KNOW THIS AND FINISH ALREADY :)

Michael, a 72 year old male patient who previously presented with stable cardiac-type chest pain has underwent a stress test. He presents today to review the stress test results, which show EKG findings of ST segment depression during the exam in leads V3 and V4 as well as some concurrent chest discomfort. Based on these findings, which of the following are NOT priority medical decisions? *Prescribe metoprolol (Lopressor) 12.5mg PO BID *Prescribe aspirin 81mg PO daily *Refer to cardiology for angiography • Check for thyroid dysfunction

Check for thyroid dysfunction

You are evaluating a 41 year old female patient in your clinic with symptoms of right upper quadrant pain which worsens with deep breathing. The patient exhibits a positive Murphy sign. These findings are most consistent which one of the following?

Cholecystitis

The patient with congestive heart failure with an ejection fraction of 35% has become symptomatic with shortness of breath when performing activities of daily living but does not have any symptoms at rest. This is suggestive of New York Heart Association heartfailure classification?

Class III

Gladys, a 72 year old patient with a history of anemia of chronic disease from kidney failure, diabetes mellitus, and hypothyroidism presents today with concerns her thyroid medication is not working well enough. Her most recent labs reflect her TSH is 5.9 (normal range 0.5-5 kU/mL) and Free T4 is 0.3 ng/dL (normal range 0.8-2.8 ng/dL). Which one of the following clinical signs and/or symptoms would you expect a patient with these findings to present with?

Cold intolerance.

You are examining the mouth of a patient and ask the patient to put out his tongue and notice the tongue deviates by pointing to the left.Which one of the following is the correct diagnosis of this finding?

Cranial XII (Hypoglossal nerve) lesion on the left.

You perform a sensory assessment on the face and notice abnormal sensation to sharp/dull testing on the left cheek. Which one of the following cranial nerves would you expect to cause this abnormality?

Cranial nerve V

Your patient has made an attempt on their own life, and has survived. In assessing them, it is important the nurse practitioner recognize that patients with a history of self-harm need to be evaluated for which of the following underlying disease states, which is the most common co-diagnosis in patients who have made attempts of self-harm?

Depression

The nurse practitioner is caring for a patient with an elevated WBC, fever, chills, and malaise. When developing a differential diagnosis for this finding, which of the following is not a potential cause of the elevated WBC?

Diabetes Mellitus Type 2.

During a post-hospital discharge visit, you notice your 71 year old female patient has been diagnosed with a "new murmur" found by the hospitalist during their recent hospitalization for CHF exacerbation. In evaluating the patient, during which phase of the cardiac cycle would you anticipate auscultation of a S3 or S4 heart sound?

Diastole

While evaluating Tori, a 24 year old female patient who presented to your clinic for an annual well-visit, you discuss her health history of migraines and endometriosis. She reports heavy menses since menarche, sometimes 14 days in duration which has been well controlled with a combined oral contraceptive (OCP). Her migraines although frequent seem to be well controlled with the use of daily propranolol (Inderal) and abortive therapy of sumatriptan (Imitrex). While evaluating the patient, which of the following questions should the nurse practitioner consider a priority?

Do you have any visual, sight, or taste symptoms before your migraine symptoms present?

Your 53 year old female patient with pale skin and easy freckling presents for a skin survey due to their family history of skin cancer. When screening for melanoma, which one of the following findings would be considered a suspicious feature of a mole characteristic of a possible melanoma?

Dual color, particularly white-reddish or blue-black.

Which one of the following sweat glands concentrated in the palms of the hands and soles of the feet and is involved in temperature regulation?

Eccrine.

While managing the care of the patient with chronic alcoholism, the nurse practitioner would likely anticipate which findings on the CBC with differential?

Elevated MCV and MCH.

A 16-year-old female patient with heavy menses has been diagnosed with iron deficiency anemia. She is also having longer and more irregular periods than is typical as well as extremely painful cramping. You would likely need to consider which of the following diagnoses in your workup:

Endometriosis

Your 31 year old female patient states they are experiencing lateral lower back pain and urinalysis reveals bacteria in the urine, culture reveals gram negative rods after 24 hours of growth. Which of the following is the least likely agent to cause her urinary tract infection?

Enterococcus

During your visit with a 19 year old patient for a college health physical, your health history includes a diagnosis of angioedema. What of the following parts of the body are were likely involved?

Face and Lips

Your patient with a suspected diagnosis of COPD has been seen by pulmonology and has underwent a pulmonary function test (PFT) with spirometry. As the patient's primary healthcare provider, you have been asked to explain the findings of the PFT to the patient in afollow-up visit at which time the patient asks what the study was evaluating. To describe the PFT to the patient in more useful terms, you state that the large inspiration of air to the furthest extent they could reasonably accomplish followed by a full exhalation is referred to as which of the following measurements during the PFT?

Forced Vital Capacity.

Your 22 year old female patient is seeing you for complaints of sinus pressure and congestion. Which one of the following sinuses should be palpated during your examination?

Frontal

educating your patient about the non-pharmacologic management of gastroesophageal reflux disease, you include teaching to the patient that their heartburn is aggravated by al of the following except which one?

Gastric dumping, or increased emptying into the small intestines

Your 18 year old patient has recently been diagnosed with streptococcal infection and has been successfully treated with an appropriateantimicrobial agent. They have no other noteworthy health history, chronic illness, or medications on record. They are complaining to day of hematuria. RBC casts on urinalysis with microscopy have been identified during this visit. Based on this finding, you can make the diagnosis of which of the following?

Glomerulonephritis

During your physical examination of a 49 year old brain cancer patient, you notice their gag reflex is impaired during the exam. This suggests damage to which one of the following cranial nerves?

Glossopharyngeal

Your 25 year old female patient presents with a recent history of malodorous discharge from their vagina. Their review of systems includes recent history of douching and multiple sexual partners without protection. Which of the following is not a test used to identify bacterial vaginosis?

Gonorrhea and Chlamydia DNA probe

Your schizophrenic patient is agitated during your exam and states "what is that awful taste?" This is an example of which of the types of hallucinations?

Gustatory

During you neurologic examination portion of your comprehensive physical of the new patient to your panel, you perform cranial nerve assessments. Which of the following represents the most effective protocol for assessment of cranial nerve I?

Have the patient close their eyes and accurately identify two different scents with one nostril closed at a time.

Your 21 year old sexually active female patient states during a routine health exam that they have some "weird bumps" on their vulva.She is concerned she has a sexually transmitted infection. You notify her that condyloma are caused by exposure to which of the following?

Human papilomavirus type 6 and 1

While performing an office visit for your patient, you notice an elevated blood pressure of 160/92. Recent visits in the electronic health record reflect similarly elevated readings, yet nothing has been done to treat this at this time. The patient then states the last time he was started on blood pressure medication, his "kidney function became poor so the physician discontinued the medicine." You decide to evaluate further for renal artery stenosis. Al of the following are conditions suspicious for renal artery disease except which one?

Hypertension controlled on 2 medications

A40 year old, female, African American patient presents for history and physical. Upon your initial assessment, you notice she has severe exophthalmos as pictured below. Which one of the following diagnoses below would be the highest on your differential diagnose of this physical examination finding? (eyes bulging out of her head)

Hyperthyroidism.

Your 19 year old female patient presents with groin pain, states they were recently involved with a sexual partner who was sexually promiscuous. You notice they are walking with a shuffling gait and their STI testing was positive for Gonorrhea and Chlamydia. Which of the following evaluations should be considered fi this were left untreated for a prolonged period of time?

Hysterosalpingogram

While working as a volunteer nurse practitioner at a college football game, a 17-year-old female patient received a bee sting. She is experiencing swelling of the face and difficulty breathing. Which of the following represents the most common diagnosis?

IgE mediated type 1 hypersensitivity reaction

Your patient had a history of Hepatitis Aapproximately one year ago. Which of the following immunoglobulin is most likely to be elevated at this time?

IgG

Your patient has just been diagnosed with Hepatitis A. Which of the following immunoglobulin are first to be elevated in the serum?

IgM.

The patient is experiencing acute closed angle glaucoma. Which of the following examination findings by the nurse practitioner is most consistent with their diagnosis?

Increase in intraocular pressure

The 33 year old male patient presents with complaints of abdominal pain after a recent birthday party where other guests alsosuspected food borne illness and gastroenteritis. To elicit the most accurate evaluation of this patient, which is the order of assessment which should be done for the abdomen?

Inspection, auscultation, palpation, percussion

Based on your evaluation of ABCDE for melanoma, which of the following represents a suspicuous finding?

Irregular borders

When performing a health history, your 52 year old male patient complains of difficulty hearing people when spoken in the right ear. During physical examination, you perform a Weber test with your patient reporting increased hearing of vibrations in the right ear. Which one of the following would you suspect based on these findings?

Left side sensorineural hearing loss.

While evaluating your patient for a sick visit, you notice Scott, a 29year old male patient appears drowsy but open eyes and looks at you when you question him, answers appropriately, but then appears to nearly fall asleep while sitting in the exam chair. Which of the following is the most accurate descriptor of Scott's mental status?

Lethargic

Which one of the following patients would you most anticipate to complain of hemoptysis?

Lung cancer

Your patient has presented with a new onset rapid heart rate thatis irregularly irregular, heart rate 100, BP 120/74, R 16 non labored, and SP02 is 99%. They state this has been going on for a week or so intermittently, but for the last 4 days straight it hasn't stopped. Your first priority intervention for this patient is to do which of the following:

Maintain rate control and anticoagulate prior to rhythm conversion

Adequate understanding for the newly diagnosed ESRD patient during a teaching session of how dialysis works has been successful when the patient verbalizes that the use of hemodialysis to remove pollution from the body is based primarily on which of the following concepts:

My blood is cleaned by diffusing across a semipermeable membrane.

Your 49 year old male patient presents with weight loss, night sweats, anhedonia, and a CXR showing profoundly enlarged hilar adenopathy. Based on these findings, a diagnosis of lymphoma would be in your working differential. Which one of the following assessment findings when palpating lymph nodes would be INCONSISTENT with this diagnosis?

Non-tender, minimally palpable anterior cervical chain node palpation.

While assessing the patient, you covered their right eye while you covered your left eye, then brought a set number of fingers or wiggling fingers into each quadrant of the patient's visual field while you had them identify when they saw your fingers/movement. A normal exam would be documented as which of the following?

Normal Confrontation

While assessing the complete metabolic profile of the 66 year old female patient with end stage renal disease (ESRD) on dialysis, youfind acreatinine of 4.3, BUN of 62, phos of 5.2. On review of the CBC with differential, you would anticipate which of the following levels?

Normal MCH, Hemoglobin 9.6

The most common causes of uterine cancer include which of the following history items?

Obesity and smoking

Upon reviewing an old H&P for a 45 year old male patient new to your practice, you notice they have a documented paresthesiaassociated with the left hand from an old cerebrovascular accident (CVA). Based on this documentation, which of the following should the nurse practitioner expect to see on their examination?

Patient complains of numbness and tingling sensations in their left hand

The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where would the S1 heart sound correlate with the electrocardiographic waves?

Peak of the R wave

The sexually active 19 year old female patient with a shuffling gate and inguinal pain is most likely to be diagnosed with the following assessment and plan of care?

Pelvic inflammatory disease, treat for Gonorrhea and Chlamydia

In evaluating a patient with suspicion of mononucleosis, the nursepractitioner percusses the left upper quadrant of the abdomen. Which of the following would raise your suspicion of splenomegaly when percussing the spleen?*Percussion that changes from tympany to dull as you percuss from the right midaxillary line to the right anterior axillary line.

Percussion that changes from dull to tympany as you percuss from the left anterior axillary line to the left sternal border.

Your 55 year old male patient with a history of diabetes, systolic heart failure, and hyperlipidemia presents to your clinic for a new complaint of progressive onset over the past 6 months of left lower posterior leg pain with prolonged ambulation, at which time he also becomes short of breath, but this does resolve with rest. He also describes that at rest, he experiences numbnessdown the left lower leg and is having some noticeable hair loss over the anterior tibial surfaces. Based on these limited exam findings, which of the following would be the best leading diagnosis and plan?

Peripheral arterial disease, order an ankle brachial index.

While examining a 53 year old female patient, you auscultate abnormal breath sounds over all fields, and now assess transmission of voice sounds by having the patient say "ee" while auscultating the chest with the diaphragm of your stethoscope. Normally, you should auscultate a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the following will you document is present?*Positive stereognosis.*Positive for egophony.*Negative for bronchophony.*Negative for egophony

Positive for egophony

Your 29 year old male patient was a military soldier who states he "saw some pretty awful things" during his time in service. When you knock to enter the room, you notice he jumps up from the exam table and stands facing the door and states he always has to have his face toward the entrance to the room. This is most suggestive of which of the following diagnoses;

Post traumatic stress disorder

The 19 year old female patient complains of jaw pain anterior and inferior to the ear bilaterally. Al of the following are common symptoms of a temporomandibular joint (TMJ) disorder EXCEPT which one?

Relief from pain with joint displacement

In assessing your patient with suspected pyelonephritis, the following test may be sensitive to elicit a confirmatory response.

Renal punch test

Mike, your 48 year old construction worker patient presents to your clinic with a chief complaint of floaters, some flashes of light, and a curtain coming down over the visual field. As a prudent nurse practitioner, you notify Mike that he needs to be seen by ophthalmology immediately as these are al signs and symptoms of what condition?

Retinal detachment.

You are assessing a 26-year-old male patient who complains that his arm hurts. When assessing ROM of the shoulder, you ask him totouch the opposite scapula by placing his arm up and over the back of his neck, but the patient reports tremendous pain when attempting to do this. Which one of the following would you suspect?

Rotator cuff injury.

Unequal shoulder height with a lateral and rotary curvature of the spine would be associated with which one of the following spinal deformity diagnosis?

Scoliosis

A62 year old female patient with erythema on the face surrounding the nasolabial folds as well as very fine dandruff in the hair and skin is most likely describing with which of the following diseases?

Seborrheic Dermatitis

Your patient has expressed concern about a skin lesion which you identify as darkened, round, and raised. This benign lesion that appears like "stuck on" to the skin. Which of the following lesions best fits this description?

Seborrheic Keratosis.

Your patient is complaining of hypersomnia, lack of motivation, weight gain, and anhedonia. Suspecting a diagnosis of clinical depression, you anticipate the patient will benefit from treating their underlying deficit of which of the following neurotransmitters

Serotonin

Your patient has presented with dysfunctional uterine bleeding (DUB). Based on the most common cause of DUB, which of the following lab tests should be ordered by the nurse practitioner first?

Serum beta human chorionic gonadotropin (HCG)

Your 50 year old Caucasian male patient has not seen a primary care giver in 20+ years and is here for a history and physical examination. While examining the head and face, you see your patient has nonpitting periorbital edema, particularly underneath their eyes and very dry, thinned hair, including the lateral third of eyebrows (as pictured below: Sparse hairline, thin lateral eyebrows, Periobital edema). Which one of the folowing would you expect to cause this finding?

Severe hypothyroidism

Yourpatient who has underwent a recent major medical medical procedure is at a rehabilitation center and is having a hard time being motivated to do therapy. When you interview them as the nurse practitioner on staff for the subacute rehab center, they appeardespondent, and are having a hard time being wakeful during therapy sessions. They have stable vital signs, temperature, urine output, and are not ill-appearing. As a prudent nurse practitioner, you understand this may represent which of the following;

Situation depression

While performing sensory cortex testing on your patient, you gave them close their eyes and place a familiar object such as a paper clip, key or pencil in their hand, having them manipulate it skillfully and identify it within 5 seconds. This is known as which of the following tests?

Stereognosis

Your patient has provided you with a research paper about a new treatment plan that is being used, somewhat controversially, in otherareas of the world to treat sinus infections. She asks for your opinion. In reviewing the article, you educate the patient that they should look for which of the following, which are considered the highest level of research quality?

Systematic review

Your patient Steve, a 56 year old male with a history of smoking, sedentary lifestyle, and diabetes mellitus presents for follow-up from a recent hospitalization where he was documented to have symptoms of a transient ischemic attack (TIA). Which one of the following correctly identifies the etiology of TIA?

TIAs are caused by focal brain, spinal cord or retinalischemia, without acute infarction.

Your late adolescent female patient presents with a history of heavy menses and pale conjunctiva. Your review of systems is fairly unremarkable other than she lives in a house built in 1965, has an unrestricted diet, and her family heredity si Italian. She denies any history of chronic health conditions. Initial CBC with differential shows a microcytic hypochromic anemia which has not yet been diagnosed or treated and the red cell distribution width (RDW) is elevated at 15%. Based on the most common cause of microcytic hypochromic anemia, which of the following labs will you order first?

TIBC and Ferritin

The diagnosis of anxiety in your 28-year-old male patient may be differentiated from hyperthyroidism following testing?

TSH and free T4

The patient you just saw in the clinic a week ago was just admitted to the hospital in hyperthyroid crisis. The nurse practitioner at theemergency department calls your office to let you know and also ask some information about the patient. They asked about what the patient symptoms were during their most recent a visit a week ago. Which one of the following signs and symptoms would suggest a patient undergoing a hyperthyroid crisis?

Tachycardia

A patient of Mediterranean descent who presents with microcytic anemia with normal red cell distribution width should be evaluated using gel electrophoresis to confirm which of the following types of anemia?

Thalassemia

You are working in an urgent care setting as a NP when a patient presents with shortness of breath after a fall from a ladder earlier this morning. You obtain a chest xray and radiologist on call notifies you that it appears to be a tension pneumothorax. Which one of the following findings would you expect to see on the xray if this was the correct diagnosis?

The trachea shifted toward the unaffected side.

Your 43 year old female patient with no otherwise remarkable health history has a routine health visit and when evaluating the labwork, you notice a platelet count of 80,000. Which of the following is a correct diagnosis for this patient?

Thrombocytopenia

After a recent hospitalization for weakness, a diagnosis of myasthenia gravis has been made in a patient under your long term management. In the process of the examination, a CT of the chest was performed, and an object was identified as enlarged and wasremarked that it needs to be removed as it is thought to be related to this diagnosis. The patient now in your clinic states they don't remember what the object was and hoped you might know. The prudent nurse practitioner understands that the item likely represents which of the following?

Thymic remnant.

While assessing the 19 year old patient for a new onset cough, the nurse practitioner may inspect, auscultate, palpate, and/or percuss.How does performing percussion of the thorax assist the provider during the physical examination?*To assist with the confirmation of cardiac origin of angina.*To assess for deep-seated lesion and tumors.*To assess for any pain or discomfort prior to palpitation of the chest wall.*To identify if underlying tissue are air-filled, fluid-filled or consolidated

To identify if underlying tissue are air-filled, fluid-filled or consolidated

You are evaluating a 63 year old male patient with symptoms of chest pressure, arm numbness and tingling, as well as shortness of breath with excursion. Their health history includes diabetes mellitus, hypertension, hyperlipidemia, and rheumatoid arthritis. Thisrelieves with rest and is not becoming more frequent in the episodes. Based on these findings, you diagnose and plan for the patient includes which of the following?

Unstable angina, and treat with sublingual nitroglycerin and order a cardiac stress test.

As a prudent nurse practitioner, the diabetic, hypertensive patient you are seeing should be evaluated for early evidence of renal damage from both diabetes and hypertension. Which of the following assessment tools should the nurse practitioner order first for the evaluation of early renal dysfunction secondary to diabetes or hypertension?

Urinalysis with micro/macro albumin.

Your 22 year old male patient states during his review of systems thathis scrotum is very enlarged and feels like it is full a powerlifter and works as a trash collector. You suspect the patient likely has which of the following diagnoses?

Varicocele

The 43 year old male patient with macrocytic anemia should be evaluated for which of the following lab levels to help narrow down the etiology?

Vitamin B12

In addition to patient symptoms of painful urination and frequency, which of the following findings confirms a diagnosis of pyelonephritis?

WBC casts on urinalysis with microscopy.

The point of maximum impulse (PMI) is most often palpable in healthy adults when positioned in the supine or left lateral decubitus position. Which one of the following locations is most commonly described as the PMI in a healthy adult?

left 5th ICS, MCL

Your patient has a diagnosis of Addison's disease. Which of the following might you expect to find during examination?

low body temperature

Your 32 year old female patient presented for a routine health exam states they have a diagnoses of hyperthyroidism by anotherprovider a year ago. In addition to evaluation with TSH and T4 labwork, which of the following represent typical signs of hyperthyroidism expected on your exam of this patient?

tachycardia

Your newly established patient states in the past year, they have progressively developed a noticeable bump on their neck and when asked about symptoms, they report feeling very anxious, have developed a tremor, and are commonly feeling palpitations in their chest.On examination, you identify an enlarged thyroid gland suspicious for a goiter. Of the following diagnoses, which is most likely for the patient to develop based on these findings above?

thyrotoxicosis

Your patient with a diagnosis of autoimmune hepatitis is beingseen in your clinic for routine liver serology and follow-up examination. Which of the following correctly identifies the normal liver span when percussing the liver of a HEALTHY adult?

6-12 cm in the right midclavicular line.

On examination, Kim, your 68 year old female patient has the following facial muscle movements: Normal upper and lower on the rightside, Unable to move both the upper and lower muscles on the left side. You would immediately suspect which one of the following conditions?

A left peripheral lesion.

The 19 year old male patient presents with acute symptomsof abdominal pain and a history of intermittent heartburn and spicy foodintolerance, as well as anxiety due to his college athletic performance. You have a concern the patient may have a perforated gastric ulcer and is experiencing peritonitis. Which of the following exam findings is NOT supportive of this diagnosis?

Absence of pain with withdrawal of palpation.

Your 38-year-old male patient Mark is being seen in your clinic for a routine health physical and complaints of heartburn. During your evaluation, you identify darkened or velvety skin in the neck, groin, and/or axilla with associated acrochordons. This is most likely a diagnosis of which of the following?

Acanthuses nigricans

Which of the following dermatologic lesions si precancerous and likely due to prolonged exposure to UV-B?

Actinic Keratosis.

Your patient has been diagnosed with acanthosis nigricans. Which of the following exam findings would be consistent with the typical presentation of this?

Central obesity

The 84 year old lethargic patient who lives alone accidentally overdosed their amlodipine (Norvasc) was found by their daughter and taken to your clinic for evaluation. On exam, you found her blood pressure of 80/42 which the daughter says was "about what she found on her home cuff for the last 6 hours before bringing her in to be evaluated". The patient was then transferred to the hospital for evaluation. During her hospitalization she was also evaluated with CBC, BMP, and a UA. The results reflect normal labs except the UA showed trace WBCs in urine and no leukocyte esterases or nitrites and the BMP showed a creatinine of 1.9 with her normal baseline of1.2 (normal range 0.5-1.2mg/dL) and BUN of 34, with a baseline of 20 (normal range 10-20 mg/dL). What si likely to cause which of her renal issues?

Acute tubular necrosis

The nurse practitioner's evaluation of a patient with Diabetes Mellitus type 2 should include which of the folowing while evaluatingfor end organ dysfunction of the disease? *Renal function panel.*Urinalysis.*Non-dilated eye exam.*All of these are appropriate options.

All of these are appropriate options.

You are treating a patient who has stopped taking their diuretic regimen against medical advice while they are on vacation since it made them urinate too frequently for their plans. Now they are 21 pounds heavier than their baseline weight, have respiratory crackles in bilateral bases, and have severe generalized lower extremity and truncal edema extending to the sacrum and abdomen. On your documentation, this is referred to as which of the following conditions?

Anasarca

Your new patient intake history of an elderly man includes a history of Ehlers-Danlos with complications of retinal detachment treated with gas pneumopexy. In discussing this history, you recall the transparent mass of gelatinous material where the gas pneumopexy is performed can be found in which chamber(s) of the eye?

Anterior only

Your 32 year old female patient presents with a suspected diagnosis of systemic lupus erythematosus (SLE). Which of the useful labs in making the diagnosis of SLE?

Antinuclear antibody.

Your 42 year old male patient has been referred to your clinic for establishing care and on his intake survey, you note he has documented diagnosis of interstitial lung disease. You have decided to perform a diaphragmatic excursion test on the patient. Which one of the following results would you expect to see in this patient?

Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration. with a decreased overall inspiratory capacity

While evaluating a patient in your clinic for a routine health visit, you auscultate crackles in the poster left lower lobe, have the patient cough, with follow-up auscultation revealing clear breath sounds. Which one of the following would you suspect?

Atelectasis

Your 39 year old patient who has recently been hospitalized for an appendectomy and is being seen in your clinic for post-operative follow-up with primary care. On assessment, the patient complains of some incisional pain and otherwise examination is normal, with the exception of dull percussion sounds noted on the thorax over lung tissue. Which of the following diagnoses would be explained by this finding in post-operative patient?

Atelectasis

Your 72 year old female patient with a pertinent medical history of coronary artery bypass grafting (CABG) and aortic valve replacement 7 years ago with a porcine bioprosthetic valve has been previously stable on their medical regimen. Today she complains of near syncope when standing, which she states has been getting worse over the past 6 months but failed to tell anyone as she felt it was just part of natural aging and taking medications. Your workup should include evaluation of which of the following potential cardiac complications?

Bioprosthetic aortic valve stenosis

Your 32 year old patient exhibits mood changes with a cyclical nature of euphoria and bliss then troughs of depression and anhedonia. In addition to working them up for metabolic causes, you refer them to psychiatry and suggest a likely diagnosis of which of the following?

Bipolar disorder

The 18 year old female patient who inappropriately exhibits fear of abandonment, intense interpersonal relationships, affective instability, and recurrent self-harm describes which of the following diagnoses:

Borderline personality disorder

Your 22 year old female patient has been identified by labwork for a diagnosis of Systemic Lupus Erythematosus (SLE). In addition to labwork, SLE si most commonly identified by which of the following findings?

Butterfly rash on the face

As a prudent nurse practitioner, you know that a 28 year old male patient with human immunodeficiency virus (HIV) would be considered well managed when they have which of the following in addition to having undetectable or very low viral copies?

CD4 count of 500.