocturnal dyspnea.
* c- weight gain.
* D - anorexia.
shortness of breath.
The most accurate measure of diabetes control is:
* A - the absence of micro- and macrovascular complications.
* B - serial fasting and periodic postprandial capillary blood sugars.
O c - early morning glucose levels.
D - glycosylated hemoglobin.
glycosylated hemoglobin.
Which of the following clinical findings is NOT consistent with a diagnosis of pyloric stenosis in a 3-month-old infant?
O A - The Infant appears to be hungry all the time.
* B - The infant has sunken eyeballs and a depressed anterior fontanelle.
* c - The NP detects a bloated, tense tympanic abdomen.
* D - The NP palpates a mass in the right upper quadrant that is the size and shape of an olive.
The NP detects a bloated, tense tympanic abdomen.
A patient with chronic obstructive pulmonary disease (COPD) presents for follow-up. The patient reports stopping salmeterol (Serevent), a long-acting beta agonist (LABA), because the side effect of “heart racing” was bothersome. The nurse practitloner could consider switching to:
O A - a long-acting muscarinic antagonist (LAMA).
* B - a different long-acting beta agonist.
* c - a combination LAMA/LABA.
* D - an Inhaled corticosteroid.
a long-acting muscarinic antagonist (LAMA).
The American Academy of Pediatrics recommends cholesterol screening In children:
* A - annually after age 8 years.
* B - who are genetically predisposed to cardiovascular conditions.
* C - between ages 9 and 11 years.
* D - after they reach young adulthood.
9-11
lo open an independently owned and operated nurse practitioner clinic, it is necessary to:
A - be in a state with full practice authority for NPs.
*B - have a clean practice record (no malpractice claims).
* c - have the skill and confidence to pursue business ownership.
* D - be willing to only provide direct primary care.
have the skill and confidence to pursue business ownershiA - be in a state with full practice authority for NPs.
When performing a full ENT assessment on a patient, removal of cerumen would NOT be helpful when:
* A - evaluating conductive hearing loss.
* B - evaluating semsorineural hearing loss.
* c - ear discomfort is present.
* D - impressions for hearing aid fitting have not been taken.
evaluating semsorineural hearing loss.
Given appropriate patient edlacation by the primary care providor, poor adherence to modical recommerdations is insut ortion due tal
* A - willul disobedience.
* B - vision and/or hearing detes.
* C - anxiety,
D - limited health Iteracy
limited health Iteracy
Which of the following psychiatric diagnoses is the LEAST likely to be a risk factor for suicide?
* A - Depression
* B - Bipolar disorder
* c - Obsessive-compulsive disorder
* D - Substance use disorder
OCD
A sexually active patient reports vaginal discharge. The cardinal presenting symptom of pelvic Inflammatory disease Is:
O A - dysuria.
* B - low back paln.
* c - abnormal uterine bleeding.
D - lower abdominal pain.
lower abdominal pain.
Which class of medications is contraindicated in the treatment of systolic heart tallure?
* A - ACE inhlbitors
* B - Nitrates
* c - Beta-adrenergic blockers
D - Calcium channel blockers
CCB
An older adult patient presents with a gray-white ring around the periphery of the Iris. This is probably:
A - Indicative of underlying atherosclerotic disease.
B - a normal variant associated with the aging process.
* c - an emerging cataract.
* D - early stages of glaucoma.
B - a normal variant associated with the aging process.
Tricyclic antidepressants (TCAs) should be avoided in older adult patients because they have potentially disabling side effects. Which of the following Is LEAST likely to be a side effect of TCAs?
Seizures
The nurse practitioner is inspecting the skin of a 63-year-old patient and notes a single pearly gray papule with a raised border, central clearing, and telangiectasias.
The lesion is located on the patient’s posterior neck. What is the most likely
diagnosis?
Basal Cell Carcinoma
Which of the following statements about asymptomatic bacteriurla (ABU) is true?
O A - High-risk patients should be screened periodically for ABU.
* B - ABU may be caused by increased uropathogens in the postmenopausal vagina and introitus.
* c - Untreated ABU increases morbidity and mortality.
* D - Antibiotic treatment of ABU reduces the frequency of symptomatic urinary tract Infection.
ABU may be caused by increased uropathogens in the postmenopausal vagina and introitus.
What prophylaxis medication is recommended for a patient who is younger than 35 years and has a positive PPD test?
D - Isonlazid (INH)
Which of the following is NOT a true statement about medication use in an older adult patient?
* A - Drug-drug interactions between prescription and over-the-counter medications are more common in older adults.
* B - The older adult patient is likely to have multiple prescribers, resulting In polypharmacy and Increasing the potentlal for drug-drug Interaction.
* c - The older adult patient is likely to experience increased tolerance and subtherapeutic effects of prescription drugs given in combination with over-the-counter medications.
* D - When prescribing for the older adult patient, caution should be used due to a decreased rate of metabolism and excretion of medications.
The older adult patient is likely to experience increased tolerance and subtherapeutic effects of prescription drugs given in combination with over-the-counter medications.
Nurse practitioners are permitted to perform male circumcisions in some states but not in others. This is related to:
:
B - scope of practice.
Today, a patient is diagnosed with iron deficiency anemia and started on a daily iron supplement. The nurse practitioner should advise the patient to follow up in:
O D - 1 month for a CBC.
one month for CBC
An adolescent patient presents with symptoms of skin dryness, itching, and erythema. The least likely differential diagnosis in this patient is:
* A - scables.
* B - atopic dermatitis.
* c - impetigo.
* D - psoriasis.
impetigo
A 79-year-old patient is brought to the family practice clinic by a caregiver. The caregiver reports that the patient complained of palpitations, weakness, and shortness of breath. The patient denles symptoms at the moment. The patient’s heart rate is 136. What is an appropriate action by the nurse practitioner?
* A - Order an ECG and prepare to start the patient on a medication to control heart rate.
* B - Obtaln an ECG, cardiac enzymes, and request a cardiology consult for follow-up.
* C - Obtain an ECG and prepare to transport the patient to the nearest emergency department.
* D - Obtain an ECG and start the patient on an anticoagulant.
- Obtaln an ECG, cardiac enzymes, and request a cardiology consult for follow-up.
The most common complication of insect bites is:
* A - pruritus.
* B - secondary infection.
* C - eczema.
* D - erythema.
secondary infection
First-time caregivers of a newborn infant are seeking recommendations for car seat use. The correct response is that:
A - a child should be secured in a rear-facing car safety seat in the backseat until they reach the highest weight or height allowed by their
* B - the Infant car seat may be secured in the back or front seat, but must be rear-facing.
O c - the infant car seat may be front-facing when the infant is 1 year old.
* D - a front-facing infant car seat secured in the back seat s acceptable as long as the restraint system is intact.
- a child should be secured in a rear-facing car safety seat in the backseat until they reach the highest weight or height allowed by their
Medications used in the treatment of erythema infectiosum include:
A - nonsteroidal anti-Inflammatory drugs (NSAIDs) and topical antihistamines.
* B - topical steroids and antibiotics.
* c - oral antibiotics and antinistamines.
* D - oxygen and intravenous immunoglobin.
nonsteroidal anti-Inflammatory drugs (NSAIDs) and topical antihistamines.
Which of the following characteristics is NOT associated with the development Type 2 diabetes mellitus (T2DM)?
* A - The birth of a macrosomic infant
* B - Being of Hispanic or Native American descent
* c - Alcohol or other drug abuse
* D - Family history of T2DM in a first-degree relative
alcohol and drugs
An early indication of diabetic nephropathy is elevated:
A - serum creatinine.
* B - serum albumin.
* c - urinary microalbumin.
* D - urinary protein.
urinary microalbumin.
An 8-year-old patient presents with several rounded, dome-shaped, pink waxy papules on the upper chest and left arm. They are approximately 2-3 mm in diameter. Through further examination, the NP identifles papules that are umbilicated and contain a caseous plug. This condition is most likely to be:
* A - pyoderma..
* B - verruca vulgarls.
* C - epidermal cyst.
D - molluscum contaglosum.
D - molluscum contaglosum
A 2-year-old child is being evaluated by the nurse practitioner. His clinical appearance and history are consistent with sickle cell anemia. What is the most appropriate laboratory test to diagnose sickle cell anemia?
A - Hemoglobin electrophoresis
* B - CBC with peripheral smear
* c - Hemoglobin S solubility testing
D - Haptoglobin level
Hemoglobin electrophoresis
Which drug class is most effective in alleviating rhinorrhea assoclated with the common cold?
* A - Antihistamines
* B - Oral decongestants
* C - Topical decongestants
D - Nasal corticosteroids
C
A female patient presents with painful vesicular lesions on the vulva. Which of the following would be the most specific and sensitive in detecting herpes simplex virus?
* A - KOH slide preparation
* B - Nucleic acid amplification test, PCR assay for HSV DNA
* c - Scraping for Tzanck prep
* D - Cell culture
Nucleic acid amplification test, PCR assay for HSV DNA
Subsequent to successful completion of the nurse practitioner certification exam, the candidate is considered to be:
* A - licensed.
B - certified.
C - credentialed.
D - incident to.
certified.
An adult patient with diabetes has periorbital cellulitis secondary to a sinus nfection. What course of action should the nurse practitioner take?
O A - Dilate the eye to assess for increased intracular pressure.
* B - Refer the patient to an ophthalmologist.
* C - Initiate amoxicillin clavulanate (Augmentin) 875 mg orally twice a day for 14 days.
* D - Have the patient transported to the emergency department.
Have the patient transported to the emergency department.
A 13-year-old patent reports light vaginal bleeding. Which of the following would NOT be part of the initial evaluation?
O A - Urine pregnancy test
O B- Urinalysis
O C- Pelvic examination
D - Palpation of thyroid
Palpation of thyroid
A 37-year-old patient has a negative rubella titer. How long after immunization should the patient avold pregnancy?
A - 28 days
B - 60 days
C - 90 days
D - 120 days
28
A healthy 4-week-old infant has experienced continuous ipsilateral eye tearing for the past 3 days. On exam, no evidence of purulence, erythema, or swelling Is present. The most appropriate recommendation by the NP is:
* A - regular nasolacrimal duct massage.
* B - an ophthalmic antibacterial agent.
* c - an ophthalmic steroid combination.
* D - a referral to a pediatric ophthalmologist.
regular nasolacrimal duct massage.
Which of the following statements about antiretroviral therapy during the acute phase of HIV infection is true?
* A - Antiretroviral therapy during the acute phase increases the size of the viral reservoir.
OB - The risks of starting antiretroviral therapy during the acute phase outweigh the benefits.
* c - Antiretroviral therapy during the acute phase reduces the risk of nfectiousness to others
D - Immune function is not necessarily preserved if antiretroviral therapy Is started during the acute phase of HIV.
Antiretroviral therapy during the acute phase reduces the risk of nfectiousness to others
A patient newly dlagnosed with Type 2 diabetes is referred to a diabetes nurse educator and completes the initial educational program. The need for further education is indicated if the patient says which of the following?
O A - “My body has developed resistance to my own insulin.”
* B - *1 may notice some weight loss as my diabetes gets under better control.”
© c- ‘One of my medicines could make my blood sugar drop too low, so I will keep some candy in my purse.
* D - ‘It is more important for me to focus on intake of sugars and carbohydrates than the number of calories.”
1 may notice some weight loss as my diabetes gets under better control.”
A patient has a history of cryptorchidism. Which of the following is NOT a potential sequela of cryptorchidism?
* A - Impaired spermatogenesis
O B - Testicular cancer
* c - Erectile dysfunction
* D - Testicular torsion
Erectile dysfunction
A college student presents to the campus health clinic with a generalized rash on the trunk. The student states that the rash began as around ringworm.” The lesions are oriented in a Christmas tree pattern and are mildly pruritic. What is this patient’s diagnosis and how should they be treated?
* A - Tinea corporis: treat with a topical antifungal cream for 10 to 14 days.
* B - Atopic dermatitis: treat with a topical corticosterold.
* c - Viral exanthem: no specific treatment is needed except rest and fluids.
D - Pityriasis rosea: treat with a topical antipruritic.
Pityriasis rosea: treat with a topical antipruritic.
A patient with epididymitis was empirically treated with ceftriaxone and doxycycline for 10 days. The results of the NAAT test for gonorrhea and chlamydia are now available and are positive. The NP should advise the patient to:
A - go to the pharmacy and pick up an additional prescription for azithromycin.
* B - begin taking ciprofoxacin in addition to the doxycycline.
* c - complete the course of doxycycline and return in 2-3 months for test of cure.
* D - stop the doxycycline and begin taking levoloxacin.
C
A patient with a history of frequent sun exposure presents with a multicolored lesion on their back. It has irregular borders and is about 11 mm in diameter. What should the nurse practitioner suspect?
* A - Squamous cell carcinoma
* B - Malignant melanoma
C - Actinic keratoses
* D - Basal cell carcinoma
malignant melanoma
The nurse practitioner is providing follow-up care for a 12-month-old child who experienced seizure activity 3 days ago. The seizure lasted less than a minute. At. the time of the seizure, the patient was diagnosed with a viral infection. No additional seizure activity has occurred, and the illness has resolved. The nurse practitioner appropriately explains to the parents that:
* A - the child should take antiseizure medication prophylactically for the next month.
* B - the seizure may impact cognitive function as the child develops.
* C - this type of seizure activity exists only in the presence of an elevated body temperature.
* D - the recurrence risk of another febrile seizure is 90% within the first year after this seizure.
this type of seizure activity exists only in the presence of an elevated body temperature.
A 58-year-old male presents with complaints of nocturnal enuresis. The nurse practitioner should assess for medications that can decrease bladder contractility or cause detrusor underactivity. These may include:
* A - diltiazem (Cardizem).
* B - testosterone cypionate (Depo-testosterone)
* c - bupropion hydrochloride (Wellbutrin SR).
* D - pseudoephedrine (Sudafed).
Sudafed
A breastfeeding parent tells the provider about a night out planned for this weekend. The patient requests information on alcohol use and breastfeeding. The nurse practitioner advises the patlent:
* A - daily alcohol use is the most worrisome.
* B - to pump and discard breast milk for 48 hours after the last alcohol was consumed.
* C - that even a small amount of alcohol is transferred and breastfeeding should be delayed for 2-3 hours after consuming even one glass of wine.
* D - that it depends on the type of alcohol and the breastfeeding parent’s age, because these factors determine how quickly the alcohol is metabolized.
- C - that even a small amount of alcohol is transferred and breastfeeding should be delayed for 2-3 hours after consuming even one glass of wine.
If a female patient accidentally takes two combined oral contraceptive pills in a day, the patient should be instructed to:
* A - skip 1 day and then resume the pill pack.
* B - resume dosing with the next daily pill on the next day.
* C - skip 2 days of dosing, then resume the pill pack.
* D - discard this pack and start a new pack the following day.
resume dosing with the next daily pill on the next day.
When assessing a patient with a chief complaint of cough, the most important historical question to ask is:
* A - Is the cough productive?
* B - When is the cough most severe?
* c - How long have you had the cough?
* D - Do you have any other symptoms?
How long have you had the cough?
When considering catch-up vaccinations for a child who has never received any vaccinations, the initial step is to determine which vaccinations are needed based on:
* A - risk factors.
* в - age.
* c - number of vaccinations missed.
О.
D - immune status.
age.
A patient has experienced nausea and vomiting, headache, malaise, low-grade fever, abdominal cramps, and diarrhea for 32 hours. The patient’s white blood cell count is slightly elevated, with a shift to the left. The most approprate intervention Is to:
* A - prescribe an antidiarrheal agent and a proton pump inhibitor and recommend a clear liquid diet for 24 hours.
* B - order a stool culture and, once obtained, initiate a broad-spectrum antibiotic.
* c - prescribe an antlemetic medication and provide Instruction about oral fluid and electrolyte replacement.
* D - order serology tests, ultrasound of the abdomen, and begin a nitroimidazole antibiotic.
prescribe an antlemetic medication and provide Instruction about oral fluid and electrolyte replacement.
A 23-year-old patient is being evaluated by the nurse practitioner for Immunization status. The patient has documentation of completion of IPV DTaP, and MMR serles.
The patient states, “I got a shot when I was 12 years old, but none since.” Which vaccine(s) should the patient receive today?
* A - Td
* B - HBV and Hib
* c - Hib and Ta
* D - Td and HBV
Td and HBV
A 38-year-old female reports low sexual desire and difficulty reaching orgasm.
Which of the following medications is likely to contribute to these symptoms?
O A - Levothyroxine (Synthroid)
* B - Buspirone (Buspar)
* C - Escitalopram (Lexapro)
* D - Metoprolol (Lopressor)
- Escitalopram (Lexapro)
A parent brings their 3-year-old child to the nurse practitioner to ask whether it is normal for the child to still have an umbilical hernia. The hernia is easily reducible and has not Increased in size. The approprate response by the nurse practitioner is that:
A - this Is a normal finding. It will probably resolve before the child is 5 years old.
* B - this is a normal finding. If it has not resolved in the next 6 months, the child will be referred to a surgeon for repair.
* C - this is an abnormal finding at this age. I will refer the child to the surgeon of your choice.
* D - this is an abnormal finding, but it will probably resolve with use of an umbilical belt at night while the child sleeps.
this Is a normal finding. It will probably resolve before the child is 5 years old.
Which of the following patients with a confirmed first incidence of a urinary tract Infection requires further Imaging studles?
* A - A 6-month-old female who is afebrile after 48 hours of antibiotic treatment
* B - A 6-month-old male who remains febrile after 72 hours of antiblotic treatment
* C - A 3-year-old female who is febrile after 48 hours of antibiotic treatment
* D - A 4-year-old male who is afebrile after 72 hours of antibiotic treatment
SUBMIT
- A 6-month-old male who remains febrile after 72 hours of antiblotic treatment
A frequent cause of death in patients with anorexia nervosa is:
* A - starvation.
B - suicide.
* c - sepsis.
* D - renal failure.
B - suicide.
Which disease process is most commonly associated with Bouchard’s nodes?
* A - Rheumatoid arthritis
* B - Systemic lupus erythematosus
* C - Osteoarthritis
* D - Gouty arthritis
OA
In a presentation that is suspicious for rheumatic fever in a child, the nurse practitioner would NOT expect to find:
* A - an elevated C-reactive protein.
* B - a temperature greater than 101°F.
* C - a painful rash on the abdomen.
* D - complaints of joint pain.
a painful rash on the abdomen.
Which characteristic is typical of the murmur associated with aortic stenosis?
* A - It radiates toward the apex of the heart.
* B - It Is always associated with shortness of breath.
* c - It is best heard at the aortic listening point.
* D - It is a diastolic murmur.
It is best heard at the aortic listening point.
Which of the following is LEAST Ikely to contribute to vitamin B12 deficiency and pernicious anemia?
O A - Administration of proton pump Inhibitors
* B - Helicobacter pylori infection.
* C - Strict vegan diet
D - Chronic laxative use
Chronic laxative use
At a routine visit, the examination findings for a 1-month-old Infant are unremarkable except for three medium-brown macular lesions on the upper back and the right side of the chest. The lesions appear to have smooth edges and range in size from 0.2 to 0.5 cm in diameter. The nurse practitioner suspects:
* A - neurofibromatosis.
* B - café au lait spots.
* c - dermal melanocytosis (formerly referred to as “Mongolian spots”).
* D - melanoma.
café au lait spots.
Which of the following medications may trigger an asthma exacerbation?
O A - Triptans (serotonin receptor agonists)
* B - Ophthalmic timolol maleate (Timoptic)
* C - Angiotensin-converting enzyme (ACE) inhibitors
* D - Acetaminophen (Tylenol)
B
A 6-month-old infant presents with generalized erythematous papular lesions on the wrists and the flexural surfaces of the arms and legs. The infant’s caregiver states that the child is constantly scratching the affected areas. The nurses suspects:
O A - scables.
B - atopic dermatitis.
C - impetigo.
D - contact dermatitis.
atopic dermatitis
The hyperinsulinemia and insulin resistance associated with metabolic syndrome cause all of the following EXCEPT:
O A - pear-shaped weight gain pattern and peripheral edema.
© B - hypertriglyceridemia, reduced HDL, and Increased LDL.
c - high levels of serum fatty acids stored as fat.
*..
D - hypertension, atherosclerotic plaque formation, and coronary artery disease.
pear shaped weight gain and pattern of peripheral edema
Primary hypertension without a known underlying disease is most common in:
O A - Infants.
* B - toddlers.
* c - school-aged children.
* D - adolescents.
adolescents
A patient reports right flank pain that began 2 days ago and has progressively worsened. On examination of the area, the nurse practitioner Identifies papular fluid-filled lesions that are confluent and linear. The nurse practitioner would appropriately order a(n):
* A - narcotic medication.
* B - topical analgesic.
C - oral antiviral.
* D - topical steroid cream.
oral antiviral
A nurse practitioner is providing guidance to a patient newly diagnosed with diabetes. The patient’s diabetes is being managed with Insulin. The nurse practitioner would be correct to tell the patient to self-treat signs and symptoms of hypoglycemia with:
* A - 5 grams of sugar, or 1 Life Saver candy.
* B - 8 grams of sugar, or 2 teaspoons of granulated sugar.
C - 15 grams of sugar, or 5 Life Saver candles.
* D - 30 grams of sugar, or 1 cup of orange juice.
15 grams of sugar, or 5 Life Saver candles.
A patient in the 23rd week of pregnancy presents with a productive cough. The nurse practitioner suspects acute bronchitis and recommends:
© A - high-dose amoxicillin..
* B-a cool mist humidifler.
* C - over-the-counter cough lozenges.
* D - Robitussin-DM.
cool mist humidifier
Which of the following laboratory tests is useful in the diagnosis of spontaneous abortion?
* A - Serial quantitative beta human chorionic gonadotropin levels
* B - Qualitative plasma estradiol levels
* C - Plasma dehydroeplandrosterone sulfate (DHEA-S) levels
* D - Qualitative plasma human chorionic gonadotropin levels
Serial quantitative beta human chorionic gonadotropin levels
Which of the following is an appropriate medication for the initial on-demand treatment of an adult with reflux symptoms that occur an average of twice weekly?
* A - Famotidine (Pepcid)
* B - Sucralfate (Carafate)
* c - Metoclopramide (Reglan)
* D - Omeprazole (Prilosec)
A
Pharmacotherapeutics of drug therapy in the older adult are affected by an Increase in:
* A - total body water.
* B - lean muscle mass.
* C - hepatic blood flow.
* D - percent of body fat.
- percent of body fat.
A most significant barrier to the diagnosis and appropriate management of depression In the older adult population is:
* A - the belief that depression is inherent to the aging process.
* B Fithe serlous side effects associated with antidepressant medications.
* C - the risk of drug-drug interactions due to polypharmacy.
* D - poor patient adherence as a result of cognitive impairment.
the belief that depression is inherent to the aging process.
A critically ill patient states “my family is well provided for.” The nurse practitioner must Interpret this as meaning the patient:
* A - Is suicidal!
* B - wishes to discuss the topic of death.
C - is no longer interested in treatment.
D - is depressed.
wishes to discuss the topic of death
A 32-year-old male reports a 3-day history of urinary frequency and burning on urination. Urinalysis reveals bacteriuria and positive nitrites. The empiric first-line treatment should be:
* A - trimethoprim-sulfamethoxazole (Bactrim) for 7 to 10 days.
* B - ciprofloxacin (Cipro) for 3 to 5 days.
* c - trimethoprim-sulfamethoxazole for 3 days.
* D - ceftriaxone (Rocephin) IM x 1 and azithromycin (Zithromax).
trimethoprim-sulfamethoxazole (Bactrim) for 7 to 10 days.
After hearing the news that they are pregnant, a patient remarks, “I’m not in good enough shape to have a baby. How can I get in shape?” The nurse practitioner would appropriately advise her to:
O A - Join an aerobic exercise class.
B - begin walking about three times per week with a family member or friend.
* c - take yoga or tai chi classes for mental and physical relaxation.
OD - avold exertion, because adequate rest is more important.
B - begin walking about three times per week with a family member or friend.
A patient with shortness of breath has suspected heart failure (HF). The initial diagnostic measure that will best help in confirming this suspicion is a(n):
* A - brain natriuretic peptide (BNP).
* B - electrocardiogram (ECG).
* C - CPK (creatine phosphokinase).
* D - chest X-ray (CR).
brain natriuretic peptide (BNP).
A patient is taking a combined hormonal oral contraceptive to prevent pregnancy.
The patient should be instructed that a backup method of contraception should be used:
* A - if they experience symptoms of pelvic inflammatory disease.
* B - if irregular menses occurs.
* c - if amoxicillin-clavulanate (Augmentin) is prescribed for a sinus infection.
* D - if two consecutive doses of the oral contraceptive are missed.
if two consecutive doses of the oral contraceptive are missed.
Postexposure prophylaxis should be offered to sexual partners and needle sharing partners of a patient who was just diagnosed with HIV if they have had contact within the past:
* A - 72 hours.
O B - 7 days.
* C - 14 days.
* D - 21 days.
72 hours
Which of the following is NOT a component of the diagnostic criteria for Meniere’s
* A - At least two episodes of vertigo lasting 20 minutes to 12 hours
* B - Symptoms of high-frequency hearing loss, tinnitus or bilateral ear fullness
* C - Fluctuating symptoms of reduced or distorted hearing, tinnitus, or fullness in the affected ear
* D - Audiometrically documented low- to mid-frequency sensorineural hearing loss in the affected ear
Symptoms of high-frequency hearing loss, tinnitus or bilateral ear fullness
A patient is receiving timolol maleate (Timoptic) for chronic open-angle glaucoma.
When prescribing propranolol (Inderal), the nurse practitioner should educate the patient about which risk factor?
* A - Blurred vision
* B - Elevated intraocular pressure
* C - Bradycardia
* D - Exacerbation of prostate hyperplasia
Bradycardia
A patient with diabetes is taking low-dose enalapril (Vasotec) to manage hypertension. A record of the patient’s blood pressure over 4 weeks ranges from 140 mm Hg to 145 mm Hg systolic and 85 mm Hg to 95 mm Hg diastolic. How should the nurse practitioner respond?
* A - Add a second medication, such as an angiotensin receptor blocker, to the regimen.
* B - Increase the dosage of the current antihypertensive medication.
* C - Continue the current medication and dosage for 4 more weeks.
* D - Add a thiazide diuretic to the current medication regimen.
- Add a second medication, such as an angiotensin receptor blocker, to the regimen.
The hyperinsulinemia and insulin resistance associated with metabolic syndrome cause all of the following EXCEPT:
* A - pear-shaped weight gain pattern and peripheral edema.
* B - hypertriglyceridemia, reduced HDL, and increased LDL.
* c - high levels of serum fatty acids stored as fat.
* D - hypertension, atherosclerotic plaque formation, and coronary artery disease.
pear-shaped weight gain pattern and peripheral edema.
The AUDIT-C is a questionnaire containing three questions. It is used in primary care to assess:
* A - alcohol use disorders.
* B - types of headaches.
* c - dementia as differentiated from depression.
* D - cognitive dysfunction.
alcohol use disorders.
The nurse practitioner is caring for a 19-year-old patient with iron deficiency anemia secondary to heavy menstrual bleeding. The MOST appropriate initial treatment for this patient is:
A - a combined oral contraceptive.
* B - daily oral multivitamin with iron.
* C - oral ferrous sulfate.
* D - to educate the patient about the need for increased intake of dietary iron.
oral ferrous sulfate.
A guardian brings their 6-month-old infant to the nurse practitioner because of concerns that the infant’s vaginal opening appears small. Physical examination is essentially negative except for the presence of labial adhesions. The nurse practitioner is concerned about urinary obstruction. The most appropriate intervention at this time is to:
* A - recommend labial separation under local anesthesia.
* B - apply conjugated estrogen cream to the vaginal labia for 2 weeks.
* c - provide instruction in perineal hygiene.
* D - refer to a pediatric gynecologist.
apply conjugated estrogen cream to the vaginal labia for 2 weeks.
Which of the following set of symptoms should raise clinical suspicion for a brain tumor?
* A - Focal headaches that awaken the patient from sleep and are accompanied by clear nasal discharge
* B - Vague, dull headaches that are accompanied by a reported sense of impending doom
* c - Periorbital headaches occurring primarily in the evening and accompanied by pupillary dilation and photophobia
* D - Holocranial headaches that are present in the morning and accompanied by projectile vomiting without nausea
Holocranial headaches that are present in the morning and accompanied by projectile vomiting without nausea
The most significant finding in the history of a patient being evaluated for possible cerebral vascular accident (CVA) is:
* A - family history of cerebral aneurysm.
* B - history of migraine headaches.
* c - history of atrial fibrillation.
* D - history of trigeminal neuralgia.
history of atrial fibrillation.
Which immunization(s) is(are) contraindicated in a patient who is immunodeficient?
1. Varicella 2. inactivated polio vaccine (IPV) 3. Measles, mumps, rubella (MMR) 4.Hepatitis B (HBV)
* A - 4
* B - 1,3
* C-1,3,4
* D - All of the above
1,3
A college freshman who lives in the dormitory was recently treated for scabies infestation with permethin (Nix). After being asymptomatic for 2 weeks, the patient returns with complaints of itching and new skin burrows. How should the nurse practitioner proceed?
* A - Have the patient re-treat the living environment; no further topical treatment is warranted.
* B - Advise the patient that this is likely a continuation of the previous infestation and prescribe hydrocortisone cream to decrease itching.
* C - Tell the patient that itching can last 2 to 4 weeks after the infection is cleared.
* D - Tell the patient that this is likely a reinfestation and he will need to be retreated with permethrin (Nix).
Tell the patient that this is likely a reinfestation and he will need to be retreated with permethrin (Nix).
A 60-year-old male with glaucoma returns for follow-up of hypertension. The nurse practitioner notes several elevated blood pressure readings on his log. Today’s blood pressure reading is 160/92 mm Hg. The nurse practitioner is considering long-acting propranolol (Inderal), but before prescribing it, should ask the patient:
* A - whether he smokes or consumes alcohol on a daily basis.
B - what other medications have been prescribed for him.
* c - if he has been experiencing any frontal headaches.
* D - if he has experienced any loss of peripheral vision.
what other medications have been prescribed for him.
Which of the following statements about asymptomatic bacteriuria (ABU) is true?
* A - High-risk patients should be screened periodically for ABU.
* B - ABU may be caused by increased uropathogens in the postmenopausal vagina and introitus.
* C - Untreated ABU increases morbidity and mortality.
* D - Antibiotic treatment of ABU reduces the frequency of symptomatic urinary tract infection.
ABU may be caused by increased uropathogens in the postmenopausal vagina and introitus.
Nurse practitioners are permitted to perform male circumcisions in some states but not in others. This is related to:
* A - standards of practice.
B - scope of practice.
C - prescriptive authority.
scope of practice.
A young adult presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across three thoracic dermatomes. The patient complains of pain, burning, and itching. The nurse practitioner should suspect:
* A - bullous pemphigoid and refer to a dermatologist.
* B - toxicodendron radicans and prescribe a topical corticosteroid.
C - herpes zoster and order testing for HIV.
* D - varicella recurrence and treat the symptoms.
- herpes zoster and order testing for HIV.
A child and their caregiver each have several 10-cm round, reddened skin patches with central clearing. The rash presents on the trunk in a Christmas tree-shaped pattern. The caregiver has been treating the rashes with over-the-counter topical steroid cream without success. The nurse practitioner’s best response is to:
* A - prescribe an antifungal cream and advise continued use for 7 days after symptoms subside.
* B - educate the patient that there is no recommended treatment for this rash. It will spontaneously resolve in 4-8 weeks.
* C - reassure the patient that this is a viral rash and prescribe an oral antiviral to accelerate the healing process.
* D - refer to dermatology for further evaluation to rule out causes of contact dermatitis.
- educate the patient that there is no recommended treatment for this rash. It will spontaneously resolve in 4-8 weeks.
The nurse practitioner examines a 2-month-old infant and observes unequal gluteal and thigh skinfolds with decreased abduction on the right side. Initially, the nurse practitioner should:
* A - send the infant for bilateral hip X-rays.
* B - order an ultrasound of both hips.
* C - perform Ortolani and Barlow maneuvers.
* D - refer the infant to a pediatric orthopedist.
perform Ortolani and Barlow maneuvers.
At what age does vision normally become approximately 20/20?
* A - 1 year
O B - 2 years
O c - 4 years
* D - 6 years
6
Screening for increased intraocular pressure or early glaucoma is:
A - performed with tonometry only.
* B - indicated only if symptoms such as eye pain or vision are noted.
* C - recommended every 1-3 years starting at age 40.
* D - part of the routine physical examination of an adult.
recommended every 1-3 years starting at age 40.
A pregnancy of 6 weeks’ gestation is confirmed in a moderately overweight patient.
The patient asks the nurse practitioner, “Should I diet so I won’t gain too much weight during this pregnancy?” The nurse practitioner appropriately responds:
* A - “It is probably a good idea to wait until the second trimester before initiating a diet for weight loss.”
B - “A weight gain of approximately 25 pounds is ideal for both you and baby.”
* c - “It doesn’t matter how much weight you gain or lose as long as you eat a well-balanced diet.”
* D - “Just try to limit your weight gain as much as you are able.”
A weight gain of approximately 25 pounds is ideal for both you and baby.”
Routine monitoring of a patient receiving isotretinoin does NOT include:
* A - liver function tests.
B - serum cholesterol checks.
* C - complete blood cell count.
* D - triglyceride measurement.
CBC
Anticipatory guidance for children aged 4 to 12 years should focus primarily on:
* A - disease prevention.
* B - discipline.
* c - injury prevention.
* D - nutrition.
injury prevention.
Medications used in the treatment of erythema infectiosum include:
A - nonsteroidal anti-inflammatory drugs (NSAIDs) and topical antihistamines.
* B - topical steroids and antibiotics.
* c - oral antibiotics and antihistamines.
* D - oxygen and intravenous immunoglobin.
A - nonsteroidal anti-inflammatory drugs (NSAIDs) and topical antihistamines.
Which refractive error is commonly associated with the normal aging process?
* A - Myopia
* B - Astigmatism
C - Presbyopia
D - Hyperopia
Presbyopia
Combined oral contraceptives should not be initiated within the first 21 days postpartum because:
* A - they may interfere with lactation.
* B - they may delay uterine shrinkage.
* c - their use is associated with an increased risk of venous thromboembolism.
* D - they may potentially worsen postpartum depression.
their use is associated with an increased risk of venous thromboembolism.
When educating the caregivers of children with sickle cell disease about the importance of preventing vaso-occlusive crisis, the nurse practitioner should stress that:
* A - limiting physical activity is paramount.
* B - trace mineral supplementation should be included in the diet.
C - diligent hydration and analgesic use is necessary.
* D - home schooling is strongly recommended for infection control.
diligent hydration and analgesic use is necessary.
The nurse practitioner correctly diagnoses iron deficiency anemia in a patient whose lab report identifies:
A - an increased reticulocyte count.
* B - a mean corpuscular volume (MCV) >100 fL.
* c - hemoglobin (Hgb) 14.0 mg/dL (140g/L).
* D - an increased total iron binding capacity (TIBC).
an increased total iron binding capacity (TIBC).
An adult patient with diabetes reports bilateral pain in the lower legs while walking.
The pain disappears at rest. On physical examination, the nurse practitioner would expect to find:
* A - an increase in the ankle-brachial index.
* B - diminished pedal pulses, cool, dry skin, and atrophied calf muscles.
* c - normal nail growth and muscle density.
* D - thickened toenails and skin below the knee with brownish discoloration.
diminished pedal pulses, cool, dry skin, and atrophied calf muscles.
A sexually active patient reports vaginal discharge. The cardinal presenting symptom of pelvic inflammatory disease is:
* A - dysuria.
* B - low back pain.
* c - abnormal uterine bleeding.
* D - lower abdominal pain.
lower abdominal pain.
The nurse practitioner notes several patchy, scaly, raised, irregularly-shaped lesions on sun-exposed areas of an older adult patient. The nurse practitioner suspects:
A - seborrheic keratosis.
* B - melanocytic nevus.
* C - malignant melanoma.
D - actinic keratosis.
actinic keratosis
A 3-year-old child presents with fever, anemia, and a palpable mass in the right upper quadrant of the abdomen. During the abdominal examination, the NP identifies mild pain on palpation. A urine specimen shows hematuria. The child’s body temperature is 100°F. The most likely diagnosis is:
A - urinary tract infection (UTI).
* B - pediatric functional abdominal pain.
* C - a Wilms tumor.
* D - vesicoureteral reflux.
a Wilms tumor.
Which of the following signs and symptoms is typical of hyperthyroidism?
A - Increased perspiration
* B - Myalgias
* c - Paresthesia
D - Lethargy
Increased perspiration
A 64-year-old patient has a sudden onset of right eye pain, blurred vision, and dilated pupil. The most likely diagnosis is acute:
* A - open-angle glaucoma.
B - angle-closure glaucoma.
C - retinal detachment.
D - uveitis.
angle closure glaucoma
Which drug class is most effective in the treatment of very high triglyceride levels (hypertriglyceridemia) of >650 mg/dL?
* A - Bile acid sequestrants
* B - Nicotinic acid
* C - Fibrates
* D - HMG-COA reductase inhibitors
Fibrates
Children younger than 6 months old who are diagnosed with developmental hip dysplasia and present with hip instability on examination are initially treated with:
* A - watchful waiting until age 1 year.
* B - surgical open reduction followed by pelvic and/or femoral osteotomy.
* C - a variety of adduction orthoses.
* D - the Pavlik harness, with reduction confirmed by ultrasound.
the Pavlik harness, with reduction confirmed by ultrasound.
The caregiver for a 75-year-old patient reports that the patient has trouble falling asleep and roams the house at night. The patient has fallen twice. According to the Beers Criteria, which of the following medications would be the most effective and safe to treat insomnia in an older adult patient?
* A - Doxepin (Silenor)
* B - Diphenhydramine (Benadryl)
* C - Lorazepam (Ativan)
* D - Zolpidem (Ambien)
Doxepin (Silenor)
The nurse practitioner suspects cholecystitis in a patient with risk factors including female sex, obesity, a high-fat diet and typical complaints of:
* A - generalized abdominal pain that radiates to the right lower quadrant.
* B - right upper quadrant pain that radiates to the right scapula.
* c - umbilical pain that radiates to the left lower flank.
* D - epigastric pain that radiates to the left upper quadrant.
right upper quadrant pain that radiates to the right scapula.
A patient received a prescription for fluoxetine (Prozac) 2 months ago, when diagnosed with a first episode of major depression. The patient reports considerable improvement in symptoms and states an intention to discontinue the medication. Which action should the nurse practitioner take at this time?
* A - Advise the patient to stop the antidepressant medication.
* B - Before advising the patient to discontinue the medication, question them to determine whether their self-assessment is correct.
* c - Recommend that the patient continue the antidepressant medication for at least 4 more months.
* D - Discuss with the patient the need to take the antidepressant medication indefinitely.
Recommend that the patient continue the antidepressant medication for at least 4 more months.
A test of cure for patients with a diagnosis of gonorrhea should be performed if the patient is treated with:
* A - the recommended therapies and the infectious site is urogenital.
* B - the recommended therapies and the infectious site is rectal.
* C - an alternative therapy and the infectious site is rectal.
* D - an alternative therapy and the infectious site is pharyngeal.
an alternative therapy and the infectious site is pharyngeal.
An adult patient with diabetes has periorbital cellulitis secondary to a sinus infection. What course of action should the nurse practitioner take?
* A - Dilate the eye to assess for increased intraocular pressure.
* B - Refer the patient to an ophthalmologist.
* C - Initiate amoxicillin clavulanate (Augmentin) 875 mg orally twice a day for 14 days.
* D - Have the patient transported to the emergency department.
Have the patient transported to the emergency department.
An example of primary prevention is:
A - providing an adolescent with information about sexually transmitted diseases.
* B - performing a testicular exam on an adolescent during a sports physical.
* C - instructing an adolescent to perform a self- examination of the breasts.
* D - performing a urine pregnancy test on a 14-year-old female who reports having vaginal intercourse with a male partner.
providing an adolescent with information about STD
The nurse practitioner is performing a routine assessment of an adult patient who wants to lose weight. The patient has truncal obesity and a BMI of 38. Upon review of the patient’s history, physical examination, and laboratory reports, the nurse practitioner diagnoses metabolic syndrome. The characteristic that is NOT part of the diagnostic criteria for metabolic syndrome is:
* A - a low HDL level and elevated triglycerides.
* B - hyperinsulinemia.
* c - hypertension.
D - irregular menses.
Irregular menstruation
Which of the following is an appropriate medication for the initial on-demand treatment of an adult with reflux symptoms that occur an average of twice weekly?
* A - Famotidine (Pepcid)
* B - Sucralfate (Carafate)
* C - Metoclopramide (Reglan)
* D - Omeprazole (Prilosec)
Famotidine (Pepcid)
A caregiver is planning the weekly meals for an older adult with a history of diverticulosis. Which of the following foods should NOT be on the menu?
* A - Eggs
B - Bran cereal
* c - Yogurt
* D - Brown rice
Cc
Which of the following is NOT a component of the fetal biophysical profile?
* A - Gestational age estimate
* B - Fetal tone
* C - Amniotic fluid volume
* D - Fetal movements
Gestational age estimate
An adolescent presents with abdominal pain and complaints of nausea and vomiting. A complete blood count (CBC) reveals moderate leukocytosis. Which assessment finding may be identified in this patient?
* A - A positive Murphy’s sign
* B - A positive shifting dullness test
* C - A positive Murphy’s punch test
* D - A positive psoas sign
A positive psoas sign
The appropriate initial treatment for a child presenting with a severe head injury is:
* A - prevention of seizure activity with prophylactic anticonvulsant medication.
* B - preventing loss of consciousness, which is the most important determinant of neurologic recovery.
* c - resuscitation and then maintenance of oxygenation and blood flow.
* D - normalization of intracranial pressure, followed by intracranial pressure monitoring.
resuscitation and then maintenance of oxygenation and blood flow.
Which of the following statements is NOT accurate when educating a nonpregnant patient about folic acid deficiency anemia?
* A - Folic acid is the synthetic form of vitamin B2.
* B - Foods high in folate include broccoli and eggs.
* C - Oral folic acid of 1-5 mg daily is recommended to treat deficiency.
* D - Folic acid replacement may be given orally or parenterally.
Folic acid is the synthetic form of vitamin B2.
The preferred therapeutic regimen for a pregnant patient diagnosed with Chlamydia trachomatis infection is:
A - doxycycline 100 mg orally twice a day for 7 days.
* B - penicillin G 1.2 million units x 1 dose.
* C - a single IM dose of ceftriaxone (Rocephin) 500 mg.
* D - a single dose of azithromycin (Zithromax) 1 gram orally.
a single dose of azithromycin (Zithromax) 1 gram orally.
A 28-year-old sexually active female presents for a well examination. The patient reports a history of three sexual partners and no new partners in the past 6 months.
This patient should be screened for:
* A - syphilis.
* B - trichomonas.
* C - HIV.
* D - Neisseria gonorrhoeae.
HIV
Which physical modality recommended in the treatment of rheumatoid arthritis provides the most effective long-term pain relief?
* A - Superficial and deep heat
* B - Massage
* C - Transcutaneous electrical nerve stimulation (TENS)
* D - Exercise
exercise
A patient presents with a wound sustained while building a fence. The patient has completed a primary vaccination series and had a Td booster 3 years ago. Does the patient need a Td booster today?
- A - No, expert opinion supports vaccination after a contaminated wound when more than 5 years have elapsed since the last Td vaccine.
A preadolescent patient presents with a history of pharyngitis treated 2 weeks ago and a temperature of 102°F for the past 2 days. Examination reveals bilateral tender, swollen knees, a pinkish red macular rash on the upper abdomen and chest, a heart rate of 95 beats/minute, and a holosystolic murmur that is best audible at the apex of the heart. Based on these symptoms, the most appropriate initial pharmacologic approach would be to administer:
* A - intravenous immunoglobulin (IVIG).
* B - long-acting intramuscular penicillin.
* c - high-dose corticosteroid.
* D - an anticoagulant.
long-acting intramuscular penicillin.
A patient has chronic prostatitis. What is the initial drug treatment of choice for this
A - Ciprofloxacin (Cipro)
* B - Doxycycline (Vibramycin)
* C - Amoxicillin (Amoxil)
* D - Nitrofurantoin (Macrodantin)
- Ciprofloxacin (Cipro)
A 17-year-old patient is brought into the clinic by their guardian, who has consented to allowing the adolescent to get a tattoo if the nurse practitioner identifies no medical concerns or consequences. The NP should:
* A - advise against getting a tattoo due a history of congenital heart disease.
* B - determine the patient’s immunization status against hepatitis B.
* C - confirm that the patient has received their tetanus vaccine.
* D - test for sexually transmitted diseases, including a hepatitis panel.
determine the patient’s immunization status against hepatitis B.
A nurse who has worked in the intensive care unit (ICU) for the last 10 years has just earned their master’s degree in nursing with a concentration as a family nurse practitioner (FNP). As an FNP, which of the following settings is the new NP NOT prepared to practice in?
* A - Urgent care
* B - Health maintenance organization
* C - Intensive care unit
* D - School-based clinic
Intensive care unit
An 8-year-old female presents with severe injuries that are inconsistent with the explanation given by the child’s caregiver. Upon further questioning, the caregiver states that the child’s other guardian caused the injuries. Once the child’s condition is stabilized, the nurse practitioner should:
* A - report the incident to local child protection authorities.
* B - isolate the child from all caregivers until authorities arrive.
* C - ask whether the guardian who is present has also been abused.
* D - separate the guardian from the child and question the child alone.
report the incident to local child protection authorities.
On examination of the skin of an adult patient, assessment findings include several erythematous eruptions with scaly, flaky yellowish plaques over the nasolabial fold, scalp, and eyebrows. The nurse practitioner suspects:
* A - herpes zoster.
* B - tinea corporis.
C - seborrheic dermatitis.
* D - psoriasis.
seborrheic dermatitis.
Which statement is true about treatment for external genital warts caused by human papillomavirus (HPV) in a nonpregnant patient?
* A - Treatment of active genital warts will help prevent infertility.
* B - Once treated effectively, warts are not likely to recur.
* C - Topical acyclovir (Zovirax) is the appropriate treatment.
* D - Most warts will spontaneously resolve without treatment.
Most warts will spontaneously resolve without treatment.
Home monitoring of pulmonary air flow changes by the patient with asthma is best determined by:
* A - report of nighttime symptoms.
* B - measurement of lung capacity by incentive spirometer.
* c - peak expiratory flow rate (PEFR).
* D - frequency of rescue inhaler use.
peak expiratory flow rate (PEFR).
Which of the following statements about nicotine replacement therapy (NRT) is true?
02:21:26
A - The benefits of NRT outweigh the risks because NRT does not contain the harmful chemicals in tobacco products.
* B - Nicotine replacement should only be offered to smokers who are unsuccessful after three attempts to stop smoking.
* C - The use of nicotine replacement should be discouraged in smokers with cardiovascular disease.
* D - Dependence on NRT is as much of a concern as tobacco dependence.
SUBMIT
The benefits of NRT outweigh the risks because NRT does not contain the harmful chemicals in tobacco products.
Which activities are NOT characteristic of preschool children in their current developmental stage?
* A - Social, cooperative, and shared play
* B - Independent toileting with occasional accidents
* C - Always following rules during playground games
* D - Use of security objects
Always following rules during playground games
A patient presents with a complaint of urinary incontinence. Urinary tract infection has been ruled out. Which of the following circumstances does NOT warrant referral to a specialist?
O A - Pelvic pain
* B - Microscopic hematuria
* C - Increased sensation of bladder fullness
* D - Persistently increased postvoid residual
Increased sensation of bladder fullness
In a presentation that is suspicious for rheumatic fever in a child, the nurse practitioner would NOT expect to find:
* A - an elevated C-reactive protein.
* B - a temperature greater than 101°F.
* C - a painful rash on the abdomen.
a painful rash on the abdomen.
A patient with a history of frequent sun exposure presents with a multicolored lesion on their back. It has irregular borders and is about 11 mm in diameter. What should the nurse practitioner suspect?
* A - Squamous cell carcinoma
* B - Malignant melanoma
* C - Actinic keratoses
* D - Basal cell carcinoma
Malignant melanoma
The long-term prognosis for a patient with a diagnosis of dementia is:
* A - unpredictable, because the condition is characterized by remissions and exacerbations.
* B - dependent on the cause of the dementia.
* C - variable, depending on the family history and other comorbidities.
D - poor, because cognitive deterioration is progressive and irreversible.
poor, because cognitive deterioration is progressive and irreversible.
Acute complicated urinary tract infection may be differentiated from an uncomplicated urinary tract infection by the presence of:
* A - urinary frequency or urgency.
* B - pelvic pain.
* c - pyuria.
D - flank pain.
flank pain.
A diagnosis of depression is MOST likely in the adult patient who:
* A - responds to affection from family.
B - prefers to stay at home.
* c - retains humor.
* D - accepts assistance and care.
prefers to stay at home.
Certification for nurse practitioners is offered through:
* A - the American Nurses Association.
* B - individual state boards of nursing.
* C - national certifying organizations.
* D - universities providing graduate education.
- national certifying organizations.
At what age is it appropriate to begin administering the pneumococcal conjugate vaccine (PCV13 or Prevnar13)?
A - 2 months as a routinely scheduled vaccine
* B - 12 years if immunocompetent
* C - 20 years if a healthcare worker
D - 50 years
2 months as a routinely scheduled vaccine
Which assessment finding is NOT typical in a patient with psoriasis?
O A - Pruritus
* B - Positive Auspitz sign
* C - Pitted nails
D - Satellite lesions
Satellite lesions
An adult patient presents with recurrent atrial fibrillation. The patient’s digoxin level has decreased from 1.4 to 0.4 ng/dL. The atrial fibrillation has been well controlled for more than a year, with digoxin levels at 1.4 to 1.5 ng/dL. The likely cause of the decreased digoxin level and decreased therapeutic effect is:
A - taking sucralfate for gastric irritation.
* B - switching from a brand to a generic form of digoxin.
C - a decrease in creatinine clearance.
* D - a decrease in body mass index.
B
A patient who is experiencing daily symptoms of asthma with nocturnal awakenings more than once per week is classified as having:
* A - intermittent asthma.
* B - mild persistent asthma.
* c - moderate persistent asthma.
D - severe persistent asthma.
moderate persistent asthma.
The treatment of choice for all stages of syphilis is:
A - ceftriaxone (Rocephin).
B - parenterally delivered penicillin G.
* c - penicillin delivered by any route.
* D - azithromycin (Zithromax).
parenterally delivered penicillin G.
A 3½-year-old healthy male presents with a history of continuous unsuccessful attempts at toilet training. The child experiences urinary incontinence at least once daily and a few nights weekly. The child has been continent of stool for the past 2 months. Urine dipstick results are within normal limits. The nurse practitioner correctly documents a diagnosis of:
* A - age-appropriate bladder control.
* B - primary enuresis.
* C - secondary enuresis.
* D - nocturnal enuresis.
age-appropriate bladder control. ??
The guardian of a full-term 3-day-old infant is concerned about the baby. Birth history reveals an uneventful vaginal delivery. The symptom that would be cause for concern is:
* A - a serosanguineous vaginal discharge.
* B - bluish-purple discoloration on the lips when crying.
* c - a thumbnail-sized opening on the posterior fontanel.
* D - a disconjugate eye gaze.
bluish-purple discoloration on the lips when crying.
Which class of drugs increases a patient’s risk for developing rhabdomyolysis?
* A - Nonsteroidal anti-inflammatories
* B - Thiazide diuretics
* C - HMG-CoA reductase inhibitors
D - Anticoagulants
HMG-CoA reductase inhibitors
When assessing a patient with acute low back pain, the most reliable indicator(s) of neurologic deficit is (are):
* A - a straight leg raise test.
0
B - a vibratory sensation test and spinal tenderness.
C - deep tendon reflexes, strength, and sensation.
D - proprioception and changes in bowel and bladder function.
- deep tendon reflexes, strength, and sensation.
The LEAST likely assessment finding in a patient with acute epididymitis is:
* A - a reactive hydrocele.
B - testicular pain.
C - negative cremasteric reflex.
* D - positive Prehn sign.
negative cremasteric reflex.
A patient attended a health screening at a local church and was told they have
“high cholesterol.” The patient’s total cholesterol (nonfasting) was 275 mg/dL.
Which action is most appropriate for the nurse practitioner?
* A - Order a fasting lipid profile, because this finding is most reflective of true triglyceride levels.
* B - Obtain a high-density lipoprotein (HDL) level in order to determine the patient’s cardiovascular risk.
* C - Initiate niacin and fish oil capsules, along with lifestyle modifications.
* D - Encourage lifestyle modifications to decrease total cholesterol levels.
SUBMIT
- Order a fasting lipid profile, because this finding is most reflective of true triglyceride levels.
A patient reports right flank pain that began 2 days ago and has progressively worsened. On examination of the area, the nurse practitioner identifies papular fluid-filled lesions that are confluent and linear. The nurse practitioner would appropriately order a(n):
A - narcotic medication.
B - topical analgesic.
* C - oral antiviral.
* D - topical steroid cream.
- oral antiviral.
Social determinants of health include:
* A - physical barriers, especially for people with disabilities.
* B - exposure to toxic substances.
* c - safe housing.
D -Social determinants of health include:
* A - physical barriers, especially for people with disabilities.
* B - exposure to toxic substances.
* c - safe housing.
D - access to healthcare services.
access to health care services
A patient complains of fever and throat pain. Bilateral exudate is present on the tonsils. The patient describes having an anaphylactic reaction to penicillin in the past. Which antibiotic should the nurse practitioner prescribe if she believes the causative agent is bacterial?
* A - Amoxicillin-clavulanate (Augmentin)
* B - Erythromycin
* C - Cefadroxil monohydrate (Duricef)
* D - Ceftriaxone (Rocephin)
Erythromycin
The LEAST likely physical finding associated with Kawasaki disease is:
* A - body temperature greater than 101°F for 5 days.
* B - nontender cervical lymphadenopathy.
* c - painful rash and edema of the feet.
* D - arthralgia.
B
A female patient presents with painful vesicular lesions on the vulva. Which of the following would be the most specific and sensitive in detecting herpes simplex virus?
* A - KOH slide preparation
* B - Nucleic acid amplification test, PCR assay for HSV DNA
* C - Scraping for Tzanck prep
* D - Cell culture
Nucleic acid amplification test, PCR assay for HSV DNA
The parents of a 2-year-old child report that the toddler is not saying any words but makes sounds, babbles, and understands simple commands. The child’s guardians are not concerned. The nurse practitioner responds:
* A - “Your child should be saying a few words by this time. The child should be referred for further assessment of speech and hearing.”
* B - “Your child should be saying a few words by this time. We will wait another 3 to 6 months and observe for further progress.”
C - “Your child’s language skills are not as developmentally advanced as we would expect. Speech therapy is recommended.”
* D - “Your child should be referred to an ear, nose, and throat specialist to assess hearing.”
“Your child should be saying a few words by this time. The child should be referred for further assessment of speech and hearing.”
A patient with hepatic cirrhosis presents with pedal edema. The patient reports that their partner prepares all meals. A typical day of food consists of: oatmeal and half a small apple for breakfast; a ham-and-cheese sandwich with baked chips and sweetened ice tea for lunch; and a bowl of fresh vegetable soup followed by fresh fruit for dinner. The patient states that they do not salt to their food. The food that is most likely causing the edema is the:
* A - sweetened tea.
* B - ham and cheese.
* C - fresh vegetable soup.
* D - oatmeal.
ham and cheese
A patient with Type 2 diabetes mellitus has sporadically recorded blood glucose levels in their glucose diary for the past 3 months. Every reading is between 100 and 140 mg/dL (5.6-7.8 mmol/L). A glycosylated hemoglobin of 14% for this patient would indicate:
A - that this patient is not likely reporting accurate readings of their blood glucose.
* B - that the patient’s postprandial blood glucose levels are 200 mg/dL.
* C - that the patient has had poor control of blood glucose for the last 2 weeks.
* D - that the patient’s average blood glucose has been >300 mg/dL over the past 2-3 months.
that the patient’s average blood glucose has been >300 mg/dL over the past 2-3 months.
The sign of neurofibromatosis (von Recklinghausen disease) that is present in almost 100% of affected patients is:
* A - acoustic neuroma.
* B - infantile hemangiomas.
* C - astrocytoma of the retina.
* D - cafe au lait spots.
cafe au lait spots.
The sign of neurofibromatosis (von Recklinghausen disease) that is present in almost 100% of affected patients is:
* A - acoustic neuroma.
* B - infantile hemangiomas.
* C - astrocytoma of the retina.
* D - cafe au lait spots.
cafe au lait spots.
A child between the ages of 0 and 3 years is at highest risk for developing dental caries if the:
* A - parent has active caries and doesn’t provide fluoride to the child.
* B - child has special healthcare needs.
* c - child has more than three sugary snacks a day.
* D - child is put to bed with a bottle containing a beverage containing sugar.
child bed with bottle with sugar
A child presents with a history of pharyngitis treated 2 weeks ago and a temperature of 102°F for the past 2 days. Examination reveals tender, swollen bilateral knees, a heart rate of 95 beats/minute, and a holosystolic murmur that is best audible at the apex of the heart. The MOST appropriate diagnostic study to order at this time is:
* A - an echocardiogram.
* B - a chest X-ray.
* c - an antistreptolysin-O (ASO) titer.
* D - a blood culture.
Echo
The leading cause of chronic kidney disease in the United States is:
* A - hypertension.
B - diabetes.
* c - polycystic kidney disease.
* D - medication use.
DM
A 6-month-old infant presents with a soft, short systolic murmur. The nurse practitioner considers this to be an innocent murmur because the murmur:
* A - is of low intensity.
* B - is audible after S2.
* c - diminishes when the infant is supine.
* D - is accompanied by a systolic thrill.
low intensity
A 30-year-old patient started taking bisoprolol (Zebeta) for symptomatic mitral valve prolapse 3 days ago. A common initial and transient complaint among patients who take bisoprolol is:
A - fatigue.
O B- flushing.
* c - reflex tachycardia.
* D - lower extremity edema.
fatigue
A simple case of impetigo and folliculitis can be successfully treated with:
* A - systemic antibiotics.
* B - topical antibiotics.
* c - antiseptic body wash.
D - debridement and irrigation.
topical abx
Which of the following clinical findings is consistent with a diagnosis of hypoparathyroidism?
* A - Headaches and diplopia
* B - Positive Chostek’s sign
* C - Polyuria with hypercalciuria
* D - Hypotonic deep tendon reflexes
positive chosteks sign
When evaluating an infant or child for suspected talipes equinovarus, radiographic images should be obtained:
* A - while weight bearing.
* B - only if the foot cannot be manipulated.
* c - with oblique views.
* D - while non-weight bearing.
A
A patient with heart failure (HF) presents with symptoms of mild heart failure exacerbation. The patient takes Prinivil (lisinopril, metoprolol (Lopressor), ASA, and low-dose furosemide every morning. The LEAST likely cause of this patient’s exacerbation is:
* A - three skipped doses of Prinivil.
* B - daily ibuprofen dosing to manage pain associated with knee arthritis.
* C - atrial fibrillation.
D - taking three doses of calcium carbonate the day before.
taking three doses of calcium carbonate the day before.
A 65-year-old patient presents with a history of alcoholism, hemoglobin 10 g/dL (100 g/L), and mean corpuscular volume (MCV) 110 fL. These laboratory values are most consistent with which of the following?
* A - Thalassemia major
* B - Anemia of chronic disease
* C - Iron deficiency anemia
* D - Folic acid deficiency anemia
Folic
A 2-week-old infant with a history of a traumatic vaginal delivery is brought to the clinic for evaluation. The parents state that the infant fusses when handled or picked up. The NP notes decreased movement of the right arm with assessment of the Moro reflex and crepitus on palpation of the right clavicle. Imaging studies reveal a simple fracture of the right clavicle. The nurse practitioner should:
* A - apply a “figure 8” clavicle brace for 6 to 8 weeks.
* B - apply a shoulder/trunk spica cast.
* C - inform the parents that this type of fracture requires no treatment.
* D - refer the patient to an orthopedic surgeon.
no treatmetn
The nurse practitioner diagnoses epididymitis in a 24-year-old sexually active patient. The empirical antibiotic treatment of choice for this patient is:
* A - oral ciprofloxacin (Cipro).
* B - oral doxycycline (Vibramycin) plus intramuscular ceftriaxone.
* c - oral trimethoprim-sulfamethoxazole (Bactrim).
* D - intramuscular penicillin.
oral doxycycline (Vibramycin) plus intramuscular ceftriaxone.
Which of the following psychiatric diagnoses is the LEAST likely to be a risk factor for suicide?
O A - Depression
* B - Bipolar disorder
* c - Obsessive-compulsive disorder
* D - Substance use disorder
OCD
Question #113
The greatest known risk factor for hepatitis B infection among adolescents in the United States is:
A - alcohol use.
* B - intravenous drug use.
C - tattooing and piercings.
* D - unprotected sexual activity.
unprotected sexual activity.
A professional liability insurance policy that provides coverage for injuries arising from incidents occurring during the period the policy was in effect, even if the policy subsequently expires or is not renewed by the policy holder, is termed a(an):
* A - claims made policy.
* B - individual policy.
* c - occurrence-based policy.
* D - supplemental policy.
claims made policy.
A patient who has 20/80 visual acuity can see:
* A - at 20 feet what a person with normal vision can see at 60 feet.
* B - at 80 feet what a person with normal vision can see at 20 feet.
* C - at 20 feet what a person with normal vision can see at 80 feet.
*
20 feet person can see at 80 feet
Which diagnostic test is necessary for the confirmation of Meniere’s disease?
A - Magnetic resonance imaging
B - Vestibular testing
C - Audiometry
D - Serum viral panels
C
Children who are at risk for developing Type 2 diabetes are least likely to present with:
A - acanthosis nigricans.
* B - hypertension.
C - weight loss.
* D - dyslipidemia.
Which diagnosis would be included in the differential for a patient with heavy albuminuria and minimal or absent hematuria?
A - Glomerulonephritis
* B - Diabetic nephropathy
* C - Acute tubular necrosis
* D - Acute kidney injury
Diabetic nephropathy
A pregnant patient asks if it will be safe to breastfeed her infant while she takes methadone maintenance medications for opioid dependence syndrome. The nurse practitioner advises:
* A - to avoid breastfeeding while receiving methadone.
* B - that the ability to breastfeed will depend on the status of the newborn.
* c - to consider weaning off the methadone to promote bonding with infant.
* D - that breastfeeding is acceptable as long as the breastfeeding parent’s nutritional status is adequate.
that breastfeeding is acceptable as long as the breastfeeding parent’s nutritional status is adequate.
A 6-month-old infant was diagnosed with three café au lait spots on the back and chest 4 months ago and returns for re-evaluation of the lesions. The nurse practitioner observes four more lesions ranging in size from 0.2 to 1 cm. The nurse practitioner should:
* A - refer the infant to a pediatric dermatologist.
* B - refer the infant to a pediatric geneticist.
* C - inform the guardians that these lesions are precursors to melanomas.
* D - inform the guardians that surgical removal of the lesions will be necessary as the infant grows.
refer to geneticist
A 6-year-old female presents with rib fractures that are inconsistent with the explanation given by the child’s guardian. The nurse practitioner suspects child abuse and should:
* A - report the suspected abuse to child protection authorities.
* B - perform an additional screening to look for risk factors for abuse.
* C - ask another provider to perform an assessment and find out if they are concerned about possible abuse.
* D - report to the social worker and ask them to talk to the child’s. social worker.
refer to authorities
A very active patient has painful hemorrhoids. The patient’s job requires frequent travel. Which of the following foods is the MOST appropriate to recommend for this patient?
* A - Dairy products, corn, chia seeds
* B - White bread, potatoes, fruit juices
C - Whole grains, fresh fruit, nuts and seeds
* D - Meat, poultry and fish
Whole grains, fresh fruit, nuts and seeds
Which symptom is associated with hyperthyroidism?
* A - Cold intolerance
* B - Myalgias
C - Frequent stools
D - Lethargy
Frequent stools
A 13-year-old patient reports light vaginal bleeding. Which of the following would NOT be part of the initial evaluation?
* A - Urine pregnancy test
* B - Urinalysis
* C - Pelvic examination
* D - Palpation of thyroid
palpation of thyroid
Which behavior would NOT be expected in a 2-year-old child?
* A - Kicking a ball
* B - Running around a corner without falling down
* C - Riding a tricycle
* D - Climbing on a chair and standing up to reach an object
riding a trike
The guardian of a 16-year-old high school student athlete is concerned that the adolescent has not had a menstrual period yet. On physical examination, the nurse practitioner finds normal growth and development, including appropriate secondary sexual characteristics. What is the most action by the NP?
* A - Refer to a endocrinologist.
* B - Order a pelvic ultrasound.
* C - Attempt a progesterone challenge.
* D - Prescribe an oral contraceptive.
progesterone challenge
The signs and symptoms of severe chronic heart failure are NOT likely to include:
* A - malnutrition or cachexia.
* B - systemic venous hypertension, resulting in ascites.
* c - tricuspid regurgitation.
D - increased systolic arterial pressure.
increased systolic arterial pressure.
A patient with chronic obstructive pulmonary disease (COPD) presents for follow-up. The patient reports stopping salmeterol (Serevent), a long-acting beta agonist (LABA), because the side effect of “heart racing” was bothersome. The nurse practitioner could consider switching to:
* A - a long-acting muscarinic antagonist (LAMA).
* B - a different long-acting beta agonist.
* C - a combination LAMA/LABA.
* D - an inhaled corticosteroid.
- A - a long-acting muscarinic antagonist (LAMA).
A female patient is diagnosed with pelvic inflammatory disease. The patient’s sexual partners):
* A - does not require partner treatment.
* B - should be treated after the causative organism is determined.
* C - should be empirically treated for chlamydia and gonorrhea.
* D - only requires treatment if they are symptomatic.
should be empirically treated for chlamydia and gonorrhea.
Medicare-approved private insurance that provides coverage for outpatient prescription drug benefits is known as Medicare Part:
D
Provided no contraindications are present, which medication regimen is MOST appropriate for the outpatient management of acute biliary colic related to cholecystitis in a patient who is awaiting surgery?
* A - Ketorolac (Toradol) IM at visit, followed by oral ibuprofen as needed
* B - Ketorolac (Toradol) IM at visit, followed by oxycodone and acetaminophen (Percocet) as needed
* C - Meperidine (Demerol) IM at visit, followed by hyoscyamine (Levsin)
as needed
D - Meperidine (Demerol) IM at visit, followed by omeprazole (Prilosec) as needed
A
A 2-year-old child is diagnosed with Haemophilus influenzae type b (Hib) meningitis. The sick child, as well as two siblings who are younger than 4 years, have not been immunized against Hib. The nurse practitioner should initiate rifampin (Rifadin) prophylaxis for:
* A - all close contacts younger than 2 years.
* B - all household contacts, including the adults.
* C - both siblings regardless of age.
* D - only the parents.
both siblings regardless of age.
A patient with a history of mitral valve prolapse is scheduled for routine dental cleaning. According to the American Heart Association’s guidelines for endocarditis prophylaxis, what should the nurse practitioner advise this patient?
* A - The patient should receive prophylaxis on the day of their dental cleaning.
* B - The patient does not need prophylaxis for any dental procedures.
* C - The patient should receive prophylaxis on the day before and the day of their cleaning.
* D - The patient needs prophylaxis only for tooth extraction and deep dental procedures.
The patient needs prophylaxis only for tooth extraction and deep dental procedures.
Anogenital warts that are flat, papular, or pedunculated are usually diagnosed via:
A - biopsy.
B - visual inspection.
C - staining.
D - culture.
visual
A symptomatic patient has tested positive for gonorrhea. When a patient is diagnosed with gonorrhea, the sexual partners of the patient who require treatment are those with whom sexual contact occurred:
* A - in the 60 days preceding symptom onset.
* B - in the prior 30 days.
* C - in the week preceding symptom onset.
* D - in the prior 6 months.
60 days
A female patient asks “How do I calculate my ideal body weight?” The nurse practitioner appropriately answers:
* A - Start with 100 pounds and add 5 pounds for every inch in height over 5 feet.
* B - Add 6 pounds for every inch over 5 feet, then add 100 pounds.
* C - Start with 100 pounds and add 10 pounds for every inch in height over 5 feet.
* D - Multiply your height in inches times 2.
- A - Start with 100 pounds and add 5 pounds for every inch in height over 5 feet.
A 15-year-old male presents with a chief complaint of right lower quadrant pain.
The patient complains of nausea and is unable to fully lie flat for abdominal examination due to pain. A complete blood count identifies moderate leukocytosis.
The MOST likely diagnosis is:
* A - acute gastroenteritis.
* B - ulcerative colitis.
* c- renal calculi.
D - acute appendicitis.
acute appendicitis
Urethritis is most commonly caused by:
A - Escherichia coli.
* B - Klebsiella species.
* C - Pseudomonas aeruginosa.
D - Neisseria gonorrhoeae.
N gonorrhoeae
The process by which the nurse practitioner requests to be reimbursed for services provided is known as:
A - empaneling.
* B - certification.
C - credentialing.
* D - privileging.
credentialing
The most prevalent nonviral sexually transmitted infection in the United States is:
A - bacterial vaginosis (BV).
* B - trichomoniasis.
* c - herpes simplex.
* D - syphilis.
Trich
Which statement about breastfeeding is NOT accurate?
A - An infant with hyperbilirubinemia should not be breastfed.
* B - A breastfeeding parent with flat or inverted nipples may be able to breastfeed.
* c - Improper positioning of the infant can result in the breastfeeding parent having sore nipples.
* D - A breastfeeding parent with a plugged milk duct should not stop breastfeeding.
An infant with hyperbilirubinemia should not be breastfed.
A patient complains of urinary incontinence. Which characteristic supports a diagnosis of stress incontinence?
* A - Frequent small-volume voids
* B - Strong urge to urinate and an inability to make it to bathroom
* C - No urge to void, but urine leakage with laughing or sneezing
* D - Urinary frequency and involuntary loss of urine without warning
No urge to void, but urine leakage with laughing or sneezing
Which of the following screenings is not necessary in a female patient recently diagnosed with HIV?
* A - Trichomoniasis
* B - Syphilis
* c - Cervical cancer
D - Breast cancer
breast cancer
Health maintenance organizations (HMOs):
* A - provide coverage specific to wellness and preventive care.
* B - provide insured members with a wide choice of providers and coverage.
c- are always high-deductible plans.
D - empanel providers to provide in-network care at reduced cost.
empanel providers to provide in-network care at reduced cost.
A 4-month-old infant presents with several blue-black macular lesions over the buttocks and lower back area. The nurse practitioner suspects congenital dermal melanocytosis (formerly referred to as “Mongolian spots”) but should include in the differential diagnosis:
* A - café au lait spots.
* B - idiopathic thrombocytopenic purpura.
- child abuse
* D - hemangioma.
child abuse
The nurse practitioner assesses a 43-year-old patient, who is determined to have a
10-year cardiovascular risk score of 3.5 (low risk). The patient asks if they would benefit from taking aspirin 325 mg every day to prevent a myocardial infarction.
What should the nurse practitioner recommend?
* A - Daily aspirin at a dose of 81 mg will decrease the risk of having an early cardiovascular event.
* B - Numerous studies support the use of 325 mg of aspirin daily for the primary prevention of cardiovascular events.
* C - The risks associated with daily aspirin outweigh the benefits in the primary prevention of cardiovascular events.
* D - Daily aspirin may be indicated if the patient has hypertension and hyperlipidemia.
The risks associated with daily aspirin outweigh the benefits in the primary prevention of cardiovascular events.
The recommended alternative treatment regimen for a patient who tests positive for gonorrhea and has an allergy to macrolide antibiotics is dual therapy with ceftriaxone (Rocephin) and:
* A - azithromycin (Zithromax).
B - clarithromycin (Biaxin).
C - doxycycline (Doryx).
* D - cefixime (Suprax).
doxycycline (Doryx).
A patient with chronic atrial fibrillation takes a generic version of Coumadin (warfarin). The NP should advise the patient about consuming:
* A - carbonated beverages.
B - green tea.
C - milk.
D - caffeine.
Green tea
Which of the following are characteristic of patients with type 2 diabetes? 1. Beta cell destruction 2. High body mass 3. Central obesity 4. Unexplained weight loss 5.
Insulin resistance
A - 1, 2, 3
B - 2, 3, 5
C - 1, 4, 5
D - 1, 3, 4
2,3,5
A 4-year-old male returns for a 6-week follow-up visit after being diagnosed with Kawasaki disease. During the physical examination, the nurse practitioner notes normal vital signs and no rash or edema on the feet. Laboratory results show a normal sedimentation rate. The nurse practitioner documents that this child is in the:
* A - acute stage of the illness.
* B - subacute stage of the illness.
* C - prodrome stage of the illness.
* D - convalescent stage of the illness.
convalescent stage
Evaluation of a heart murmur’s pitch should be made by classifying its frequency.
Using the diaphragm of the stethoscope, the nurse practitioner auscultates a mild to moderate-pitched systolic ejection murmur audible over the upper left sternal border (ULSB) and radiating to the back. These findings are MOST consistent with:
A - pulmonary stenosis.
B - mitral valve insufficiency.
C - aortic stenosis.
D - tricuspid regurgitation.
pulmonary stenosis.
The parents of a 2-year-old child report that the toddler is not saying any words but makes sounds, babbles, and understands simple commands. The child’s guardians are not concerned. The nurse practitioner responds:
* A - “Your child should be saying a few words by this time. The child should be referred for further assessment of speech and hearing.”
* B - “Your child should be saying a few words by this time. We will wait another 3 to 6 months and observe for further progress.”
* c - “Your child’s language skills are not as developmentally advanced as we would expect. Speech therapy is recommended.”
* D - “Your child should be referred to an ear, nose, and throat Specialist to assess hearing.”
“Your child should be saying a few words by this time. The child should be referred for further assessment of speech and hearing.”
log back in your exam will resume at the last question answered. Your timer will continue to
run.
Question #13
The evaluation of growth and development in children of all ages is performed routinely to identify red flags or delays. The child who would warrant further examination is the:
A - 7-year-old female with vaginal bleeding.
B - 9-year-old female who has experienced her first menstrual period.
* C - 10-year-old female who has not reached thelarche.
* D - 12-year-old male who has not experienced spermarche.
7 year old with bleeding
Nurse practitioner services are filed with Medicare for reimbursement:
and paid by medicare part B
Which refractive error is commonly associated with the normal aging process?
presbyopia
Which class of drugs increases a patient’s risk for developing rhabdomyolysis?
C - HMG-CoA reductase inhibitors
Which of the following statements about tuberculosis (TB) testing is accurate?
A - A positive skin test reaction indicates exposure to tuberculosis but is not a diagnostic of active tuberculosis.
* B - Frequent serial X-rays are required to monitor progression of tuberculosis lesions in the lungs when the TB skin test is positive.
* C - The result of the TB skin test is NOT affected by a history of Bacillus Calmette-Guerin vaccine administration.
* D - A positive skin test reaction means that the area of erythema was greater than 10 mm in diameter at 48 hours.
A positive skin test reaction indicates exposure to tuberculosis but is not a diagnostic of active tuberculosis.
An 18-year-old nonpregnant patient has irregular menstrual cycles that vary in volume and duration. What should be included in the differential diagnosis?
* A - Adenomyosis
* B - Uterine leiomyoma
C - Polycystic ovarian syndrome
* D - Endometrial polyp
POS
The most effective treatment for anemia of chronic disease is:
* A - iron replacement therapy.
B - treatment of the underlying disease.
* C - an oral folate supplement.
* D - glucocorticosteroid therapy.
treat underlying disease
An 8-year-old female presents with severe injuries that are inconsistent with the explanation given by the child’s caregiver. Upon further questioning, the caregiver states that the child’s other guardian caused the injuries. Once the child’s condition is stabilized, the nurse practitioner should:
* A - report the incident to local child protection authorities.
* B - isolate the child from all caregivers until authorities arrive.
* C - ask whether the guardian who is present has also been abused.
* D - separate the guardian from the child and question the child alone.
report to authorities
Which of the following is true of bacterial vaginosis (BV)?
A - A vaginal pH >4.5 is needed for diagnosis.
* B - The patient with BV has a greenish frothy vaginal discharge.
* C - Pseudohyphae are found on wet prep.
* D - Bacterial vaginosis is only sexually transmitted.
vaginal PH >4.5
When considering catch-up vaccinations for a child who has never received any vaccinations, the initial step is to determine which vaccinations are needed based on:
A - risk factors.
B - age.
C - number of vaccinations missed.
* D - immune status.
age
Which of the following is least likely to be the cause of ophthalmia neonatorum?
* A - Haemophilus influenzae infection
* B - Silver nitrate reaction
* C - Chlamydia trachomatis infection
* D - Herpes simplex infection
- Haemophilus influenzae infection
An appropriate initial treatment for benign positional vertigo is:
* A - turning of the head from side to side.
* B - a sodium-restricted diet.
C - an intranasal steroid.
* D - meclizine (Antivert, Bonine).
meclizine
An older adult with a diagnosis of Parkinson’s disease presents for follow-up. The most common nonmotor comorbidity to screen for in this patient is:
A - delusions.
B - hallucinations.
C - anxiety.
D - depression.
depression
A 22-year-old patient reports itchiness in both eyes, erythema of the eyelids, and flaking of the lid margins. The most likely diagnosis is:
* A - conjunctivitis.
* B - dacryostenosis.
C - blepharitis.
D - a chalazion.
blepharitis
When examining a pregnant patient, where should the fundal height be at 22 weeks?
A - Slightly above the symphysis pubis
B - At the level of the umbilicus
* C - Midway between the symphysis pubis and umbilicus
* D - Above the umbilicus
above the umbilicus
Which of the following is NOT a common symptom of carpal tunnel syndrome?
* A - Nocturnal paresthesia
* B - Weakness in the affected hand
C - Feelings of tightness or swelling
* D - Numbness in the last two fingers
Numbness in the last two fingers
A 61-year-old patient with a recent history of sinusitis presents with complaints of nausea and vomiting, fever, and headache that began 24 hours ago. The diagnosis that must be considered is:
* A - migraine headache.
* B - subarachnoid hemorrhage.
* C - temporal arteritis.
D - meningitis.
meningitis
The risk factor that is NOT associated with the development of a first episode of depression in an older adult patient is:
A - social isolation.
B - female sex.
* c - the use of opioids.
* D - sleep deprivation.
C
A 55-year-old male patient presents with dysuria, urgency, perineal pain, and temperature 101 degree F (38.3C). What is the most likely diagnosis?
A - Cystitis
B - Epididymitis
C - Urethritis
D - Prostatitis
prostatitis
An 8-year-old patient presents with several rounded, dome-shaped, pink waxy papules on the upper chest and left arm. They are approximately 2-3 mm in diameter. Through further examination, the NP identifies papules that are umbilicated and contain a caseous plug. This condition is most likely to be:
- molluscum contagiosum.
The treatment of choice for all stages of syphilis is:
* A - ceftriaxone (Rocephin).
B - parenterally delivered penicillin G.
C - penicillin delivered by any route.
* D - azithromycin (Zithromax).
parenterally delivered penicillin G.
Which of the follow conditions is curable with surgical intervention?
A - Ulcerative colitis
B - Celiac disease
C - Crohn’s disease
D - Inflammatory bowel disease
Ulcerative colitis
A 15-year-old patient presents with moderate to severe inflammatory acne vulgaris on the face, back, and chest. The nurse practitioner should prescribe:
A - a topical antibiotic as monotherapy.
* B - combination therapy with benzoyl peroxide and a topical retinoid.
C - a systemic antibiotic.
D - combination therapy with a topical retinoid and an antimicrobial.
combination therapy with benzoyl peroxide and a topical retinoid.
A definitive diagnosis of osteomyelitis is based on:
* A - a known causative injury such as a puncture wound, bite, or decubitus ulcer.
* B - biopsy or culture of the pathogen from blood or bone aspirate.
healing.
* c - general and localized clinical manifestations with prolonged
D - lucent areas identified on plain X-rays.
biopsy or culture of the pathogen from blood or bone aspirate.
A 6-year-old female presents with rib fractures that are inconsistent with the explanation given by the child’s guardian. The nurse practitioner suspects child abuse and should:
* A - report the suspected abuse to child protection authorities.
* B - perform an additional screening to look for risk factors for abuse.
* C - ask another provider to perform an assessment and find out if they are concerned about possible abuse.
* D - report to the social worker and ask them to talk to the child’s social worker.
report the suspected abuse to child protection authorities.
The initial step in the management of peptic ulcer disease (PUD):
* A - is to determine if complications associated with the peptic ulcer are present.
B - is to establish the underlying etiology of the peptic ulcer, which will direct treatment.
* C - is aimed at diminishing prostaglandin synthesis, to allow healing of the stomach mucosa.
* D - is to instruct the patient in a reflux-reducing diet and the absolute avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs).
s to establish the underlying etiology of the peptic ulcer, which will direct treatment.
Which of the following statements is NOT true about biopsy of anogenital warts?
A - Biopsy of anogenital warts should be completed if lesions do not respond to standard therapy.
* B - HPV testing should be completed to determine HPV type.
* C - If the warts worsen during therapy, a biopsy should be completed.
* D - Biopsy is warranted if the patient is HIV positive and the presentation is atypical.
HPV testing should be completed to determine HPV type
An infant is diagnosed with diaper dermatitis. The most appropriate initial intervention would be to apply a topical:
* A - zinc oxide preparation until the rash clears.
* B - antibiotic to the site until the rash clears.
* C - antifungal agent nightly until the rash clears.
* D - steroid cream to the site twice daily until the rash clears.
zinc oxide preparation until the rash clears.
A patient with depression has received treatment and achieved relief of symptoms while on antidepressant medication. Which patient statement indicates a correct understanding of depression?
* A - As long as the medication is working, I do not need psychotherapy.
B - Because this is my first episode of depression, I must remain on medication for about 6 months.
* c - I do not need to be weaned off my antidepressant medication.
* D - I can wean off of the medication as soon as my symptoms
Because this is my first episode of depression, I must remain on medication for about 6 months.
Which of the following is NOT an appropriate treatment for chronic bacterial prostatitis (CBP)?
* A - Doxycycline (Vibramycin)
* B - Ciprofloxacin (Cipro)
* C - Trimethoprim/sulfamethoxazole (Bactrim DS)
* D - Nitrofurantoin (Macrobid)
Nitrofurantoin (Macrobid)
Which diagnostic test is necessary for the confirmation of Meniere’s disease?
* A - Magnetic resonance imaging
* B - Vestibular testing
C - Audiometry
* D - Serum viral panels
Audiometry
Which of the following psychiatric diagnoses is the LEAST likely to be a risk factor for suicide?
* A - Depression
* B - Bipolar disorder
C - Obsessive-compulsive disorder
* D - Substance use disorder
OCD
Which of the following patients would appropriately be diagnosed with isolated systolic hypertension (ISH)?
* A - A 43-year-old patient with a blood pressure of 188/108 mm Hg
* B - A 39-year-old patient with a blood pressure of 148/92 mm Hg
C - A 78-year-old patient with a blood pressure of 204/112 mm Hg
D - A 69-year-old patient with a blood pressure of 156/86 mm Hg
D - A 69-year-old patient with a blood pressure of 156/86 mm Hg
?
A male patient is diagnosed with folliculitis on the bearded part of his face. The nurse practitioner prescribes topical mupirocin (Bactroban) and tells the patient:
* A - the medication should be kept in the refrigerator.
* B - prolonged use of the medication can cause a superinfection.
* C - a referral to a dermatologist is needed.
* D - warm compresses may exacerbate pruritis.
can cause superinfection
A male patient is diagnosed with folliculitis on the bearded part of his face. The nurse practitioner prescribes topical mupirocin (Bactroban) and tells the patient:
* A - the medication should be kept in the refrigerator.
* B - prolonged use of the medication can cause a superinfection.
* C - a referral to a dermatologist is needed.
* D - warm compresses may exacerbate pruritis.
prolonged use of the medication can cause a superinfection.
A pediatric patient presents with honey-colored crusty lesions around the right side of the mouth and extending to the right cheek. The nurse practitioner diagnoses the patient with nonbullous impetigo. The most appropriate intervention would be to:
A - recommend gentle cleansing to remove the crusts of nonbullous impetigo using antibacterial soap and a washcloth.
* B - prescribe a topical antibiotic and instruct the caregiver in providing good wound care with an antibacterial cleanser.
* c - instruct the caregiver on providing good wound care with an antibacterial cleanser and prescribe an oral antihistamine to relieve the itching.
* D - prescribe an oral antihistamine and a topical steroid.
prescribe a topical antibiotic and instruct the caregiver in providing good wound care with an antibacterial cleanser.
A patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem?
* A - Methyldopa (Aldomet)
* B - Insulin
* C - Famotidine (Pepcid)
* D - Albuterol (Salbutamol, Ventolin)
Methyldopa
Provided no contraindications are present, which medication regimen is MOST appropriate for the outpatient management of acute biliary colic related to cholecystitis in a patient who is awaiting surgery?
* A - Ketorolac (Toradol) IM at visit, followed by oral ibuprofen as needed
* B - Ketorolac (Toradol) IM at visit, followed by oxycodone and acetaminophen (Percocet) as needed
* c - Meperidine (Demerol) IM at visit, followed by hyoscyamine (Levsin)
as needed
* D - Meperidine (Demerol) IM at visit, followed by omeprazole (Prilosec) as needed
- Ketorolac (Toradol) IM at visit, followed by oral ibuprofen as needed
Which case of epistaxis is the most concerning?
A - A child younger than 2 years
B - An 8-year-old child with a history of allergies
C - A child with fresh clots in one naris
D - A teenager who uses a nasal decongestant
child under 2
Which one of the following recommendations has been issued by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) about the use of the live attenuated varicella vaccine?
* A - The first dose of the MMR vaccine and the varicella vaccine should be administered together to maintain an efficient immunization schedule.
* B - Children vaccinated between the ages of 12 and 18 months will need a booster at age 12 years.
* C - The varicella vaccine should be issued as a routine two-dose vaccination, with the first dose administered at age 12 months.
* D - Children with a positive history of varicella infection are still considered susceptible and should be vaccinated.
- The varicella vaccine should be issued as a routine two-dose vaccination, with the first dose administered at age 12 months.
Which of the following changes is NOT a normal variant of pregnancy?
A - Decreased cardiac ejection fraction
* B - Increased cardiac output
* C - Expanded blood volume
* D - Reduced systemic vascular resistance
Decreased cardiac ejection fraction
Which of the following presentations warrants emergency referral?
* A - Right inguinal hernia with an associated hydrocele
* B - Indirect inguinal hernia with groin pain during exertion (e.g., lifting)
C - Febrile patient with edematous right femoral hernia
* D - Inguinal hernia appearing in Hesselbach’s triangle.
febrile pt with right femoral hernia
A 12-year-old male presents for a routine exam. Examination reveals that the patient grew approximately 3 inches in the past 2 years. On the genital exam, the patient’s testes measure 3.6 cm and the pubic hairs are coarse and curled over the pubis. The nurse practitioner documents that he is in Tanner Stage:
A - two.
B - three.
C - four.
* D - five.
three
A positive drawer sign supports a diagnosis of:
* A - meniscal tear.
* B - cruciate ligament injury.
* C - osteoarthritis of the knee.
* D - patellar ligament injury.
crucial ligament
After a thorough examination, a 2-month-old breastfed infant is diagnosed with infantile colic. What should be included in the initial education of the child’s guardian about this condition?
* A - Encourage a maternal diet that is low in dairy and wheat and high in soy and shellfish.
* B - Offer 3 ounces of an oral hypotonic glucose and water solution during colic events.
* c - During a colic episode, position the infant so their stomach rests on the guardian’s forearm and they support the infant’s head in the palm of their hand.
* D - Restrict breast and bottle feeding to every 3 hours in frequency and 15 minutes in duration.
uring a colic episode, position the infant so their stomach rests on the guardian’s forearm and they support the infant’s head in the palm of their hand.
An infant should be expected to triple their birth weight by age:
A - 6 months.
B - 10 months.
C - 12 months.
* D - 15 months.
12 months
A 6-month-old infant presents with generalized erythematous papular lesions on the wrists and the flexural surfaces of the arms and legs. The infant’s caregiver states that the child is constantly scratching the affected areas. The nurses
susoects
* A - scabies.
B - atopic dermatitis.
C - impetigo.
* D - contact dermatitis.
atopic dermatitis.
Which of the following symptoms would be an unusual clinical presentation in a patient with cataracts?
A - Increased myopia
* B - Glare intolerance
* C - Scotoma
* D - Irregular or absent red reflex
scotoma
A highly contagious viral illness characterized by the development of pruritic vesicles and papules on the skin, scalp and, less commonly, on mucous membranes, is suspicious for:
* A - scarlet fever.
B - Kawasaki disease.
C - varicella.
* D - rubella.
varicella
A patient was diagnosed with hypertension during the second trimester of pregnancy. If elevated blood pressure persists postpartum, at what point is it considered chronic hypertension?
* A - 2 weeks
* B - 6 weeks
* C - 12 weeks
* D - 16 weeks
12 weels
A patient complains of intermittent “stomach pains” for the past month. When distinguishing between a gastric ulcer and a duodenal ulcer, what question is LEAST important to ask?
A - Does your abdominal pain radiate to your shoulder blade?
* B - Have you had diarrhea or blood in your stool?
* c - Is your stomach pain made worse by eating?
* D - Does your stomach pain wake you up in the early morning?
Does your abdominal pain radiate to your shoulder blade?
Which of the following is LEAST likely to be a risk factor for erectile dysfunction (ED)?
* A - Diabetes mellitus
* B - History of chlamydial infections
* C - Paroxetine (Paxil) use
D - Enalapril (Vasotec) use
hx of chlamydia
A person with 20/80 vision:
* A - is legally blind.
* B - will have difficulty reading a newspaper.
* C - can see perfectly at 80 feet.
D - has poorer vision than someone with 20/40 vision.
has poorer vision than someone with 20/40 vision.
The nurse practitioner is discussing contraception options during lactation with a pregnant patient. Which of the following methods of contraception would NOT be appropriate for use while breastfeeding?
* A - Levonorgestrel
* B - A low-dose oral contraceptive
* C - An intrauterine device
* D - A diaphragm and spermicide
A low-dose oral contraceptive
A young adult patient presents with a fever of 100.2° F, nausea and vomiting, and flank pain. The first-line empiric antibiotic treatment for this patient is:
* A - ciprofloxacin (Cipro) BID for 10 days.
* B - trimethoprim-sulfamethoxazole (Bactrim) BID for 5 days.
* c - nitrofurantoin (Macrobid) 100 mg BID for 14 days.
* D - clindamycin (Cleocin) 300 mg every 6 hours for 7 days.
ciprofloxacin (Cipro) BID for 10 days.
In an affected patient, flexion of the wrist at 90 degrees for 60 seconds reproduces symptoms of:
* A - radiocarpal arthritis.
* B - carpal tunnel syndrome.
* C - a ganglionic cyst.
* D - De Quervain’s tenosynovitis.
carpal tunnel syndrome
On transillumination of the scrotum, the nurse practitioner identifies a hydrocele in a 3-month-old infant. The next step would be to:
* A - refer the patient to a pediatric urologist for surgical repair.
* B - monitor the infant until age 12 months.
* C - inspect the external genitalia for ambiguity.
* D - transilluminate the scrotum with a UV light.
- monitor the infant until age 12 months.
Which of the following laboratory tests is useful in the diagnosis of spontaneous abortion?
* A - Serial quantitative beta human chorionic gonadotropin levels
* B - Qualitative plasma estradiol levels
* C - Plasma dehydroepiandrosterone sulfate (DHEA-S) levels
* D - Qualitative plasma human chorionic gonadotropin levels
- A - Serial quantitative beta human chorionic gonadotropin levels
The most appropriate medications for older adults:
* A - are highly protein bound.
* B - may be dosed once a day.
* C - can be given with meals.
* D - have a narrow therapeutic index.
once a day
An example of an indirect role of the nurse practitioner is:
* A - response to illness and assessment of health status and health risks.
B - An example of an indirect role of the nurse practitioner is:
* A - response to illness and assessment of health status and health risks.
B - educator, administrator, or researcher, influencing the delivery of direct care.
* c - diagnosing actual or potential health problems based on analysis of the data collected.
* D - evaluating the effectiveness of an intervention with the client.
* c - diagnosing actual or potential health problems based on analysis of the data collected.
* D - evaluating the effectiveness of an intervention with the client.
educator, administrator, or researcher, influencing the delivery of direct care.
A caregiver is planning the weekly meals for an older adult with a history of diverticulosis. Which of the following foods should NOT be on the menu?
A - Eggs
B - Bran cereal
* C - Yogurt
* D - Brown rice
C
The nurse practitioner knows that the frail older adult is at high risk for malnutrition.
Which of the following factors does NOT contribute to malnutrition in this population?
* A - Dental health
* B - Cognitive changes
* C - Slower rate of food absorption
* D - Economic factors
slower rate of food absorption
The nurse practitioner suspects migraine headaches in a 6-year-old child. The child complains of experiencing headaches 2-3 times a week over the past 2 months.
The finding MOST consistent with a diagnosis of migraine headaches is:
* A - bifrontal throbbing pain.
* B - localized facial pain and ataxia.
* c - problems at home, school, and with peers.
* D - ipsilateral rhinorrhea and lacrimal tearing.
bifrontal throbbing pain.
The sign of neurofibromatosis (von Recklinghausen disease) that is present in almost 100% of affected patients is:
A - acoustic neuroma.
B - infantile hemangiomas.
C - astrocytoma of the retina.
D - cafe au lait spots.
cafe au lait spots.
Nurse practitioners are permitted to perform male circumcisions in some states but not in others. This is related to:
* A - standards of practice.
B - scope of practice.
C - prescriptive authority.
* D - reimbursement.
scope of practice
Which of the following is NOT a component of the fetal biophysical profile?
A - Gestational age estimate
* B - Fetal tone
* C - Amniotic fluid volume
* D - Fetal movements
gestational age
Which of the following factors is not associated with female sexual dysfunction?
A - A prior history of sexual abuse
B - A lack of privacy
C - Conflict within a relationship
* D - A prior history of sexually transmitted disease
prior hx of STD
The nurse practitioner performs a routine physical examination on a preschool-aged child. The NP palpates a hard, painless mass in the abdomen, along with lymph node enlargement and lower limb paresis. Blood and imaging studies identify markers for neuroblastoma. What information is correct to give to the child’s guardians?
A - The diagnosis must be confirmed by tissue biopsy or by bone marrow aspiration, plus urine or serum catecholamine levels.
* B - Neuroblastoma is the final diagnosis, based on physical examination and blood and imaging markers.
* C - Signs and symptoms, along with the blood imaging markers, define the tumor as stage D: metastasis beyond lymph nodes.
* D - The prognosis is poor, based on the likelihood that there is metastasis to the bone.
The diagnosis must be confirmed by tissue biopsy or by bone marrow aspiration, plus urine or serum catecholamine levels.
During the physical examination of a 67-year-old patient, the NP notes hearing loss. The patient states that the hearing loss has been progressive and that hearing high-pitched voices is the most difficult. The patient also reports difficulty localizing sound. The most likely diagnosis for this patient’s symptoms is:
* A - otosclerosis.
* B - Meniere disease.
* c - presbycusis.
* D - conductive hearing loss.
presbycusis.
A postmenopausal patient has atrophic vaginitis. The patient has a history of breast cancer at age 40. What is the appropriate initial treatment for this patient?
A - Vaginal progestin cream
B - Oral medroxyprogesterone acetate
C - Topical medroxyprogesterone acetate
vaginal conjugate estrogen cream
After a thorough physical examination, a child is diagnosed with recurrent abdominal pain. Patient and parent counseling should include:
* A - acknowledgment that the pain is real, although there is no known physical cause.
* B - extensive education about inflammatory bowel diseases and the appropriate medications for treatment.
* c - a list of high-fiber foods that are to be avoided in the child’s diet.
* D - the need to encourage the child to sit on the toilet a half-hour after eating for approximately 20 minutes once or twice a day.
acknowledgment that the pain is real, although there is no known physical cause.
Which red blood cell (RBC) index is most useful for differentiating types of anemias?
* A - Mean corpuscular volume (MCV)
* B - Mean corpuscular hemoglobin concentration (MCHC)
* C - Hematocrit (Hct)
* D - Red blood cells
Mean corpuscular volume (MCV)
A patient who takes oral contraceptives for pregnancy prevention has missed her last 2 pills. What should the nurse practitioner advise the patient to do to minimize the risk of pregnancy?
A - Take today’s dose and do not miss any more during this month.
B - Double today’s dose and use a barrier method for the rest of this
month.
* C - Double today’s dose and tomorrow’s dose, and use a barrier method for the rest of this month.
* D - Stop the pills today and restart a new pill pack in 1 week.
Double today’s dose and tomorrow’s dose, and use a barrier method for the rest of this month.
A common finding associated with temporal arteritis is:
* A - severe headache.
* B - facial nerve paresis or paralysis.
* C - rhinorrhea.
* D - dental pain.
severe HA
Which of the following is true about cognitive abilities in older adults?
* A - The most significant decline in cognition occurs in the sixth decade.
* B - Skills training and motivational incentives have no effect on memory.
* C - Older adults perform poorly in comparison to young adults on tests of verbal skills.
* D - Apprehension about competitive situations has little effect on performance.
- The most significant decline in cognition occurs in the sixth decade.
A 25-year-old female presents for a routine wellness exam. On physical examination, the nurse practitioner notes a scant nipple discharge, absence of a palpable mass, and absence of lymph node enlargement. Which of the following is the most likely diagnosis?
A - Intraductal papilloma
* B - Breast cancer
* C - Chest wall syndrome
* D - Fibrocystic breast disease
Intraductal papilloma
A 4-year-old child is brought to the nurse practitioner due to the guardian’s concerns that the child has been bruising easily. An ecchymotic lesion on which of the following areas would be most concerning for a possible bleeding disorder?
* A - A 4-cm ecchymotic lesion on the right lateral thigh
* B - A 5-cm ecchymotic lesion on the forehead
* C - A 6-cm ecchymotic lesion on the left knee
D - A 7-cm on the left lower quadrant of the abdomen
A 7-cm on the left lower quadrant of the abdomen
To be successful in preventing disease, programs are most likely to be successful when:
* A - they target secondary prevention.
* B - they address cultural profiles of the population.
* C - they are adequately funded for the community.
* D - emphasis is placed on future health benefits.
they address cultural profiles of the population.
According to existing data on child abuse, which parent characteristics are most closely associated with the use of abusive parenting practices?
* A - Older in age, following the example set by the previous generation
* B - Younger in age, isolated, with low self-esteem
* C - Working full time, feeling pressure to perform multiple duties
* D - Single, working part time, and attending trade school
Younger in age, isolated, with low self-esteem
When performing a full ENT assessment on a patient, removal of cerumen would NOT be helpful when:
* A - evaluating conductive hearing loss.
* B - evaluating sensorineural hearing loss.
* c - ear discomfort is present.
* D - impressions for hearing aid fitting have not been taken.
sensorinerual hearing loss
In comparing sensitivity to specificity, sensitivity refers to a:
* A - true positive.
B - false positive.
C - false negative.
D - true negative.
true positive.
A lesion that typically begins as a tiny vesicle or pustule, then ruptures and progresses to a honey-colored crusty lesion with an erythematous base, is most likely:
A - varicella.
* B - herpes simplex.
C - impetigo.
* D - herpes zoster.
impetigo
A pregnant patient presents for a first prenatal visit. On physical examination, the patient’s uterus is approximately 24 weeks in gestational size. The patient does not know when their last menstrual period was, nor do they know when conception occurred. Gestational age for this patient can most accurately be assessed by:
* A - Naegele’s rule.
* B - biophysical profile.
C - measurement of fundal height.
D - ultrasonography.
US
Which of the following is NOT an expected finding associated with a diagnosis of folic acid deficiency?
* A - Glossitis and cheilitis
* B - Pallor and/or jaundice
* C - Depression and listlessness
* D - MCV <80 fL
MCV <80
A 59-year-old patient complains of joint pain, swelling, and stiffness in multiple joints that improves after the first 3 or 4 hours in the morning. He states that he
“has no energy.” Spinal X-rays reveal joint space narrowing. What is the most likely diagnosis?
A - Osteoarthritis (OA)
* B - Rheumatoid arthritis (RA)
* C - Polymyalgia rheumatica
* D - Ankylosing spondylitis
RA
A preadolescent patient presents with a history of pharyngitis treated 2 weeks ago and a temperature of 102°F for the past 2 days. Examination reveals bilateral tender, swollen knees, a pinkish red macular rash on the upper abdomen and chest, a heart rate of 95 beats/minute, and a holosystolic murmur that is best audible at the apex of the heart. Based on these symptoms, the most appropriate initial pharmacologic approach would be to administer:
* A - intravenous immunoglobulin (IVIG).
B - long-acting intramuscular penicillin.
C - high-dose corticosteroid.
D - an anticoagulant.
IM PCN
A patient presents with cracked and sore nipples. The patient is breastfeeding their first child, who is 4 weeks old. The nurse practitioner would be accurate to advise the patient to:
* A - stop breastfeeding until the nipples have healed.
B - apply a vitamin E moisturizing cream after each feeding and continue to breastfeed.
C - use a breast shield with each feeding.
* D - apply an antibiotic cream after each feeding.
- apply a vitamin E moisturizing cream after each feeding and continue to breastfeed.
An afebrile pediatric patient reports severe left ear pain. On examination, the tympanic membrane is gray and intact. Green discharge is present in the external canal. What action by the nurse practitioner is most appropriate?
* A - Irrigate the green discharge before examining the tympanic membrane.
* B - Prescribe an otic antibiotic/corticosteroid suspension.
* C - Prescribe an oral antibiotic and an analgesic for pain.
* D - Refer to an otolaryngologist for tympanocentesis.
Refer to an otolaryngologist for tympanocentesis. ??
An otherwise healthy pregnant patient at 12 weeks’ gestation complains of feeling dizzy upon standing. This is the patient’s first pregnancy. The nurse practitioner knows that:
A - the most likely cause is orthostasis due to systemic vasodilation in the first trimester.
* B - lightheadedness in pregnancy is a concern, and an electrocardiogram should be ordered.
* C - this is likely related to an abnormal elevation in blood pressure, which is common during pregnancy.
* D - low blood glucose may be causing this problem, and an oral glucose tolerance test is indicated.
he most likely cause is orthostasis due to systemic vasodilation in the first trimester.
After vaccination with the influenza vaccine, antibodies against influenza will develop in about:
* A - 24 hours.
* B - 3 days.
* C - 7 days.
D - 2 weeks.
2 weeks.
Which of the following patients is least likely to exhibit secondary hypertension?
* A - A 38-year-old patient with untreated Graves’ disease
* B - An 18-year-old patient who is addicted to cocaine
* C - A 62-year-old patient with untreated depression
* D - A 29-year-old patient with untreated Cushing syndrome
A 62-year-old patient with untreated depression
The most effective treatment approach to noninfectious bursitis includes:
* A - a prophylactic broad-spectrum antibiotic and compression dressing applied at the site.
* B - an intra-articular corticosteroid injection and a concomitant oral
NSAID.
* c - a tapering regimen of oral corticosteroid therapy and a topical analgesic.
D - increased fluids, frequent active range of motion in the joints, and a topical analgesic.
an intra-articular corticosteroid injection and a concomitant oral
NSAID.
Which of the following statements about antiretroviral therapy during the acute phase of HIV infection is true?
* A - Antiretroviral therapy during the acute phase increases the size of the viral reservoir.
* B - The risks of starting antiretroviral therapy during the acute phase outweigh the benefits.
* C - Antiretroviral therapy during the acute phase reduces the risk of infectiousness to others
* D - Immune function is not necessarily preserved if antiretroviral therapy is started during the acute phase of HIV.
reduces risk to others
Education of patients with fibrocystic breast disease should include which of the following statements?
* A - Fibrocystic breast disease is often a precursor to breast cancer.
* B - Annual mammography is recommended beginning at age 40.
* C - Caffeine may trigger breast pain.
* D - Oral contraceptives are not useful in the treatment of this disease.
Caffeine may trigger breast pain.
Intranasal steroids are highly efficacious in treating allergic rhinitis. Which statement is NOT true about intranasal steroids?
* A - Intranasal steroids control the 4 major symptoms of rhinitis: sneezing, itching, rhinorrhea, and nasal congestion.
* B - Intranasal steroids are effective as monotherapy.
* C - Intranasal steroids are effective in controlling ocular symptoms..
* D - Intranasal steroids may be more effective than monotherapy with nasal cromolyn or antihistamines.
controlling occular sx
Which immunization(s) is(are) contraindicated in a patient who is immunodeficient?
1. Varicella 2. inactivated polio vaccine (IPV) 3. Measles, mumps, rubella (MMR) 4.
Hepatitis B (HBV)
0 A -4
B - Which immunization(s) is(are) contraindicated in a patient who is immunodeficient?
1. Varicella 2. inactivated polio vaccine (IPV) 3. Measles, mumps, rubella (MMR) 4.
Hepatitis B (HBV)
0 A -4
B - 1, 3
C - 1, 3, 4
D - All of the above
C - 1, 3, 4
D - All of the above
1 and 3
Prescriptive authority is:
A - granted by the state pharmacy board.
* B - NOT prohibited by physician collaboration or supervision.
* c - exercised by giving a verbal medication order to a pharmacist.
D - automatically conferred with certification.
A
According to the Standards of Advanced Practice Nursing developed by the American Nurses Association (ANA), an advanced practice registered nurse (APRN) who informs the patient of the risks, benefits, and outcomes of a healthcare regimen is following which standard of practice?
* A - Leadership
O B - Research
* c - Interdisciplinary process
D - Ethics
SUBMIT
ethics
A patient comes to the health clinic in October for immunization against influenza.
The patient has never had one before and requests information about the influenza vaccine. Which of the following is true about the influenza vaccine?
* A - Getting the influenza vaccine prevents patients from getting influenza infection if exposed to the virus.
* B - Influenza vaccination reduces the risk of mortality associated with influenza.
* C - Influenza season in the U.S. is predictable, and vaccines should be given in September.
D - Administration of the influenza vaccine may make the patient more susceptible to other viruses.
- Influenza vaccination reduces the risk of mortality associated with influenza.
The guardian of a 3-year-old male is concerned because the child wets the bed 3-4 times a week. The guardian thinks the child has nocturnal enuresis and is requesting medication to treat this condition. The nurse practitioner should:
* A - suggest that the guardian wake the child during the midsleep cycle to urinate.
* B - recommend that the guardian require the child to change the bedding on nights that bedwetting occurs.
* C - prescribe desmopressin acetate (DDAVP) nasal spray to be administered at bedtime.
* D - explain to the guardian that enuresis at night at this age does not warrant treatment.
explain to the guardian that enuresis at night at this age does not warrant treatment.
A professional liability insurance policy that provides coverage for injuries arising from incidents occurring during the period the policy was in effect, even if the policy subsequently expires or is not renewed by the policy holder, is termed a(an):
* A - claims made policy.
* B - individual policy.
* c - occurrence-based policy.
* D - supplemental policy.
occurrence-based policy.
In addition to a microcytic anemia, patients with beta thalassemia may present with:
A - jaundice.
* B - masked facies.
C - lymphadenopathy.
* D - hypercalcemia.
jaundice
A 16-year-old patient presents to the clinic for a scheduled immunization. The patient is not accompanied by an adult. The nurse practitioner’s action is based on the knowledge that:
A - a minor must have the informed consent of a parent or guardian to receive an immunization.
* B - the minimum age of consent is 21 years.
C - consent is considered “informed” when the patient’s mental age is at least 12 years.
* D - consent is considered “informed” when the patient is at least 16 years old.
minor should have informed consent for immunizations
The best way for a pregnant patient to avoid injury for both birth parent and fetus in the event of a motor vehicle collision is to:
* A - use the lap restraint only.
* B - avoid exposure to air bag deployment.
C - use both the lap and shoulder restraint.
D - use the shoulder harness restraint only.
use both the lap and shoulder restraint.
A 25-year-old female patient has a history of frequent candidal vaginal infections in the past year. The patient is in a monogamous heterosexual relationship and uses an intrauterine device (IUD) for contraception. Of the following, which is the most likely underlying condition predisposing her to recurring candidal vaginitis?
* A - Hypothyroidism
* B - Diabetes mellitus
* C - Trichomoniasis
* D - Fluctuating hormones
DM
To lower mortality rates associated with cardiovascular disease, patients should increase their dietary intake of:
* A - fiber.
* B - unrefined carbohydrates.
* c - saturated fatty acids.
* D - monounsaturated fatty acids.
monounsaturated fatty acids.
State Medicaid programs must meet minimum federal guidelines that include the population to whom services are provided. The population for whom Medicaid coverage is NOT mandated at the federal level is:
* A - children up to age 18 years in low-income families.
* B - all pregnant people regardless of federal poverty level status.
* c - parents or caregivers with very low income.
* D - people with disabilities who receive supplemental security income (SSI).
all pregnant people regardless of federal poverty level status.
The principal goal of treatment in Kawasaki disease is to prevent coronary artery disease. Therefore, the mainstay of treatment is to initially administer:
* A - high-dose corticosteroids and aspirin.
* B - intravenous immunoglobulin (IVIG) and aspirin.
* c - intravenous immunoglobin (IVIG), aspirin, and high-dose corticosteroids.
* D - intravenous immunoglobin (IVIG) and high-dose corticosteroids.
intravenous immunoglobulin (IVIG) and aspirin.
An adolescent patient was treated with a systemic antibiotic for moderate acne vulgaris. He has completed the medication as prescribed and returns to the nurse practitioner for a follow-up visit. His acne has cleared and, for maintenance, the nurse practitioner recommends:
A - benzoyl peroxide.
* B - a topical antibiotic for 4 weeks.
* c - another 7 days of the oral antibiotic.
* D - a combination of a topical therapy with a retinoid and an antibiotic.
- a combination of a topical therapy with a retinoid and an antibiotic.
A patient with type 2 diabetes mellitus is 22 weeks pregnant and presents with symptoms of vaginal candidiasis. The most appropriate treatment for this patient is to:
* A - increase the patient’s subcutaneous insulin.
* B - prescribe oral fluconazole (Diflucan).
* C - prescribe topical miconazole (Monistat) vaginal.
* D - advise the patient to purchase hydrocortisone cream to help with itching
monistat
Antibiotic treatment of asymptomatic bacteriuria:
* A - prevents the development of UTI.
* B - is recommended in patients with indwelling urinary catheters.
* C - contributes to the development of resistant bacterial strains.
* D - is recommended in males only.
contributes to the development of resistant bacterial strains.
The nurse practitioner documents the assessment of a burn as partial thickness with involvement of the dermis and epidermis, along with edema and vesicles. This is a:
* A - first-degree burn.
* B - second-degree burn.
* C - third-degree burn.
* D - fourth-degree burn.
2 nd degree
The lower urinary tract symptom that is LEAST likely to lead the nurse practitioner to suspect benign prostatic hyperplasia (BPH) is:
A - urinary intermittency.
B - nocturia.
C - incontinence.
D - dysuria.
D
Advance directives are:
* A - documents specifying who the patient has designated, or assigned, the legal authority to make healthcare decisions on their behalf.
* B - documents establishing the patient’s wish not to receive life-prolonging medical treatment.
* C - documents guiding medical decision making in the event the patient becomes incapacitated or unable to convey their wishes.
* D - legally binding in all 50 states in the United States.
documents guiding medical decision making in the event the patient becomes incapacitated or unable to convey their wishes.
Spirometry readings in a patient with emphysema are expected to include:
* A - decreased residual volume (RV).
* B - increased vital capacity (VC).
* C - increased forced expiratory volume (FEV-1).
* D - increased total lung capacity (TLC).
ncreased total lung capacity (TLC).
A 6-month-old infant presents with a soft, short systolic murmur. The nurse practitioner considers this to be an innocent murmur because the murmur:
* A - is of low intensity.
* B - is audible after S2.
* C - diminishes when the infant is supine.
D - is accompanied by a systolic thrill.
is of low intensity.
A 50-year-old male patient is scheduled for an annual wellness visit. The nurse practitioner would appropriately recommend:
* A - screening for testicular cancer.
B - digital rectal exam.
* c - screening for abdominal aortic aneurysm.
D - screening for abnormal blood glucose.
screening for abnormal blood glucos
A 58-year-old male presents with complaints of nocturnal enuresis. The nurse practitioner should assess for medications that can decrease bladder contractility or cause detrusor underactivity. These may include:
* A - diltiazem (Cardizem).
* B - testosterone cypionate (Depo-testosterone).
* c - bupropion hydrochloride (Wellbutrin SR).
* D - pseudoephedrine (Sudafed).
sudafed
A 35-year-old adult presents with radicular pain followed by the appearance of grouped vesicles consisting of about 20 lesions across three thoracic dermatomes.
The patient complains of pain, burning, and itching. The nurse practitioner:
* A - considers this a common case of shingles and prescribes an analgesic and an antipruritic agent.
B - knows that this is a typical case of shingles and prescribes acyclovir (Zovirax), an analgesic and an antipruritic agent.
* c - suspects that this patient is immunocompromised due to the dissemination of the herpes zoster.
* D - thinks that this is likely a recurrence of chickenpox due to age and the dissemination of the lesions.
Typical and provide analgestic and antipruritic agent
A patient presents with a furuncle in the right axilla. The nurse practitioner should prescribe an oral antibiotic and instruct the patient to:
* A - frequently apply warm moist compresses to the affected area.
* B - perform wet-to-dry dressing changes twice daily.
* C - apply topical mupirocin ointment (Bactroban).
* D - squeeze the furuncle gently after showering, to promote drainage.
frequently apply warm moist compress to affected area
A patient presents with complaints of bilateral eye irritation and crusting upon awakening. Swelling and inflammation of bilateral lids and conjunctiva are present. Based on the most probable diagnosis, the best choice of treatment is an ophthalmic:
A - mast cell stabilizer.
* B - antibiotic drops.
C - antibiotic-steroid combination.
* D - steroid drops.
antibiotic drops
A female patient asks “How do I calculate my ideal body weight?” The nurse practitioner appropriately answers:
* A - Start with 100 pounds and add 5 pounds for every inch in height over 5 feet.
* B - Add 6 pounds for every inch over 5 feet, then add 100 pounds.
* C - Start with 100 pounds and add 10 pounds
Start with 100 pounds and add 5 pounds for every inch in height over 5 feet.
When evaluating an infant or child for suspected talipes equinovarus, radiographic images should be obtained:
* A - while weight bearing.
* B - only if the foot cannot be manipulated.
* C - with oblique views.
D - while non-weight bearing.
wt bearing
Education of patients with fibrocystic breast disease should include which of the following statements?
* A - Fibrocystic breast disease is often a precursor to breast cancer.
* B - Annual mammography is recommended beginning at age 40.
* C - Caffeine may trigger breast pain.
* D - Oral contraceptives are not useful in the treatment of this disease.
caffeine may tirgger breast pain
An older adult patient who lives alone tells the nurse practitioner, “I get enough to eat. I don’t need much.” The patient does not prepare food at home and prefers to eat a noon meal at a neighborhood restaurant. The patient reports having a bowl of cereal in the morning or in the evening if hungry. Which of the following is the most sensitive indicator of this patient’s nutritional status?
* A - Hemoglobin and red blood cell indices
O B - Fatigue and weight loss
* C - Serum prealbumin level
* D - Serum electrolyte and minerals
Serum prealbumin level
When considering a combined oral contraceptive for the purpose of pregnancy prevention, which of the following is considered an unacceptable risk factor?
A - Blood pressure >140/90 mm Hg
B - BMI >35
C - Migraine with aura
D - Inflammatory bowel disease
Migraine with aura
Which infectious process would cause the cervical lymph nodes to enlarge in the preauricular region of the neck?
A - Sinusitis
B - Conjunctivitis
* c - Pharyngitis
* D - Lymphomas
conjuncitivitis
The nurse practitioner suspects temporomandibular joint (TMJ disorder in a patient. As the patient slowly opens and closes the lower jaw, the nurse practitioner palpates the TMJ, which is:
* A - anterior to the mastoid process.
* B - anterior to the tragus.
* C - at the styloid process under the ear.
* D - at the angle of the jaw.
anterior to the tragus
The recommended alternative treatment regimen for a patient who tests positive for gonorrhea and has an allergy to macrolide antibiotics is dual therapy with ceftriaxone (Rocephin) and:
* A - azithromycin (Zithromax).
* B - clarithromycin (Biaxin).
* c - doxycycline (Doryx).
* D - cefixime (Suprax).
cefixime (suprax)
A 38-year-old female reports low sexual desire and difficulty reaching orgasm. Which of the following medications is likely to contribute to these symptoms?
* A - Levothyroxine (Synthroid)
* B - Buspirone (Buspar)
C - Escitalopram (Lexapro)
* D - Metoprolol (Lopressor)
lexapro
When a patient presents with symptoms of biliary colic, the nurse practitioner should order a:
* A - flat and erect abdominal X-ray.
* B - transabdominal ultrasound.
* C - CT of the abdomen.
* D - general surgery consult.
US
A highly contagious viral illness characterized by the development of pruritic vesicles and papules on the skin, scalp and, less commonly, on mucous membranes, is suspicious for:
* A - scarlet fever.
* B - Kawasaki disease.
* C - varicella.
* D - rubella.
varicella
The nurse practitioner correctly diagnoses iron deficiency anemia in a patient whose lab report identifies:
* A - an increased reticulocyte count.
B - a mean corpuscular volume (MCV) >100 fL.
* c - hemoglobin (Hgb) 14.0 mg/dL (140g/L).
* D - an increased total iron binding capacity (TIBC).
TIBC
Asymptomatic bacteriuria is more common in:
* A - patients who are pregnant.
B - patients with prostatitis.
* c - toddlers.
D - female patients older than 65 years.
female patients older than 65 years.
Which of the following statements is true about use of the female condom?
* A - Female condoms can be used multiple times within a 24-hour period.
* B - Female condoms and male condoms may be used simultaneously.
* C - Female condoms do NOT protect against sexually transmitted infections.
* D - Female condoms may be inserted up to 8 hours prior to intercourse.
D
An anxious guardian brings their 3-day-old infant to the nurse practitioner because the infant has serosanguineous vaginal discharge. The nurse practitioner informs the guardian that:
* A - this is a normal finding in female newborns.
* B - the discharge usually resolves by the time the infant is 3 months old.
* C - the discharge should be cultured to assess for bacterial infection.
D - the discharge should be checked for occult blood.
this is a normal finding in female newborns.
* B - the discharge usuall
The most effective treatment approach to noninfectious bursitis includes:
* A - a prophylactic broad-spectrum antibiotic and compression dressing applied at the site.
* B - an intra-articular corticosteroid injection and a concomitant oral NSAID.
* c - a tapering regimen of oral corticosteroid therapy and a topical analgesic.
* D - increased fluids, frequent active range of motion in the joints, and a topical analgesic.
an intra-articular corticosteroid injection and a concomitant oral NSAID.
Pharmacotherapeutics of drug therapy in the older adult are affected by an increase in:
* A - total body water.
* B - lean muscle mass.
O c - hepatic blood flow.
* D - percent of body fat.
percent of body fat
A 15-year-old male has a history of cryptorchidism that was surgically repaired as an infant. Based on this history, it is essential for the nurse practitioner to educate the patient about:
* A - testicular self-examination.
* B - protection of the testes during sports activities.
* c - the increased risk for testicular torsion.
* D - his increased risk for inguinal hernia.
testicular self exam
The hemoglobin A1C level in a patient with Type 2 diabetes mellitus is 7.2. The patient is taking a sulfonylurea medication. Which of the following medications should be added next to the medication treatment regimen?
O A - Glipizide (Glucotrol)
* B - NPH insulin
* C - Regular insulin
D - Metformin (Glucophage)
metformin
The diagnostic criteria for Type 2 diabetes mellitus does NOT include:
A - a serum glucose of 140 mg/dL or greater after a 2-hour oral glucose tolerance test with 75 g of glucose.
* B - a hemoglobin A1C of >6.5%.
* c - consecutive fasting glucose levels of 126 mg/dL or greater.
* D - a random serum glucose >200 mg/dL plus symptoms of hyperglycemia.
- a serum glucose of 140 mg/dL or greater after a 2-hour oral glucose tolerance test with 75 g of glucose.
The most effective first-line pharmacologic treatment for bulimia nervosa is:
* A - topiramate (Topamax).
* B - fluoxetine (Prozac).
* c - quetiapine (Seroquel).
* D - clonazepam (Klonopin).
prozac
A 45-year-old female in good health reports “pink-tinged” urine. Urinalysis demonstrates alkaline urine that is positive for nitrites and leukocyte esterase. The most likely diagnosis is:
O A - renal calculi.
* B - interstitial cystitis.
* c - bladder neoplasm.
D - urinary tract infection.
UTI
A patient with Type 2 diabetes mellitus has sporadically recorded blood glucose levels in their glucose diary for the past 3 months. Every reading is between 100 and 140 mg/dL (5.6-7.8 mmol/L). A glycosylated hemoglobin of 14% for this patient would indicate:
* A - that this patient is not likely reporting accurate readings of their blood glucose.
* B - that the patient’s postprandial blood glucose levels are 200 mg/dL.
* C - that the patient has had poor control of blood glucose for the last 2 weeks.
* D - that the patient’s average blood glucose has been >300 mg/dL over the past 2-3 months.
D averge BS above 300
Which of the following diseases is NOT acquired transplacentally?
* A - Rubeola
* B - Toxoplasmosis
C - Tuberculosis
* D - Varicella
TB
When assessing visual behavior in infants, the nurse practitioner would expect an infant to exhibit a conjugate gaze by age:
A - 2 months.
B - 4 months.
c- 6 months.
* D - 9 months.
6 months
What extrapancreatic diagnosis may be associated with an elevated serum amylase level?
* A - Peptic ulcer disease
* B - Irritable bowel disease
* C - Cholecystitis
* D - Crohn’s disease
cholecysitis
Which of the following patients with a confirmed first incidence of a urinary tract infection requires further imaging studies?
* A - A 6-month-old female who is afebrile after 48 hours of antibiotic treatment
* B - A 6-month-old male who remains febrile after 72 hours of antibiotic treatment
* C - A 3-year-old female who is febrile after 48 hours of antibiotic treatment
* D - A 4-year-old male who is afebrile after 72 hours of antibiotic treatment
A 6-month-old male who remains febrile after 72 hours of antibiotic treatment
Symptoms of moderate persistent asthma are most likely to be effectively managed with daily dosing of:
* A - an oral leukotriene receptor antagonist and glucocorticoids.
* B - short- and long-acting bronchodilators.
* c - inhaled corticosteroids and long-acting bronchodilators.
* D - oral steroids and short-acting bronchodilators.
inhaled corticosteroids and long acting bronchodilators
The most effective strategy in the management of an adult with resistant hypertension is to:
* A - re-educate and reinforce the need for lifestyle modifications (i.e., diet, exercise, smoking cessation).
* B - add a fourth medication to the current regimen to achieve control of the blood pressure.
* c - perform a comprehensive evaluation to identify a secondary cause of the hypertension.
* D - assure that the patient is taking their medication appropriately.
perform a comprehensive evaluation to identify a secondary cause of the hypertension.
A patient presents with complaints of fatigue and mild muscle cramps. The nurse practitioner suspects hypokalemia that is most likely caused by:
* A - furosemide (Lasix).
* B - an angiotensin receptor blocker (ARB).
* c - spironolactone (Aldactone).
* D - heparin.
lasix
Which of the following medications is indicated for primary prevention of febrile seizures?
* A - Phenobarbital
* B - Acetaminophen (Tylenol)
* C - Diazepam (Valium)
* D - Phenytoin (Dilantin)
Tyelnol
The condition that is least likely to be included in the differential diagnoses for scarlet fever is:
O A - fifth disease.
* B - Epstein-Barr virus.
* C - staphylococcal scalded skin syndrome (SSSS).
D - impetigo.
impetigo
An adult who has been treated for depression for the past 4 months decides that medication is no longer necessary. The patient stops taking the selective serotonin reuptake inhibitor (SSRI) that was prescribed for them. Antidepressant discontinuation syndrome is less likely to occur if this patient:
* A - is younger than 50 years.
* B - has been on the medication for less than 6 months.
O c - has been taking an SRI with a short half-life.
* D - gradually tapers SSRI use.
gradually taper SSRI
If a female patient accidentally takes two combined oral contraceptive pills in a day, the patient should be instructed to:
* A - skip 1 day and then resume the pill pack.
* B - resume dosing with the next daily pill on the next day.
C - skip 2 days of dosing, then resume the pill pack.
* D - discard this pack and start a new pack the following day.
resume dosing with the next daily pill on the next day.
Which choice below is NOT a contraindication to receiving the diphtheria, pertussis, and tetanus (DPT) vaccine?
A - Pregnancy
* B - Acute febrile illness
C - An evolving neurologic condition
* D - A severe reaction to DP I in the past
pregnancy
A patient is treated with oral metronidazole (Flagy)) for persistent bacterial vaginosis. Which of the following is NOT likely to cause a disulfiram-like reaction if taken simultaneously with metronidazole (Flagyl)?
* A - Alcohol
* B - Cough/cold syrups
C - Fluconazole (Diflucan)
* D - Intravenous trimethoprim-sulfamethoxazole
Fluconazole (Diflucan)
A complication that is NOT associated with acute bacterial prostatitis is:
A - bacteremia.
B - prostatic abscess.
C - infertility.
D - epididvmitis.
infertility
The mechanism of action of salicylates and other nonsteroidal anti-inflammatory agents does NOT include:
* A - inhibition of prostaglandin synthesis.
* B - suppression of gastric acid secretion.
* C - restoring the thermoregulatory setpoint in the hypothalamus to normal.
* D - inhibition of cyclooxygenase (COX) enzymes.
restoring the thermoregulatory setpoint in the hypothalamus to normal.
Which red blood cell (RBC) index is most useful for differentiating types of anemias?
* A - Mean corpuscular volume (MCV)
* B - Mean corpuscular hemoglobin concentration (MCHC)
* C - Hematocrit (Hct)
* D - Red blood cells
MCV
First-line interventions for the initial treatment of bulimia nervosa include:
* A - intensive individual and group psychotherapy.
* B - inpatient stabilization followed by outpatient psychotherapy.
* C - atypical antipsychotics and cognitive behavioral therapy.
* D - nutrition rehabilitation plus psychotherapy.
nutrition rehabilitation plus psychotherapy.
After vaccination with the influenza vaccine, antibodies against influenza will develop in about:
* A - 24 hours.
* B - 3 days.
* C - 7 days.
* D - 2 weeks.
2 weeks
The Centers for Disease Control and Prevention designates several populations as being at “high-risk” for sexually transmitted diseases (STDs). Which of the following is NOT considered a high-risk group requiring additional screening for sexually transmitted diseases?
* A - Pregnant patients
* B - Juveniles held in detention centers
* C - Patients with a history of prior STDs
* D - Members of the military
members of the military
Which of the following is least likely to be the cause of ophthalmia neonatorum?
* A - Haemophilus influenzae infection
B - Silver nitrate reaction
* C - Chlamydia trachomatis infection
* D - Herpes simplex infection
haemophilus influenzae infection
A frail 82-year-old patient is diagnosed with community-acquired pneumonia. The patient is allergic to fluoroquinolones, so the nurse practitioner should prescribe:
* A - azithromycin (Zithromax) 500 mg daily x 5 days.
* B - levofloxacin (Levaquin) 750 mg daily x 7 days.
C - amoxicillin-clavulanate (Augmentin) 2,000 mg BID x 5 days and azithromycin (Zithromax) dose pack.
* D - cefpodoxime (Vantin) 400 mg po BID and levofloxacin (Levaquin) 750 mg daily x 7 days.
amoxicillin-clavulanate (Augmentin) 2,000 mg BID x 5 days and azithromycin (Zithromax) dose pack.
When screening children for diabetes, the recommended test is:
* A - fasting serum glucose.
* B - random serum glucose.
* C - postprandial serum glucose.
* D - 2-hour postprandial glucose.
fasting serum glucose
Which of the following choices is NOT associated with erectile dysfunction?
* A - Beta-adrenergic blockers and calcium channel blockers
* B - NSAIDs and oral hypoglycemic agents
* C - Alcohol, marijuana, and opiates
* D - Diabetes mellitus and peripheral vascular disease
NSAIDs and oral hypoglycemic agents
A patient states that their elbow aches and burns with activities such as hand shaking or using a screw driver. The pain increases with resisted wrist extension, with the wrist radially deviated and pronated, and with the elbow extended. The most likely diagnosis is:
* A - radial tunnel syndrome.
* B - ulnar collateral ligament sprain.
* c - olecranon bursitis.
* D - lateral epicondylitis.
lateral epicondylitis
A patient presents 24 hours after an assault in which they sustained a human bite to the left arm. The wound is swollen, red, and discolored. Which is the LEAST appropriate intervention at this time?
* A - Administer tetanus diphtheria pertussis (Tap) as a standard of practice for bites.
B - Prescribe amoxicillin-clavulanate (Augmentin) and obtain a culture of the site.
* C - Suture the torn tissue and have the patient return in 7-10 days for a wound check and suture removal.
* D - Prescribe an antibiotic ointment for application with twice-a-day dressing changes.
- C - Suture the torn tissue and have the patient return in 7-10 days for a wound check and suture removal.
When performing a routine physical exam on a healthy 6-year-old patient, the nurse practitioner should seize this opportunity to teach the child about:
* A - washing their hands before eating.
* B - not allowing anyone to touch their “private parts” without permission.
* c - the importance of developing good study habits.
* D - using a seat belt instead of a car seat when riding in vehicles.
washing their hands before eating.
Evaluation of a heart murmur’s pitch should be made by classifying its frequency. Using the diaphragm of the stethoscope, the nurse practitioner auscultates a mild to moderate-pitched systolic ejection murmur audible over the upper left sternal border (ULSB and radiating to the back. These findings are MOST consistent with:
* A - pulmonary stenosis.
* B - mitral valve insufficiency.
* C - aortic stenosis.
* D - tricuspid regurgitation.
pulmonary stenosis
Which of the following is NOT true about the diagnosis of scoliosis in children?
* A - Scoliosis is most apparent during the preadolescent growth spurt.
* B - Scoliosis typically causes curvature of the spine, but not rotation of the spinal column.
* c - Kyphosis in the adolescent indicates scoliosis.
* D - When viewed from the side, a patient with scoliosis may have increased thoracic kyphosis.
C
Treatment of anogenital warts is helpful in:
* A - eradicating the human papillomavirus.
* B - slowing and preventing future outbreaks.
* c - removal of warts and reducing psychosocial distress.
D - decreasing the risk of transmission.
removal of warts and reducing psychosocial distress.
The three most common and characteristic symptoms of chronic obstructive pulmonary disease are:
* A - wheezing, chest tightness, and exertional dyspnea.
* B - paroxysmal nocturnal dyspnea, wheezing, and cough.
* c - dyspnea, chronic cough, and sputum production.
D - chronic dry cough, wheezing, and dyspnea.
dyspnea, chronic cough, and sputum production.
A patient has chronic prostatitis. What is the initial drug treatment of choice for this patient?
* A - Ciprofloxacin (Cipro)
* B - Doxycycline (Vibramycin)
O C - Amoxicillin (Amoxil)
D - Nitrofurantoin (Macrodantin)
doxy
A 3½-year-old healthy male presents with a history of continuous unsuccessful attempts at toilet training. The child experiences urinary incontinence at least once daily and a few nights weekly. The child has been continent of stool for the past 2 months.
Urine dipstick results are within normal limits. The nurse practitioner correctly documents a diagnosis of:
* A - age-appropriate bladder control.
* B - primary enuresis.
* C - secondary enuresis.
* D - nocturnal enuresis.
age-appropriate bladder control.
A female patient is diagnosed with pelvic inflammatory disease. The patient’s sexual partners):
* A - does not require partner treatment.
* B - should be treated after the causative organism is determined.
* C - should be empirically treated for chlamydia and gonorrhea.
* D - only requires treatment if they are symptomatic.
C - should be empirically treated for chlamydia and gonorrhea.
An afebrile pediatric patient reports severe left ear pain. On examination, the tympanic membrane is gray and intact. Green discharge is present in the external canal. What action by the nurse practitioner is most appropriate?
* A - Irrigate the green discharge before examining the tympanic membrane.
* B - Prescribe an otic antibiotic/corticosteroid suspension.
* C - Prescribe an oral antibiotic and an analgesic for pain.
D - Refer to an otolaryngologist for tympanocentesis.
C
A young adult presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across three thoracic dermatomes. The patient complains of pain, burning, and itching. The nurse practitioner should suspect:
* A - bullous pemphigoid and refer to a dermatologist.
* B - toxicodendron radicans and prescribe a topical corticosteroid.
* c - herpes zoster and order testing for HIV.
* D - varicella recurrence and treat the symptoms.
herpes zoster and order testing for HIV.
An adult patient is diagnosed with classic migraine headache. The headaches are frequent and debilitating. The patient is offered an abortive therapy, but requests a medication for prophylaxis instead. The nurse practitioner would recommend:
* A - a triptan.
* B - ibuprofen every 8 to 12 hours.
C - a beta-adrenergic blocking agent.
* D - a thiazide diuretic.
beta adrenergic blocking
When prescribing drug therapy for an older adult patient, the nurse practitioner understands that:
* A - underprescribing of appropriate medications is not a concern in older adults.
* B - lower dosages are advised, due to increased body fat and decreased skeletal muscle mass in older adults.
* C - older adults are less likely to use herbal and natural supplements.
* D - all medications should be reviewed once per year.
lower dosages are advised, due to increased body fat and decreased skeletal muscle mass in older adults.
Heart murmurs are graded based on their intensity. The nurse practitioner would document a murmur as Grade 4 (IV/VI) if the murmur were:
* A - moderately loud without a palpable thrill.
B - loud with a palpable thrill.
C - very loud and audible when part of the stethoscope is placed on the chest; a palpable thrill is present.
D - audible without a stethoscope on the chest; a palpable thrill is present.
loud with a palpable thrill
When interpreting the results of a complete blood count obtained on an adolescent with signs and symptoms of scarlet fever, the nurse practitioner should expect:
* A - an elevated platelet count.
* B - leukocytosis.
* c - elevated hemoglobin.
* D - decreased red blood cells.
leukocytosis
Which of the following statements is NOT true about biopsy of anogenital warts?
* A - Biopsy of anogenital warts should be completed if lesions do not respond to standard therapy.
* B - HPV testing should be completed to determine HPV type.
* c - If the warts worsen during therapy, a biopsy should be completed.
* D - Biopsy is warranted if the patient is HIV positive and the presentation is atypical.
HPV testing should be completed to determine HPV type.
A patient with a history of mitral valve prolapse is scheduled for routine dental cleaning. According to the American Heart Association’s guidelines for endocarditis prophylaxis, what should the nurse practitioner advise this patient?
* A - The patient should receive prophylaxis on the day of their dental cleaning.
* B - The patient does not need prophylaxis for any dental procedures.
* C - The patient should receive prophylaxis on the day before and the day of their cleaning.
* D - The patient needs prophylaxis only for tooth extraction and deep dental procedures.
the pt does not need phrophylaxi s for dental procedures
The assignment of a diagnosis to a patient utilizing the International Classification of Diseases (ICD) codes involves a variety of measures, but does NOT include:
* A - tracking of healthcare statistics and disease burden.
* B - measures of quality outcomes.
* C - establishing reimbursement and payment rates.
* D - tracking of morbidity and mortality statistics.
measures of quality outcomes
The nurse practitioner receives culture results for a patient with pelvic inflammatory disease (PID). The results are positive for Neisseria gonorrhea infection. The patient was empirically treated for this pathogen at the last visit. The next step for the nurse practitioner is to:
* A - perform a test of cure at 3 months.
* B - perform a test of cure only if sexual partners were not treated.
* c - advise the patient to follow up only if symptoms reoccur.
* D - schedule the patient for a yearly follow-up with testing at that time.
perform a test of cure at 3 months
A 28-year-old nonpregnant patient has regular menstrual cycles with 5-6 days of blood flow, but also experiences mild, spotty intermenstrual bleeding. What should be included in the differential diagnosis?
* A - Adenomyosis
* B - Ovulatory dysfunction
C - Polycystic ovarian syndrome
D - Endometrial polyp
POS
Examination reveals bilateral tender, swollen knees, a pinkish red macular rash on the upper abdomen and chest, a heart rate of 95 beats/minute, and a holosystolic murmur that is best audible at the apex of the heart. Based on these symptoms, the most appropriate initial pharmacologic approach would be to administer:
* A - intravenous immunoglobulin (IVIG).
* B - long-acting intramuscular penicillin.
* c - high-dose corticosteroid.
* D - an anticoagulant.
long acting PCN
A preadolescent patient presents with a history of pharyngitis treated 2 weeks ago and a temperature of 102°F for the past 2 dIn children diagnosed with hand-foot-mouth disease, the nurse practitioner informs the caregivers of the child that the cutaneous and mucosal lesions resolve in 7-10 days. However, the caregivers should also be told that the virus continues to shed in the stool for:
* A - 2-3 days.
* B - 7 days.
* C - 10 days.
D - a few weeks.ays.
a few weeks
