Practice Test

A nurse practitioner is using motivational interviewing techniques with a patient who has recently been diagnosed with hypertension. The patient expresses concerns about making lifestyle changes. Which of the following responses is the most appropriate to facilitate further discussion?

"Do you take your medications regularly?" B. "How do you feel about the changes you need to make?" C. "Is there a specific diet you're considering?" D. "You should reduce your salt intake, right?"

A 24-day-old female infant presents to the clinic with a 1-day history of fever and decreased appetite. Her parents report that she has been sleeping more than usual and has shown little interest in breastfeeding. The physical exam reveals a well-appearing infant in no acute distress. The vital signs are as follows: rectal temperature of 100.5°F, HR of 175 bpm, respiratory rate of 35 breaths/min, and oxygen saturation of 99%. What guidance should the nurse practitioner provide to the infant's parents? A. "I am concerned about possible sepsis" B. "Since it has only been 1 day, it is likely viral" C. "She needs a 10-day course of antibiotics" D. "You can give her ibuprofen (Motrin) every 6-8 hours"

"I am concerned about possible sepsis" Neonates who are febrile are at an increased risk of developing a serious bacterial infection (SBI) such as sepsis, meningitis, or a UTI. The statement, "I am concerned about possible sepsis" (A) is the most appropriate guidance for this parent. This patient has signs and symptoms that warrant immediate further evaluation and possibly empirical antibiotic therapy after obtaining appropriate cultures. Historically, all febrile neonates younger than 60-90 days old were hospitalized and underwent extensive laboratory testing of blood, urine, and CSF. However, this approach led to unnecessary invasive testing of neonates with self-limited viral illnesses.

A 36-year-old G4P3 woman presents for a routine prenatal visit at 30 weeks gestation. She was diagnosed with gestational diabetes mellitus at 26 weeks gestation. The nurse practitioner reviews the patient's vital signs and blood glucose log and orders lab work. Which of the following findings indicates effective management of this condition? 1-hour postprandial blood glucose levels < 200 mg/dL B. 2-hour postprandial glucose levels < 100 mg/dL C. Daily fasting glucose levels of < 95 mg/dL D. Weight loss of 2 pounds since the last visit

1-hour postprandial blood glucose levels < 200 mg/dL B. 2-hour postprandial glucose levels < 100 mg/dL C. Daily fasting glucose levels of < 95 mg/dL D. Weight loss of 2 pounds since the last visit

Which of the following patients with a 30 pack-year smoking history should undergo screening for lung cancer with low-dose CT of the chest, according to the USPSTF? A. A 45-year-old patient who currently smokes B. A 60-year-old patient who quit smoking 10 years ago C. A 75-year-old patient who quit smoking 20 years ago D. An 85-year-old patient who currently smokes

A 60-year-old patient who quit smoking 10 years ago The USPSTF updated its guidelines in March 2021 to recommend screening for lung cancer with low-dose CT (LDCT) in adults aged 50-80 who have at least a 20 pack-year smoking history and currently smoke or who have quit within the past 15 years. A 60-year-old patient who quit smoking 10 years ago (B) should undergo LDCT to screen for lung cancer.The most significant risk factors for developing lung cancer are smoking and older age. Additional risk factors include environmental exposures, radiation therapy, noncancerous lung conditions, and a family history of lung cancer. Patients who undergo screening should have screening repeated annually as long as they continue to meet the criteria. Tobacco cessation counseling should also be included for patients who currently smoke. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have lung surgery.

A 62-year-old man is interested in taking saw palmetto for his benign prostatic hyperplasia. The man currently takes amlodipine (Norvasc) for hypertension. Which of the following instructions should the nurse practitioner give regarding saw palmetto?

A decrease in blood pressure is a side effect B. Discontinue 2 weeks before surgical procedures due to concern for bleeding C. Interactions with the cytochrome P450 isoforms are common D. It is a significantly effective treatment for benign prostatic hyperplasia

A 22-year-old man presents to the clinic after sustaining a dog bite injury. He has multiple bite wounds. After his wounds have been thoroughly cleaned and irrigated, he asks whether he will need to have stitches. Which of the following bite wounds would it be acceptable to offer primary wound closure for?

A deep wound over the elbow joint B. A lip laceration that crosses the vermillion border C. A puncture wound on his hand D. A wound to his foot

While reading a journal article, a nurse practitioner comes across a section discussing the efficacy of a new drug. The article mentions a P value of .03 in relation to the drug's effect. Which of the following best defines what a P value is? A measure of the relationship between two variables B. The odds of an event in one group versus another C. The percentage of patients who responded to the drug D. The probability that observed results occurred by chance

A measure of the relationship between two variables B. The odds of an event in one group versus another C. The percentage of patients who responded to the drug D. The probability that observed results occurred by chance

A 70-year-old man presents to the clinic with urinary hesitancy, frequency, a slow stream, and straining to void. The symptoms have been present and progressively worsening over the past 2 years. Which of the following physical exam findings is most consistent with the suspected diagnosis?

A prostate of normal size and proteinuria on urine dipstick B. A small, firm, irregular prostate C. An enlarged, boggy, exquisitely tender prostate D. An enlarged, rubbery, symmetrical prostate

A 13-year-old girl presents to the clinic with poor school performance. The patient has had multiple runaway attempts in the past year. Which of the following would raise concern for sexual abuse and indicate the need for sexually transmitted infection screening? A. A sibling with a sexually transmitted infection B. Irregular periods C. Multiple boyfriends D. Poor hygiene

A sibling with a sexually transmitted infection

20-year-old man with a history of asthma presents to the clinic for an annual physical. He states that he currently has asthma symptoms every day that impact his daily activities. He states that he needs to take his albuterol (ProAir HFA) inhaler at least once per day for symptom relief. His most recent pulmonary function test revealed FEV₁ of 70% of predicted. What would be the best option for daily symptom control? A. Budesonide-formoterol (Symbicort) B. Prednisone C. Scheduled albuterol (ProAir HFA) D. Theophylline (Elixophyllin)

A. Budesonide-formoterol (Symbicort) Correct Asthma is an obstructive airway disease caused by a combination of airway hyperresponsiveness and inflammation. The most common presenting symptoms include wheezing, coughing, chest tightness, and shortness of breath. Asthma management involves controlling both airway hyperresponsiveness and inflammation to reduce daily symptoms and improve quality of life. Treatment decisions are based on the patient's asthma symptoms. For patients with intermittent symptoms alone, Global Initiative for Asthma (GINA) guidelines recommend as-needed use of inhaled corticosteroid (ICS)-formoterol combinations over short-acting beta agonist monotherapy. Those with daily symptoms are classified as having mild, moderate or severe persistent asthma. Patients with symptoms that impact their daily activities and who need multiple doses of a short-acting beta-agonist (SABA) each day are considered to have moderate persistent asthma. The recommended first-line agents for management of this class are ICS-formoterol combinations, for example, budesonide-formoterol (Symbicort) (A).

A 73-year-old woman presents to the clinic with reports of mild aching pain in her right knee that has occurred for the past few months. She reports no known exacerbating injury and no history of knee surgery. The pain is worse with walking and improves with rest. She has not tried anything to alleviate the pain. The physical examination reveals bony enlargement of the knee and joint line tenderness. A knee X-ray reveals narrowed joint spaces and subarticular reactive sclerosis. Which of the following is the best initial pharmacologic treatment for the suspected diagnosis?

Acetaminophen (Tylenol) B. Glucosamine and chondroitin C. Topical diclofenac (Voltaren) D. Tramadol (Ultram)

A 12-year-old afebrile patient presents to the clinic with right ear pain for the past 2 days after swimming. On examination, there is erythema and edema of the external auditory canal, with debris and crusted material visible in the external canal. The tympanic membrane is intact and nonerythematous. She reports pain when the auricle is gently pressed. Which of the following is the best therapy?

Acetic acid 2% otic solution Incorrect B. Ciprofloxacin 0.3% and dexamethasone 0.1% otic solution (Ciprodex) Correct C. Oral amoxicillin D. Oral cefdinir

A 44-year-old woman presents to the clinic with reports of gradual hearing loss in her right ear and intermittent episodes of dizziness and imbalance for 1 year. The otoscopic examination reveals no abnormal findings. The Rinne, Weber, and audiometry tests reveal significant sensorineural hearing loss on the right side. The Romberg test is normal. Which of the following is the most likely diagnosis? Acoustic neuroma B. Cholesteatoma C. Ménière disease D. Presbycusis

Acoustic neuroma Correct The clinical presentation of gradual hearing loss, dizziness, imbalance, and significantly decreased hearing on one side suggests a possible acoustic neuroma (A), also known as a vestibular schwannoma. These neoplasms commonly present with asymmetric sensorineural hearing loss and may be associated with vestibular symptoms, such as dizziness or imbalance. The physical examination typically reveals unilateral decreased sensorineural hearing acuity on the Rinne and Weber tests, and subsequent audiometry will confirm unilateral hearing loss. Balance exams (e.g., the Romberg test or the Hall-Pike test) will be normal because acoustic neuromas affect the auditory portion of the vestibulocochlear nerve rather than the vestibular component.

An 11-month-old female infant presents to the clinic to follow up on adhesions of her labia minora. She was seen 4 weeks ago and prescribed topical estradiol (Estrace) 0.01% cream after being treated for recurrent UTIs. On reassessment, the nurse practitioner notes a well-appearing infant with a soft bladder that is nontender to palpation and almost complete fusion of the labia, with no visible improvement since her previous visit. Which of the following is the most appropriate next step in management?

Add topical progesterone (Progestogel) 1% cream twice daily B. Attempt physical separation at the bedside C. Refer to pediatric gynecology for surgical separation D. Review topical application instructions and technique with the patient's caregiver

A 25-year-old patient is seen in the clinic for preconception counseling. The laboratory evaluation reveals hemoglobin of 14.8 g/dL, hematocrit of 49%, and heterozygous hemoglobin S. Evaluation of the partner's laboratory results reveals hemoglobin of 15.1 g/dL, hematocrit of 46%, and heterozygous hemoglobin S. What should the nurse practitioner advise them about the associated risk of disease for their future child?

Additional testing for presence of a JAK2V617F mutation is recommended B. The child will have beta-thalassemia, and the symptom onset is between 6 and 12 months of age C. There is a 25% chance that the child will have sickle cell disease D. There is a 75% chance that the child will be a carrier for the sickle cell trait

A 26-year-old man presents to the clinic with a report of a human bite wound to his right thumb, sustained while working as a nurse. Records indicate that a primary childhood DTaP vaccination series was completed, and he received a Tdap booster at age 19. The wound was cleaned and bandaged. Which additional step is most appropriate at this time?

Administer a Td booster B. Administer a Tdap booster C. Administer human tetanus immune globulin D. No additional treatment is recommended

Which of the following should the nurse practitioner do to help prevent the leading cause of death in adolescents 13-18 years old?

Administer immunizations B. Educate on safe sex practices C. Encourage seat belt use D. Recommend stress-reduction techniques

A 4-day-old male infant presents to the clinic to follow up on elevated bilirubin levels. He was born via an uncomplicated vaginal delivery at 37 weeks gestation and was discharged from the hospital 1 day ago with a total serum bilirubin level of 19 mg/dL. His mother reports he has been somewhat difficult to arouse and stimulate to breastfeed. The physical exam reveals a sleepy but arousable newborn with visible jaundice. His total serum bilirubin level measured during the current visit is 21 mg/dL. Which of the following is the next best step in management?

Advise the mother to transition to formula feeding B. Instruct the mother to place the newborn in front of a sunny window C. Refer for phototherapy D. Repeat a transcutaneous bilirubin level in 24 hours

A 58-year-old man is on a multidrug regimen for essential hypertension. His blood pressure is at goal, but he notes persistent bilateral pedal edema. Which of the following medications is the most likely cause of this side effect? Amlodipine (Norvasc) B. Enalapril (Vasotec) C. Losartan (Cozaar) D. Metoprolol tartrate (Lopressor)

Amlodipine (Norvasc) Correct Amlodipine (Norvasc) (A) is a calcium channel blocker (CCB) used to treat hypertension (HTN) and is known to cause pedal edema, particularly in older adults. Other adverse effects of CCBs include headaches, flushing, and bradycardia. Edema development can usually be lessened by adding an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) to the patient's regimen. CCBs are generally well tolerated and work by causing peripheral vasodilation while minimizing the reflex tachycardia common with other vasodilating agents.HTN is a common chronic health condition affecting nearly 50% of adults in the United States. Essential HTN refers to HTN that has no identifiable etiology or secondary causes. According to ACC/AHA guidelines, stage 1 HTN is systolic blood pressure (SBP) of 130-139 mm Hg or diastolic blood pressure (DBP) of 80-89 mm Hg. Stage 2 HTN is defined as SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg. Proper control is vital to reducing complications, such as cardiovascular disease, cerebrovascular disease, hypertensive nephropathy, and hypertensive retinopathy. Initial medication regimens will generally include diuretics, ACE inhibitors, ARBs, or CCBs, and they must be tailored for each patient, considering their BP measurements and 10-year atherosclerotic cardiovascular disease (ASCVD) risk.

A newly licensed nurse practitioner is preparing to start their first position at a primary care clinic. During the onboarding process, the clinic's medical director requests that the nurse practitioner sign a collaborative agreement document. Which of the following best describes a collaborative agreement? A. A contract between the nurse practitioner and the clinic for employment terms and salary B. A document formalizing the responsibilities in the clinic regarding patient load, billing, and documentation C. An agreement between the nurse practitioner and a physician outlining the scope of practice and consultation requirements D. An arrangement between the nurse practitioner and the clinic's insurance provider regarding patient billing procedures

An agreement between the nurse practitioner and a physician outlining the scope of practice and consultation requirements

A 43-year-old woman presents to the clinic to establish care. She has no significant medical history, but she has not seen a primary care clinician since childhood. She feels well and has no health concerns at this time. She reports no family history of cancer, but her mother has dense breasts, and she is concerned that her breasts might also be dense. A physical exam, including a pelvic exam and breast exam, reveals no abnormal findings. Which of the following is recommended by the USPSTF for breast cancer screening for this patient?

Annual screening with breast MRI for women 40-74 years of age with dense breasts B. Annual screening with mammography for women 40-74 years of age C. Biennial screening with mammography for women 40-74 years of age D. Biennial screening with mammography for women 50-74 years of age

A 45-year-old patient presents to the clinic for an annual physical exam. He inquires about hepatitis C virus screening, as he has not had screening for this virus in the past. He has no identifiable risk factors for hepatitis C virus and reports no current associated symptoms. Which of the following screening tests for hepatitis C virus should the nurse practitioner order first?

Anti-hepatitis C virus antibody test B. Qualitative hepatitis C virus RNA test C. Quantitative hepatitis C virus RNA test D. Screening for hepatitis C virus is not indicated The CDC recommends a universal one-time hepatitis C virus (HCV) screening test for all adults aged 18 and older, as well as HCV screening for patients who are pregnant during each pregnancy. Patients with persistent risk factors (e.g., patients who inject drugs, patients who receive hemodialysis) may also receive intermittent HCV testing. The initial HCV screening test is the anti-hepatitis C virus antibody (anti-HCV) test (A). This test detects the presence of antibodies that develop in the body when exposed to HCV. If this test's results are positive, an HCV RNA level should be obtained to confirm active HCV infection, known as a viral load.

A 77-year-old man with a history of diabetes and hypertension presents to the clinic for an annual wellness visit. He reports no acute issues at the current visit. On fundoscopic examination of the patient's eyes, the nurse practitioner notices white, ovoid lesions with irregular borders. What is the nurse practitioner visualizing on fundoscopic examination?

Arteriovenous nicking B. Hard exudates C. Microaneurysms D. Soft exudates

A 12-year-old girl presents to the clinic with redness in and watery discharge from her right eye that began 2 days ago. It now involves the left eye as well. She woke up this morning unable to open her eyes and had to wash her face with a warm washcloth to do so. She recovered from a cold 2 weeks ago and has otherwise been healthy. The physical examination reveals bilateral conjunctival injection and tearing. What is the best treatment for this condition?

Artificial tears and cold compresses B. Erythromycin ophthalmic ointment C. Ketorolac ophthalmic solution (Acular) D. Trimethoprim-polymyxin B ophthalmic solution (Polytrim)

A 53-year-old man presents to the clinic with a 3-month history of palpitations, fatigue, and weakness that he experiences shortly after starting yard work. He has a medical history of diabetes mellitus and hypertension. An ECG shows an irregularly irregular rhythm. Which of the following is the most likely diagnosis? A. Atrial fibrillation B. Atrial flutter C. First-degree atrioventricular block D. Ventricular tachycardia

Atrial fibrillation The patient's clinical presentation is consistent with atrial fibrillation (Afib) (A). Common symptoms include palpitations, fatigue, dizziness, lightheadedness, mild dyspnea, and weakness. Symptoms are often exacerbated by activity, such as the yard work described in the vignette. An irregularly irregular rhythm on ECG with an absence of distinct P waves confirms the diagnosis of Afib. It can be paroxysmal, persistent, longstanding persistent, or permanent.

Which of the following dietary guidelines is currently recommended for children 1-2 years of age? A. Avoid added sugars B. Avoid dietary fat and carbohydrates C. Be limited to 8 ounces of juice per day D. Consume at least 2 cups of skim milk daily

Avoid added sugars

A 41-year-old woman presents to the clinic with concerns about changes in weight, unusual bruising, depression, irregular menses, and a decreased libido. She has a history of asthma. On exam, you note a buffalo hump, hirsutism, striae and bruising on the abdomen and upper arms, and hyperhidrosis. Her BP is found to be elevated at 171/96 mm Hg. Which of the following is the most likely diagnosis? Adrenal insufficiency B. Cushing syndrome C. Hypothyroidism D. Polycystic ovary syndrome

B. Cushing syndrome Correct Cushing syndrome (B) is the result of hypercortisolism. Symptoms of Cushing syndrome are consistent with prolonged exposure to glucocorticoids, as with the woman in the vignette. These symptoms include changes in weight distribution, depression, hypertension, acne, hyperhidrosis, bruising, abnormal menses, glucose intolerance, and hirsutism.

Which of the following of Erikson's stages of development is consistent with a sense of pride in academic achievements? Autonomy vs shame and doubt B. Industry vs inferiority C. Initiative vs guilt D. Trust vs mistrust

B. Industry vs inferiority Correct Industry vs inferiority (B) is stage four of Erikson's stages of psychosocial development and is characterized by a desire to become competent in school-age children (i.e., 5-12 years old). A sense of pride in academic achievements is developmentally consistent with a school-age child learning new skills and feeling a sense of industry or competence when they acquire those skills. A bad grade may leave the child feeling inferior and can result in the child comparing themselves to their peers or becoming overly competitive.

A 35-year-old woman presents to her primary care nurse practitioner with two episodes in the last month of feeling like the room is spinning. The episodes lasted 30 minutes and resolved without intervention. She also reports buzzing in her left ear and difficulty hearing. On exam, transient nystagmus unrelated to position is noted. The Rinne test demonstrates bilateral air conduction greater than bone conduction, and the Weber test reveals lateralization to the right ear. An MRI of the brain is performed with no significant results. Which of the following is the most likely diagnosis?

B. Ménière disease Correct Ménière disease (B) is a condition characterized by episodic vertigo, tinnitus, and hearing loss or aural fullness. The spinning sensation may lead to nausea and vomiting, imbalance, and disequilibrium. Episodes may last from 20 minutes to 24 hours. The Rinne test will typically show bilateral air conduction greater than bone conduction. The Weber test will lateralize to the unaffected ear. The initial hearing loss in Ménière disease is sensorineural to low tones, but the loss is typically progressive and will eventually affect all frequencies in the affected ear.

Which of the following cases of bruising would raise concern for child abuse? Which of the following cases of bruising would raise concern for child abuse? A. Multiple bruises on a toddler's shins B. One bruise on a 3-month-old infant C. One bruise on a crawling child D. One bruise on a toddler's forehead

B. One bruise on a 3-month-old infant Correct

A 2-month-old Black infant presents to the clinic for a routine visit. On the physical exam, the nurse practitioner notes 2 light-brown macules with uniform borders on the infant's torso. Which of the following is the most likely diagnosis ? A. Café-au-lait spots B. Congenital dermal melanocytosis C. Milia D. Salmon patch

Café-au-lait spots B. Congenital dermal melanocytosis C. Milia D. Salmon patch

A 47-year-old woman presents with 4 days of high fever, headache, and myalgias. She developed a blanching erythematous rash with macules on her wrists and ankles that spread to her trunk 2 days ago. She reports no history of overseas travel but was camping in Arkansas last weekend. Which of the following is the most appropriate treatment for the suspected diagnosis? Ceftriaxone B. Doxycycline (Vibramycin) C. Erythromycin (Erythrocin) D. Vancomycin (Vancocin

B. Doxycycline (Vibramycin)

The nurse practitioner is tasked with conducting research in the clinic to determine the best course of action to improve compliance with prescribed treatment plans in adult patients with diabetes. Which of the following studies would offer the highest quality of evidence?

Case study on follow-up phone calls B. Cohort study on using a pill box C. Qualitative study of telemedicine visits with primary care clinician D. Randomized controlled trial of using smartphones to remind patients to check blood glucose

A 62-year-old woman presents with a report of dysuria and a fever of 100.1°F for 2 days. Which additional finding would suggest a complicated UTI rather than an uncomplicated UTI?

Bacteriuria B. Costovertebral angle tenderness C. Suprapubic pain D. Urinary frequency

A 62-year-old woman presents to the clinic with spotting for 2 weeks. Her last menstrual cycle was 8 years ago. She reports that she is sexually active with one partner. A pelvic examination reveals atrophic vaginal mucosa without evidence of bleeding, and adnexal masses are not palpable. The vulvar and urethral examination is unremarkable. Stool guaiac testing is negative. Which of the following is the most likely diagnosis? Bladder cancer B. Endometrial carcinoma C. Ovarian fibroma D. Rectal adenocarcinoma

Bladder cancer B. Endometrial carcinoma C. Ovarian fibroma D. Rectal adenocarcinoma

A 20-year-old woman presents with a swollen, red, locally tender lump on her upper eyelid margin that developed 2 days ago without a known injury. She recently started wearing eye makeup and reports frequently falling asleep without removing the eye makeup. She reports no change in vision, and her ocular movements are intact. Which of the following is the most likely diagnosis?

Blepharitis B. Chalazion C. Dacryocystitis D. External hordeolum

A 58-year-old man presents to the clinic for a follow-up on his hypertension and reports no issues. His additional medical history includes chronic kidney disease stage IV, gout, and diabetes mellitus. His laboratory studies reveal hemoglobin of 10 g/dL, hematocrit of 36%, total iron of 50 mcg/dL, and ferritin of 200 ng/mL. Which of the following should be included in the plan of care at this time? Blood transfusion B. Iron chelation therapy C. Referral to a hematologist D. Routine iron studies and CBC

Blood transfusion B. Iron chelation therapy C. Referral to a hematologist D. Routine iron studies and CBC

A 31-year-old patient presents with a history of anemia initially diagnosed approximately 10 years ago, but the patient did not start treatment at that time due to cost. The patient's mother is reported to be positive for the beta-thalassemia trait, but the father's history is unknown. Currently, she reports no symptoms but is concerned that she should be tested for thalassemia before having children. Which of the following laboratory studies is often used to confirm the diagnosis of beta-thalassemia?

Bone marrow biopsy B. Hemoglobin electrophoresis C. Iron studies D. Peripheral smear

A 5-year-old boy presents to the clinic with a sore throat and fever. On physical examination, he has pharyngeal erythema, tender cervical adenopathy, and bilateral tonsillar exudates. His rapid Streptococcus screen is positive. His mother reports the child has a history of a severe penicillin allergy. Which of the following medications is the most appropriate therapy at this time?

Cephalexin (Keflex) B. Clarithromycin C. Trimethoprim-sulfamethoxazole (Bactrim DS) D. Vancomycin (Vancocin)

An active 86-year-old man presents for evaluation of a new tremor that he has noticed intermittently over the past several years. He is concerned because the tremor was initially mild and localized to his hands, but lately, it is more pronounced and affecting his arms. He has noticed that the tremor is worse when his arms are extended and when he uses his hands, specifically handling eating utensils and drinking from a glass. He usually enjoys weekly cocktail parties but has lately been having a glass of wine at home to avoid social embarrassment. He does notice that alcohol seems to provide some relief. He is concerned that the tremor may have to do with his age. Which of the following medications is the best initial choice to manage this patient's condition?

Botulinum toxin A (Botox) B. Donepezil (Aricept) C. Propranolol (Hemangeol) D. Rasagiline (Azilect)

A 75-year-old man presents for a hospital follow-up after having a myocardial infarction. Since returning home from the hospital, he has had dyspnea on exertion and orthopnea. The physical examination reveals an S3 gallop on cardiac auscultation and trace bilateral pedal edema. Which of the following best describes the cause of his current presentation?

Bronchospasm and inflammation resulting in airway constriction B. Depression of cardiac contractility secondary to loss of functional muscle C. Heart valve regurgitation leading to increased preload D. Supranormal cardiac function that is not able to meet increased metabolic demands

A nurse practitioner is assisting with the implementation of a new electronic medical record system in the clinic. The nurse practitioner would like to remain in compliance with legal and ethical principles for managing health-care information. Which of the following system features should be prioritized? Access restricted to licensed health-care clinicians only B. Advertisements direct to patients based on their health data C. Data protection with accessibility for authorized staff D. Display of the latest medical research on the homepage

C. Data protection with accessibility for authorized staff Correct

A 70-year-old man presents to the clinic for a routine checkup. He has a history of smoking one pack of cigarettes per day for the past 40 years. He reports no discomfort today. Which of the following is the most appropriate recommendation regarding abdominal aortic aneurysm screening for this patient? Advise him to quit smoking but defer screening since he is asymptomatic B. No screening necessary, as he is beyond the recommended age C. Order an abdominal U/S for screening today D. Perform a physical examination of the abdomen to assess for a pulsatile mass

C. Order an abdominal U/S for screening today

What is the most common type of hearing loss in the older adult population?

Cerumen impaction B. Chronic otitis media with effusion C. Otosclerosis D. Sensorineural hearing loss

A 27-year-old nullipara woman who is sexually active presents to the clinic for her routine women's health visit. Which of the following clinical manifestations should prompt the nurse practitioner to offer the patient a serum pregnancy test?

Chadwick sign B. Effacement C. Lichen planus D. Vasa previa

Which of the following is the most important first step when evaluating a 15-year-old girl with a 4-month history of secondary amenorrhea? Checking weight B. Measuring FSH C. Measuring human chorionic gonadotropin levels D. Measuring TSH

Checking weight B. Measuring FSH C. Measuring human chorionic gonadotropin levels D. Measuring TSH

A 67-year-old man presents to the clinic for his annual wellness visit. He explains to the nurse practitioner that he is having difficulty seeing things directly in front of him. However, his peripheral vision is at his baseline. Which of the following is the most common risk factor for this condition?

Cigarette smoking B. Diabetes C. Elevated intraocular pressure D. Hyperthyroidism

A 12-month-old female infant presents to the clinic for a routine well-child visit. Her mother reports they recently immigrated to the United States from Guatemala. The patient is exclusively breastfed, and her weight for age is in the 65th percentile. The lab results are hemoglobin of 10.5 g/dL and a lead level of 2.3 mcg/dL. Which of the following is the best next step? A.Complete a focused history and dietary assessment B. Order a serum ferritin C. Prescribe oral iron supplementation D. Refer for lead chelation therapy

Complete a focused history and dietary assessment B. Order a serum ferritin C. Prescribe oral iron supplementation D. Refer for lead chelation therapy

A 4-year-old boy with a history of cystic fibrosis presents to the clinic for a routine follow-up visit. His mother states he recently began playing soccer. She reports no fevers, increased sputum production, abdominal pain, or diarrhea. At his last visit, he was prescribed albuterol (ProAir HFA) PRN. Other medications include pancrelipase (Pancreaze) with meals and a multivitamin daily. His height and weight are measured at 39.5 inches and 30 lbs, respectively, with a BMI of 13.5 kg/m2, placing him in the fifth percentile for weight for age and the first percentile for BMI. His FEV₁ in the office today is 85% of the predicted value. Which of the following is the most appropriate next step in management?

Complete a nutritional assessment Correct B. Discourage aerobic exercise Incorrect C. Increase pancreatic enzymes Incorrect D. Prescribe formoterol-budesonide (Symbicort) daily Cystic fibrosis (CF) is a progressive genetic disorder characterized by thick, sticky secretions that affect multiple organs, including the lungs and pancreas. Children with CF often require higher caloric intake due to malabsorption and decreased appetite. These factors, in turn, often lead to diminished growth and nutritional deficiencies. However, optimal growth and nutrition have been linked to improved longevity and quality of life. For children with CF, the weight-for-age range should be maintained at or above the 10th percentile, and the goal BMI range is above the 50th percentile. In patients who do not meet these targets, further evaluation and completion of a nutritional assessment (A) are necessary.

A nurse practitioner is considering introducing telehealth into their practice. Which of the following is true regarding telehealth? A. Compliance with HIPAA privacy and security rules is mandatory B. Health outcomes are inferior to traditional in-person visits C. Liability insurance is not available D. Only physicians are permitted to bill for telehealth services

Compliance with HIPAA privacy and security rules is mandatory Correct

A 55-year-old man with a history of depression treated with duloxetine (Cymbalta) presents for follow-up for a skin abscess. He was recently evaluated in the ED and underwent incision and drainage of a left forearm abscess, and the wound culture grew methicillin-resistant Staphylococcus aureus. He is currently on cephalexin (Keflex) and has a known allergy to sulfa drugs. What is the best next step in his management?

Continue cephalexin (Keflex) B. Stop cephalexin (Keflex) and start doxycycline (Vibramycin) C. Stop cephalexin (Keflex) and start linezolid (Zyvox) D. Stop cephalexin (Keflex) and start trimethoprim-sulfamethoxazole (Bactrim DS)

A 68-year-old woman presents to the office with reports of aching pain and stiffness in her neck, shoulders, and hips, which started 2 weeks ago. The symptoms are worse in the morning and make daily activities, such as putting on a shirt or standing up from a seated position, difficult to perform. Her labs reveal an elevated erythrocyte sedimentation rate and C-reactive protein, but a negative rheumatoid factor. Which of the following is the most appropriate treatment for the suspected diagnosis? A. Acetaminophen (Tylenol) B. Ibuprofen (Motrin) C. Methotrexate (Trexall) D. Prednisone

D. Prednisone This patient's clinical presentation is consistent with polymyalgia rheumatica (PMR), an inflammatory rheumatic condition that almost exclusively develops in adults older than 50. It is characterized by aching and stiffness in the shoulders, hip girdle, and neck. Aching and stiffness associated with PMR are of recent onset and are worse in the morning and with prolonged inactivity. The first-line treatment for PMR is prednisone (D), with a typical daily dose of 15-20 mg, which results in rapid resolution of symptoms. The dose that effectively controls symptoms should be continued for 2-4 weeks after resolution of symptoms and then can be reduced gradually. The duration of prednisone treatment for PMR is commonly > 1 year.

A 3-year-old boy presents with a 1-day history of right ear pain that began after swimming lessons. The patient's mother states that he has a history of frequent ear infections and broke out in hives approximately 1 month ago after taking amoxicillin. On physical exam, the nurse practitioner notes a bulging tympanic membrane with erythema and displaced landmarks. Which of the following is the most appropriate treatment for the patient's suspected condition? Cefdinir B. Erythromycin (Erythrocin) C. Penicillin G benzathine (Bicillin) D. Trimethoprim-sulfamethoxazole (Bactrim DS)

D. Trimethoprim-sulfamethoxazole (Bactrim DS) Acute otitis media (AOM), or suppurative otitis media, is an infection of the middle ear, which often causes otalgia, otorrhea, and hearing loss. Typical otoscopic findings include a bulging, fluid-filled tympanic membrane (TM) that may be red, opaque, or yellow in color. The cone light reflex and bony landmarks may also be displaced or absent. Recurrent cases of AOM are treated with antibiotic therapy unlike the initial observation. In the setting of an IgE-mediated reaction to penicillin, such as anaphylaxis or hives, second-line treatment options include azithromycin (Zithromax), clarithromycin, and trimethoprim-sulfamethoxazole (Bactrim DS) (D).

A 38-year-old woman presents to the clinic with reports of fatigue. A CBC reveals hemoglobin of 10.6 g/dL, hematocrit of 31%, and a mean corpuscular volume of 118 fL. The physical exam reveals pallor. Which of the following is most likely to confirm the patient's suspected diagnosis? A. Ferritin B. Platelet count C. Transferrin saturation D. Vitamin B12

D. Vitamin B12 This patient is exhibiting the signs and symptoms of anemia, including low hemoglobin and hematocrit, fatigue, and pallor. The patient's elevated mean corpuscular volume is indicative of megaloblastic anemia, such as vitamin B12 deficiency or folic acid deficiency. To confirm this patient's diagnosis, the nurse practitioner should evaluate a vitamin B12 (D) level.Many patients with vitamin B12 deficiency have a condition that predisposes them to this condition, including decreased oral intake of animal products or a strictly vegan diet, GI conditions or surgeries that inhibit absorption (e.g., bariatric surgery or Crohn disease), or genetic conditions. Certain medications, including metformin (Glumetza) and proton pump inhibitors, may increase the risk of developing vitamin B12 deficiency. Common symptoms include glossitis, paresthesias, and vague GI symptoms, such as decreased appetite or diarrhea. Folate deficiency anemia is another macrocytic anemia, which occurs with a low serum folic acid level. Diagnosis of vitamin B12 deficiency can be confirmed if a low vitamin B12 level is detected. Management includes replacement of vitamin B12 via IM or oral administration. Vitamin B12 is typically administered indefinitely for those patients whose conditions cannot be reversed.

The nurse practitioner is seeing a 68-year-old woman for a follow-up from her previous visit. The patient has been diagnosed with heart failure with a preserved ejection fraction of 55%. The patient was started on empagliflozin (Jardiance) in order to reduce cardiovascular death or hospitalization in patients with a similar diagnosis. Which of the following is a common side effect of the new medication? Bradycardia B. Hyperkalemia C. Vision changes D. Vulvovaginal candidiasis

D. Vulvovaginal candidiasis The nurse practitioner recognizes that the patient has heart failure with a preserved EF of 55%. Empagliflozin (Jardiance) is the only therapy shown to reduce cardiovascular death or hospitalization in these patients, with or without concurrent diabetes mellitus (DM). Empagliflozin (Jardiance), as well as other sodium-glucose cotransporter 2 (SGLT2) inhibitors, has been associated with an increased risk of genitourinary fungal infections, including vulvovaginal candidiasis (D)

A 9-year-old boy presents to the clinic for a follow-up visit. His mother reports that the patient has been experiencing difficulty falling and staying asleep since his last visit. There is no report of mood changes or issues with school performance. His vital signs are normal. Current medications include polyethylene glycol 3350 (Miralax) 17g once daily, methylphenidate (Ritalin) 5 mg twice daily, and a children's multivitamin once daily. Which of the following is the most appropriate next step in management? A. Decrease second dose of methylphenidate (Ritalin) to 2.5 mg B. Discontinue methylphenidate (Ritalin) and begin atomoxetine (Strattera) 40 mg once daily C. Prescribe extended-release methylphenidate (Ritalin) D. Recommend a drug holiday from methylphenidate (Ritalin)

Decrease second dose of methylphenidate (Ritalin) to 2.5 mg Insomnia is a common adverse effect of stimulant medications, such as methylphenidate (Ritalin). Timing of adverse effects is an important consideration when managing the side effects of stimulants. Decreasing the second dose of methylphenidate (Ritalin) (A) reduces the duration of action and can reduce symptoms of insomnia in this patient. In addition to reducing the dose, the nurse practitioner should also discuss the importance of implementing sleep hygiene measures to improve insomnia. Sleep hygiene measures include creating a cool, dark, and quiet environment conducive to sleep; eliminating sugary and caffeinated foods or beverages; and avoiding screen time 1-2 hours before bed. Titrating stimulants with short-acting formulations can help the nurse practitioner to determine the optimal daily dose before changing to a longer-acting option. The optimal daily dose is individualized and achieves desired outcomes with the least side effects. Doses should be adjusted gradually over 3-7 days, and it can take between 4 and 12 weeks to achieve the desired dose and frequency.

A 9-month-old female infant presents to the clinic for a routine well-child visit. Six months ago, she was prescribed omeprazole (Prilosec) due to gastroesophageal reflux and poor weight gain. At the present visit, her parents report that she is drinking approximately 24 ounces of formula daily and eating some solid foods. They report no current issues with reflux. While reviewing the patient's growth chart, the nurse practitioner notes steady and appropriate weight gain over the past 6 months. Which of the following is the next best step in management? Continue omeprazole (Prilosec) as prescribed B. Decrease the dose of omeprazole (Prilosec) and reevaluate in 3 weeks C. Discontinue omeprazole (Prilosec) and prescribe metoclopramide (Reglan) D. Discontinue omeprazole (Prilosec) and reevaluate in 3 months

Decrease the dose of omeprazole (Prilosec) and reevaluate in 3 weeks

An 80-year-old man presents to the clinic with concerns about occasional unsteadiness while walking. The nurse practitioner would like to evaluate the patient's proprioceptive function and vestibular system. Which of the following assessments is most appropriate for this purpose?

Deep tendon reflexes B. Finger-to-nose test C. Romberg test D. Two-point discrimination

A 4-year-old girl presents to the office for an annual well-child check with her parent. Her physical exam is within normal limits. Her mother asks whether children her age have a sense of spirituality. Which of the following behaviors demonstrates new, age-appropriate spiritual development for a 4-year-old child?

Demonstrates moral thinking Incorrect B. Exhibits love and trust toward a caregiver Incorrect C. Has an imaginary friend Incorrect D. Reads a bedtime story each night

An 82-year-old woman presents to the clinic with reports of increased fatigue, slower walking speed, and decreased strength over the past 6 months. She also reports an unintentional 10-lb weight loss over the past year. Laboratory tests, including CBC, kidney function, thyroid function, and vitamin D levels, are unremarkable. Which of the following is the most likely diagnosis?

Depression B. Frailty C. Malnutrition D. Parkinson disease

A nurse practitioner partners with a local university to study the effects of a novel dietary supplement on blood pressure regulation in young adults. Eager to begin, the nurse practitioner has already drafted the research protocol, identified potential participants, and secured the necessary supplements for the study. However, the university's research coordinator advises the nurse practitioner to first address a critical step before proceeding. Which of the following is essential before initiating the study? Design a marketing strategy for the dietary supplement B. Ensure the study results will be published in a top-tier journal C. Obtain approval from the institutional review board D. Secure additional funding from pharmaceutical companies

Design a marketing strategy for the dietary supplement B. Ensure the study results will be published in a top-tier journal C. Obtain approval from the institutional review board D. Secure additional funding from pharmaceutical companies

A 26-year-old patient who is pregnant and plans to breastfeed comes to the clinic to discuss postpartum contraception options. She would like to begin contraception as soon as possible after delivery. Which of the following is the most appropriate contraception method for this patient?

Diaphragm B. Ethinyl estradiol and norelgestromin transdermal patch (Xulane) C. Medroxyprogesterone acetate (Depo-Provera) D. Norethindrone (Aygestin) The ideal time to address contraception is during the antenatal period. Many factors need to be considered when counseling on contraceptive methods, including long-term family planning, medical comorbidities, and plans for breastfeeding. The risks and benefits of each contraceptive method should be considered when selecting appropriate methods. A woman who is breastfeeding may begin a progestin-only oral contraceptive, such as norethindrone (Aygestin) (D), at any time during the postpartum period. Although there are other acceptable contraception options, progestin-only pills are preferred in the immediate postpartum period for patients who desire continued fertility because they have high efficacy rates and do not interfere with milk production.Permanent sterilization via bilateral salpingectomy is an option for women who do not desire future pregnancies. Both copper and levonorgestrel IUDs do not interfere with milk production and can be used while breastfeeding, although early placement does have a risk of expulsion. Condoms have lower effectiveness but are also acceptable options while breastfeeding. The etonogestrel subdermal implant (Nexplanon) is another contraception option in the postpartum period, as it also does not interfere with breastfeeding.

A 67-year-old woman presents to the clinic with reports of left-sided facial pain. She reports the pain as severe, burning, and sharp. She was evaluated in the clinic 4 months ago for herpes zoster located over her left jaw, and she completed treatment with valacyclovir (Valtrex). Despite using capsaicin cream and ibuprofen (Motrin), she has not experienced any relief. The physical examination reveals no abnormalities or skin findings. Which of the following is the best next treatment option for the suspected diagnosis?

Duloxetine (Cymbalta) B. Gabapentin (Neurontin) C. Nortriptyline (Pamelor) D. Tramadol (Ultram)

A 30-year-old woman presents to the clinic with acute abdominal pain, anorexia, fever, and vomiting. The nurse practitioner suspects appendicitis because right lower quadrant pain is elicited when the left lower quadrant is palpated. Which of the following signs describes this finding?

Dunphy sign B. Markle sign C. Psoas sign D. Rovsing sign

You are examining a 2-week-old female infant at a routine visit. Her mother states that her child's eyes seemed to be tearing up frequently over the past several days. The examination shows excessive tearing and some slight discharge in the medial canthus bilaterally. There is no conjunctival injection or discharge detected. Which of the following is the most appropriate next step in management?

Educate the mother on how to massage the lacrimal sac B. Order ofloxacin ophthalmic (Ocuflox) eye drops to apply to both eyes C. Order oral amoxicillin twice daily D. Refer the patient to ophthalmology Congenital nasolacrimal duct obstruction, or dacryostenosis, occurs in up to 20% of infants when the nasolacrimal duct is obstructed. Signs of dacryostenosis include excessive tear production and reflux of tears from the lacrimal sac. Educating the mother on how to massage the lacrimal sac (A) 2-3 times per day is the most appropriate treatment for a child < 6 months of age. This education can be provided by placing a caregiver's finger on the side of the nose below the nasolacrimal duct and performing downward strokes 4-5 times.Clinical findings of dacryostenosis are excessive tearing with palpation of the lacrimal sac and increased size of the tear meniscus. The patient will not have conjunctival erythema on physical exam. Dacrocystocele is a differential diagnosis that results from obstruction of the nasolacrimal sac proximally and distally, and it presents as a bluish subcutaneous mass below the medial canthal tendon. A patient with a dacryocystocele will require prompt referral to an ophthalmologist due to the risk of infection. The diagnosis of dacryostenosis can be made clinically based on history and physical examination findings. In addition to lacrimal duct massage, topical antibiotics (e.g., trimethoprim-polymyxin B ophthalmic solution [Polytrim], tobramycin, erythromycin [Erythrocin]) can be used to improve mucous drainage. If the child does not have resolution of symptoms by 6-10 months old, they should be referred to ophthalmology.

Which of the following findings are the most consistent with iron deficiency anemia?

Elevated mean corpuscular volume and normal mean corpuscular hemoglobin B. Low mean corpuscular volume and low mean corpuscular hemoglobin C. Low mean corpuscular volume and normal red blood cell distribution width D. Normal mean corpuscular volume and normal mean corpuscular hemoglobin

Which of the following medications carries a higher risk of severe prolonged hypoglycemia in older adults, according to the Beers criteria?

Empagliflozin (Jardiance) B. Glyburide (Glynase) C. Metformin (Glumetza) D. Pioglitazone (Actos)

A 63-year-old woman presents to your office to review her recent DXA results. The T-score of her spine is −1.5. She has no history of fractures. Her fracture risk assessment score for the hip is 2%, and her overall risk of a major osteoporotic fracture is 17%. Which of the following is the best initial step in management?

Encourage weight-bearing exercise and discuss vitamin D and calcium supplements B. No interventions are needed, as this bone density scan is normal C. Prescribe alendronate (Fosamax) D. Prescribe denosumab (Prolia)

A 55-year-old woman presents to the clinic with hot flashes and night sweats for several months. She has not had a menstrual cycle in 2 years. She states that she has tried to treat these symptoms on her own with black cohosh, but it does not seem to help anymore. She asks whether she can be prescribed hormones. Which of the following should the nurse practitioner rule out before prescribing hormone replacement therapy?

Family history of breast cancer B. History of a transient ischemic attack C. History of melanoma D. Hypertension

A 30-year-old woman presents to the clinic with a report of skin discoloration on her neck and bilateral axilla for several months. She reports no other symptoms. The physical examination reveals BP of 138/84 mm Hg, BMI of 32 kg/m2, and large areas of dark brown, velvety textured hyperpigmentation on the right neck and bilateral axillae. Which of the following is the most appropriate diagnostic test?

HbA1C level B. Skin biopsy C. Testosterone level D. Vitamin A level

A 69-year-old man presents to the clinic with reports of redness, pain, and tearing of his left eye for the past week. He wears glasses but reports no history of recent trauma or contact lens use. The physical examination reveals conjunctival injection, dendritic corneal ulcers, and decreased visual acuity in the left eye. Which of the following is the most likely diagnosis? A. Acute angle-closure glaucoma B. Bacterial conjunctivitis C. Dry eye syndrome D. Herpes keratitis

Herpes keratitis

A 61-year-old man presents to the clinic with reports of dysuria, fever, and pelvic pain. A digital rectal exam reveals an edematous and tender prostate. The nurse practitioner plans to prescribe ciprofloxacin (Cipro) for treatment of suspected acute bacterial prostatitis. Which of the following, if included in the patient's medical history, should indicate to the nurse practitioner to avoid prescribing this medication? A.History of hyperkalemia B. History of lymphoma C. History of myasthenia gravis D. History of myocardial infarction

History of hyperkalemia B. History of lymphoma C. History of myasthenia gravis D. History of myocardial infarction

A 27-year-old man presents with a 2-day history of persistent nausea, tremors, and difficulty concentrating. His medical history is significant for bipolar disorder treated with lithium (Lithobid) and hypertension. He reports he was recently started on hydrochlorothiazide 5 days ago. The physical exam demonstrates coarse hand tremors, nystagmus, and hyperreflexia. Vital signs reveal BP of 135/90 mm Hg, a heart rate of 98 bpm, a respiratory rate of 18 breaths/min, and a temperature of 98.6°F. Which of the following is the most likely diagnosis?

Hyperkalemia B. Ischemic stroke C. Lithium toxicity D. Serotonin syndrome

A 46-year-old woman presents with perioral numbness and muscle twitching in her hands for 1 week. She has a history of parathyroidectomy. On exam, she has positive Chvostek and Trousseau signs. Which of the following is the most likely diagnosis? A. Hypercalcemia B. Hyperkalemia C. Hypocalcemia D. Hypokalemia

Hypocalcemia Hypocalcemia (C) is defined as serum calcium < 9 mg/dL or an ionized calcium level < 4.5 mg/dL. Common causes of hypocalcemia include hypoparathyroidism (e.g., postsurgical state in the vignette), chronic kidney disease (CKD), and vitamin D deficiency. The cardinal clinical manifestation of hypocalcemia is tetany (i.e., neuromuscular irritability). Clinical findings of tetany include perioral numbness, paresthesias, and muscle twitching. Assessment findings of hypocalcemia include a positive Chvostek sign (contraction of facial muscles with tapping on the facial nerve anterior to the ear) and a positive Trousseau sign (carpal spasm with occlusion of the brachial artery with blood pressure cuff).

An 81-year-old woman presents to the clinic to establish care. The patient is Mexican American. Which of the following is a health-related belief that is distinctive of Mexican culture? Illness may be attributed to a hot-cold imbalance B. Illness may be attributed to an imbalance between yin and yang C. Illness may be attributed to living out of balance with nature and social environments D. Illness may be attributed to sins committed in a prior life

Illness may be attributed to a hot-cold imbalance Correct

A nurse practitioner is presenting at a primary care conference. The topic of the presentation is the initiation of end-of-life discussions with patients with end-stage organ failure. When would be the appropriate time to have an end-of-life discussion with this patient population? After all treatment options have failed B. In the hospital C. Initial encounter D. Over the phone

Initial encounter Correct The initial encounter (C) is the most appropriate time to discuss the patient's end-of-life goals and wishes in the setting of serious illness, such as end-stage organ failure, as described in the vignette. End-of-life discussions may encompass topics such as disease prognosis, the patient's preferences regarding future treatment plans, and patient and family values. End-of-life discussions should include information regarding advance directives. Creating an advance directive while the patient is still capable of making decisions and placing it into the patient's chart would be beneficial if a medical emergency occurred and the patient could not speak for themself. This process helps health-care clinicians know how the patient would like them to proceed in an emergency should the patient lose the ability to make their own decisions.

A 40-year-old man was diagnosed with depression and prescribed a selective serotonin reuptake inhibitor for the first time. Which of the following side effects should the nurse practitioner discuss with the patient? Insomnia can be improved by taking the medication at bedtime B. Nausea typically resolves in 1-3 weeks C. Sexual dysfunction is typically irreversible D. Weight loss should be expected

Insomnia can be improved by taking the medication at bedtime B. Nausea typically resolves in 1-3 weeks C. Sexual dysfunction is typically irreversible D. Weight loss should be expected

A 72-year-old man presents to the outpatient clinic to establish care. The patient provides the office staff with a document that outlines his wishes regarding medical interventions and end-of-life care, specifically if he becomes terminally ill or unable to speak for himself. Which of the following best describes this document? A. Do not resuscitate order B. Durable power of attorney for health care C. Living will D. Medical release form

Living will An advanced care directive is a legal document that specifies the type of medical care an individual wishes to receive, or not receive, if they become unable to make their own decisions. A living will (C) is a type of advanced care directive that provides specific instructions about medical treatment to be administered when the person is terminally ill or permanently unconscious. A living will is distinct from other advanced care directives in that it focuses on the individual's preferences for medical care, especially in situations when they might be unable to communicate their wishes directly. It can address a range of treatments, including resuscitation, mechanical ventilation, artificial nutrition and hydration, and pain management. Given the specificity and personal nature of the document, it is crucial for clinicians to review and understand a patient's living will thoroughly. Doing so ensures that the care provided aligns with the patient's values and desires, respecting their autonomy even in complex medical situations.

A 3-year-old boy presents to the office for an annual exam. The nurse practitioner notices that the caregiver has an inappropriate affect, and the boy has multiple bruises at varying stages of healing. When asked about the injuries, the caregiver gives an explanation that does not match the exam findings. The nurse practitioner suspects physical abuse. Which of the following is a risk factor for physical child abuse? Age of 5-10 years old B. Living in a densely populated area C. Low socioeconomic status D. Parent with a family history of substance abuse

Low socioeconomic status Correct

A 25-year-old woman presents with a report of gray-white vaginal discharge for 1 week. A fishy odor is noted after application of 10% potassium hydroxide. Wet prep reveals vaginal squamous epithelial cells covered in bacteria, giving the cells a distinctive stippled appearance. Which of the following is the appropriate treatment for this patient? A. Azithromycin (Zithromax) B. Ceftriaxone C. Metronidazole (Flagyl) D. Miconazole

Metronidazole The woman in this vignette exhibited malodorous vaginal discharge and a distinctive stippling appearance on wet prep consistent with bacterial vaginosis. Treatment of symptomatic bacterial vaginosis includes metronidazole (Flagyl) (C) 500 mg orally twice daily for 7 days; metronidazole gel (Metrogel) 0.75%, one 5-g applicator intravaginally once daily for 5 days; or clindamycin (Cleocin) 2%, one 5-g applicator intravaginally once daily at bedtime for 7 days.

A 70-year-old man presents to the office with his daughter. She has noticed that he is having more difficulty performing complex tasks. He has problems with orientation and has become lost in familiar locations. These issues have progressively worsened over the past year. Which of the following is the most appropriate next step in diagnosing dementia? A. Brain biopsy B. CMP C. Mini-Mental State Exam D. Neuroimaging of the head

Mini-Mental State Exam

Which of the following best describes the pathophysiology of asthma?

Mixed obstructive and restrictive airway pattern with thickened secretions B. Progressive airway limitation and narrowing of the small airways C. Variable airway bronchoconstriction and inflammation D. Vasoconstriction of pulmonary blood flow

A 78-year-old man presents to the clinic for a rash. The patient is frail with multiple comorbidities, including multiple strokes. He is accompanied by a grandchild, who is his caregiver. The nurse practitioner determines the rash is likely incontinence dermatitis. The nurse practitioner also notes a 10-pound weight loss since his last visit 3 months ago. Which of the following would heighten the suspicion of neglect? A. Bruising of various ages B. Multiple missed appointments C. Sexually transmitted infections D. Sudden change in financial situation

Multiple missed appointments Correct

Nurse practitioners should be aware that they are mandated to report certain infectious disease diagnoses to the US Department of Health and Human Services. Which of the following diagnoses needs to be reported, according to the CDC? A. Coxsackievirus B. Enterovirus C. Neisseria gonorrhoeae D. Parvovirus

Neisseria gonorrhoeae Correct Case surveillance is a public health measure used by both local health departments and the CDC. It is implemented with infectious diseases, food-borne illnesses, and noninfectious conditions. Some diseases are classified as reportable, meaning that reporting the condition is mandated by local health departments and the CDC. This classification commonly includes food-borne illnesses, meningococcal diseases, and sexually transmitted infections (STIs), including Neisseria gonorrhoeae (C). The CDC also mandates reporting of syphilis and chlamydia, as surveillance activities are conducted on the three most common STIs (i.e., gonorrhea, syphilis, and chlamydia). All of these diseases can be cured with proper treatment.

A nurse practitioner-owned and -run outpatient facility recently implemented an electronic medical record and electronic prescribing program. The nurse practitioner knows that the Medicare Modernization Act of 2003 supports this technology and encourages more utilization within America's health-care system. Which Medicare plan supports the use of electronic prescribing?

Part A B. Part B C. Part C D. Part D

A 44-year-old woman presents to the office with a report of persistent generalized fatigue, weight loss, muscle aches, nausea, and vomiting for several months. More recently, she reports hyperpigmentation on her neck, near syncope when standing too quickly, and an increased craving for salty foods. Laboratory results reveal an elevated adrenocorticotropic hormone level and a decreased morning serum cortisol level. Which of the following is the most likely diagnosis? A. Adrenal adenoma B. Cushing syndrome C. Pheochromocytoma D. Primary adrenal insufficiency

Primary adrenal insufficiency Primary adrenal insufficiency (D), or Addison disease, causes serum cortisol levels to be low and adrenocorticotropic hormone (ACTH) to be elevated. ACTH is released from the pituitary gland and stimulates cortisol release at the adrenal gland. When patients present with symptoms suspicious for chronic primary adrenal insufficiency, serum cortisol levels should be evaluated within 3 hours of morning waking. When the suspicion is high, as with the patient in the vignette, serum ACTH levels may be ordered simultaneously.

A nurse practitioner is educating a group of nursing students about the levels of prevention in public health. Which of the following is an example of secondary prevention? A. Administering vaccines to children B. Encouraging regular exercise and a balanced diet C. Organizing support groups for individuals with major depression D. Performing mammograms to detect early-stage breast cancer

Performing mammograms to detect early-stage breast cancer Correct Correct answer explanation The concept of levels of prevention in public health is categorized into primary, secondary, and tertiary prevention. Each level targets a different stage in the progression of a disease or condition. Secondary prevention aims to identify and treat an illness or disease early, preventing its progression. This goal is achieved through screening tests and routine checkups. Performing mammograms to detect early-stage breast cancer (D) is an example of secondary prevention, as it focuses on early detection and intervention. Primary prevention seeks to prevent the onset of a disease or condition before it occurs, often through interventions such as vaccinations or health education. Tertiary prevention, in contrast, focuses on treating and rehabilitating patients with chronic conditions to prevent complications and improve their quality of life. Understanding these levels is crucial for clinicians, as they guide interventions and strategies to promote public health.

A 49-year-old woman presents to the clinic with reports of progressive neurological symptoms. The nurse practitioner orders an MRI of the brain, which reveals multiple demyelinated lesions. Which clinical manifestations are most consistent with multiple sclerosis? cogwheel rigidity and resting tremor B. Dysphagia, ptosis, and diplopia C. Hyporeflexia and gait imbalance D. Peripheral motor weakness and sensory loss

Peripheral motor weakness and sensory loss Multiple sclerosis (MS) is a chronic autoimmune disease affecting the CNS. It is characterized by areas of damage to the myelin sheaths that cover nerve fibers (i.e., demyelination). This damage causes scarring, or sclerosis, to develop and affects the ability of the brain to communicate with peripheral nerves. Peripheral motor weakness and sensory loss (D) are common clinical manifestations of MS, and these manifestations typically occur in an episodic pattern.

A patient presents to the office for follow-up on acid reflux. The nurse practitioner reviews their recent esophagogastroduodenoscopy, which demonstrates Barrett esophagus. Which of the following is the best next step in management? A. Give the patient reassurance that this condition is benign and no further management is needed B. Prescribe metronidazole (Flagyl) C. Prescribe omeprazole (Prilosec) D. Refer the patient to oncology

Prescribe omeprazole (Prilosec) Barrett esophagus is a precancerous condition in which the stratified squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium. This transformation is caused by prolonged acid reflux from chronic GERD. Barrett esophagus should be treated long term with proton pump inhibitors (PPIs), such as omeprazole (Prilosec) (C), to prevent further destruction. The recommended dose is 20 mg once daily, which may be increased to twice daily if symptoms persist. Omeprazole (Prilosec) is best taken first thing in the morning before breakfast.It is recommended to screen for Barrett esophagus in patients with multiple risk factors, including chronic GERD, a family history of Barrett esophagus, central obesity, hiatal hernia, male sex, age > 50, and a smoking history. The most serious risk of untreated Barrett esophagus is esophageal carcinoma. Patients with Barrett esophagus should have a surveillance endoscopy with biopsies every 3-5 years for cases without dysplasia noted or more frequently if dysplasia is noted.

A 31-year-old woman presents to the clinic for a follow-up visit after starting sertraline (Zoloft) for major depressive disorder 2 months ago. The patient reveals that she no longer feels depressed, but for the past 2 weeks, she has been increasingly distracted at work, sleeps only 3 hours each night, and experiences racing thoughts. Which of the following is the best next step in the treatment of this patient?

Prescribe zolpidem tartrate (Ambien) to help the patient sleep B. Reassure the patient that her side effects are normal with sertraline (Zoloft) C. Recommend cognitive behavioral therapy D. Refer the patient to psychiatry for suspected bipolar I disorder

A 5-month-old female infant presents to the clinic for a well-child check. She was born at 39 weeks gestation via uncomplicated vaginal delivery and has had no past medical conditions. She is exclusively breastfeeding and is appropriately gaining weight. Which of the following milestones is appropriate for this patient? A. Pushes up on the elbows when on the stomach B. Says "mama" nonspecifically C. Sits without support D. Transfers toys from hand to hand

Pushes up on the elbows when on the stomach Developmental milestones are important markers to determine whether neurologic function is progressing normally, and they should continue to be assessed routinely until 5 years of age. At 4-5 months old, a child's gross motor skills should include pushing up on the elbows when on the stomach (A), holding the head steady without support, holding a toy when placed in the hand, swinging an arm at a toy, and bringing the hand to the mouth. Cognitive milestones at this age should include, when hungry, opening the mouth to the bottle or breast and looking at the hands with interest. Language milestones at 4-5 months include making sounds such as "ooh" and "aah" and turning the head to the sound of the parent's voice. Social milestones at 4 months include smiling on their own to obtain attention and chuckling.

A 2-year-old girl with a medical history of asthma presents to the clinic for a follow-up visit. She was seen 3 days ago due to upper respiratory symptoms and tested positive for respiratory syncytial virus. Her mother reports that the patient's symptoms worsened overnight, and she refused to eat or drink this morning. Vital signs reveal a temperature of 100.5°F, heart rate of 135 bpm, respiratory rate of 65 breaths/min, and oxygen saturation of 91%, and her BMI is 16.3 kg/m2. On physical exam, the nurse practitioner notes diffuse wheezing, along with intercostal retractions and nasal flaring. Which of the following is the most appropriate next step in management? A. Administer oral dexamethasone (Decadron) B. Order a chest X-ray C. Prescribe a 3-day course of inhaled budesonide (Pulmicort) D. Refer to the ED

Refer to the ED Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis, a clinical syndrome in young children characterized by upper respiratory symptoms that progress to lower respiratory involvement and respiratory distress. Hospital admission may be warranted in the presence of signs of respiratory distress, such as retractions, nasal flaring, respiratory rate > 70 breaths/min, oxygen saturation < 95%, dyspnea, or cyanosis. Risk factors for developing severe disease and respiratory failure include age < 6 months, tobacco smoke exposure, immune compromise, a history of congenital heart disease, and the presence of underlying lung disease, such as asthma. Therefore, referring to the ED (D) is the most appropriate next step in the treatment of this patient.

A 27-year-old woman presents for clinic follow-up for hypertension. She has been attempting to lower her BP with lifestyle modifications for the past 3 months, and her BP today is 160/90 mm Hg on two separate readings. The nurse practitioner is considering starting treatment with lisinopril (Zestril). Which of the following would be a contraindication to starting this medication? A. She has a 20 mm Hg drop in BP when she stands B. She has a family history of kidney disease C. She has a personal history of diabetes D. She is planning to become pregnant in the next few months

She is planning to become pregnant in the next few months Hypertension (HTN) is one of the most commonly treated conditions in the primary care setting. Angiotensin-converting enzyme (ACE) inhibitors are common first-line agents for the treatment of HTN and have been proven to lower the risk of cardiovascular deaths, nonfatal myocardial infarctions, strokes, and kidney disease. Histories of bilateral renal artery stenosis, end-stage kidney disease, and pregnancy are all contraindications to ACE inhibitor use. In the above vignette, if the patient is planning to become pregnant in the next few months (D), it would be recommended to start an alternative to an ACE inhibitor.

A 60-year-old man with a past medical history of COPD presents to the clinic for follow-up. He was diagnosed with COPD 3 months ago and started on daily tiotropium (Spiriva). Since starting treatment, he has experienced two significant exacerbations, with the more recent episode requiring hospitalization. He is asymptomatic today in the office and is able to successfully demonstrate proper use of his inhalers. Laboratory studies from his recent hospitalization reveal an elevated eosinophil count. What is the best next step in this patient's management? A. Continue tiotropium (Spiriva) and add albuterol (ProAir HFA) as needed for exacerbations B. Continue tiotropium (Spiriva) and start an oral prednisone taper C. Stop tiotropium (Spiriva) and start fluticasone furoate-umeclidinium-vilanterol (Trelegy Ellipta) D. Stop tiotropium (Spiriva) and start roflumilast (Daliresp)

Stop tiotropium (Spiriva) and start fluticasone furoate-umeclidinium-vilanterol (Trelegy Ellipta) The management of COPD focuses on the prevention of both COPD symptoms and exacerbations. Long-acting beta-agonists (LABAs) or long-acting muscarinic agonists (LAMAs) are often used as first-line treatment for the daily management of COPD. In most patients, these drugs can be used as monotherapy, along with as-needed short-acting beta-agonists for symptom control. Patients with persistent dyspnea, multiple recurrent exacerbations, or exacerbations requiring hospitalization will often require escalation of their baseline therapy. This therapy will often start with use of LABA-LAMA combination inhalers. Patients who require hospitalization, particularly those with elevated eosinophil counts, will need the addition of an inhaled corticosteroid (ICS) to their LABA-LAMA combination therapy. The patient in the above vignette has had two significant exacerbations, and he was recently hospitalized and found to have an elevated eosinophil count. For this reason, it would be best to stop tiotropium (Spiriva) and start fluticasone furoate-umeclidinium-vilanterol (Trelegy Ellipta) (C), which is a combined ICS-LABA-LAMA.

A 19-year-old woman calls the clinic to report that she missed two oral contraceptive pills during the last week of the hormone-containing pack and had unprotected sexual intercourse within 5 days. Which is the best counseling for this patient? A. Emergency contraception should be taken as soon as possible B. Take the next dose as soon as possible, but there is no need for any other action C. Take the next dose as soon as possible, use backup contraception, and skip the placebo week D. Take two pills for each of the next two doses to make up for the missed pills and continue to the end of the pack

Take the next dose as soon as possible, use backup contraception, and skip the placebo week When two or more doses of oral contraceptive pills (OCPs) are missed, there is a higher risk of unintended pregnancy. If the missed doses occur during the last week of hormone-containing pills, the woman should be advised to take the next dose as soon as possible, use backup contraception, and skip the placebo week (C). She should use backup contraception or avoid sexual intercourse until 7 consecutive days of hormone-containing pills have been taken.OCPs are a safe, reliable contraceptive method that may be continued until menopause in healthy women who do not smoke. OCPs should be started either on the first day of menses or on the Sunday following the first day of menses. A nonhormonal backup method (e.g., condoms or abstinence) should be used for the first 7 days if starting on a Sunday. The reliability of OCPs is largely dependent on the consistency of administration. Patients should be given instructions about the importance of taking OCPs at the same time every day and what to do in the event of missed doses.

A 12-year-old girl presents to the clinic for a well-child checkup. The nurse practitioner notes that the patient has enlargement of her breasts and areolas but no separation of their contour, as well as sparse growth of straight pubic hair along the labia. Which of the following is the appropriate Tanner staging for this patient? Tanner stage 1 breast and pubic hair B. Tanner stage 2 breast and pubic hair C. Tanner stage 2 breast and Tanner stage 3 pubic hair D. Tanner stage 3 breast and Tanner stage 2 pubic hair

Tanner stage 3 breast and Tanner stage 2 pubic hair

A nurse practitioner recently graduated and is preparing to start practicing in a new state. In reviewing the state's regulations for practice, the requirements for a nurse practitioner license and a separate prescriptive authority are listed. Which of the following best describes prescriptive authority?

The authority to diagnose medical conditions B. The authority to order and interpret diagnostic tests C. The legal ability to prescribe medications and other treatments D. The legal authorization to prescribe controlled substances Prescriptive authority refers to the legal ability to prescribe medications and other treatments (C) and can vary widely by state. It is essential for nurse practitioners to be familiar with their state's regulations regarding prescriptive authority to ensure that they practice within legal boundaries. Each state has its own Nurse Practice Act, which defines the scope of practice for nurse practitioners, including their prescriptive authority. Some states grant full practice status, allowing nurse practitioners to evaluate patients, diagnose, interpret diagnostic tests, and initiate treatment plans, including prescribing medications. Other states might have restricted practice or reduced practice status, requiring nurse practitioners to have a collaborative agreement with a physician or limiting their prescriptive abilities in some manner. Additionally, even in states with full practice authority, certain medications, especially controlled substances, may have additional regulations or require specific certifications. Understanding these nuances and regulations is vital for the nurse practitioner's professional practice and legal protection.

A 54-year-old patient presents to your office with a history of nasal congestion. They have been taking oxymetazoline (Afrin) daily. What education regarding this medication should the nurse practitioner provide the patient? A. This medication is a nasal decongestant and should not be taken for more than 3-5 days B. This medication is a nasal steroid and should not be taken for more than 3-5 days C. This medication is an anticholinergic and can cause blurred vision and dry mouth D. This medication is an antihistamine and can cause drowsiness

This medication is a nasal decongestant and should not be taken for more than 3-5 days Intranasal decongestants are available OTC and offer relief of nasal congestion associated with conditions such as acute viral or bacterial rhinosinusitis or hay fever. Oxymetazoline (Afrin) is a nasal decongestant, and it should not be taken for more than 3-5 days (A) due to the risk of rhinitis medicamentosa. Rhinitis medicamentosa is characterized by inflammation of the nasal mucosa secondary to the overuse of nasal decongestants. This condition may cause symptoms of rebound congestion and mucosal damage. The recommended dose is 0.05-0.1%, one to two sprays IN every 6-8 hours.

Which of the following medications reduces increased intraocular pressure in patients with open-angle glaucoma by decreasing aqueous humor production and is considered first-line therapy? A. Brimonidine ophthalmic (Alphagan) B. Dorzolamide (Trusopt) C. Ketorolac ophthalmic (Acular) D. Timolol ophthalmic (Betimol)

Timolol ophthalmic (Betimol) Open-angle glaucoma is chronic and progressive optic neuropathy that results in irreversible loss of optic nerve fibers. The cause of open-angle glaucoma is multifactorial, and the condition causes increased intraocular pressure (IOP) that impairs the optic nerve. Treatment goals target lowering IOP by various means. Timolol ophthalmic (Betimol) (D) is a beta-blocker used in the treatment of open-angle glaucoma. It works by reducing the production of aqueous humor in the eye, thereby decreasing IOP.Chronic open-angle glaucoma is typically bilateral. Patients are typically asymptomatic in the early stages of glaucoma, so it is often found on a routine eye exam. Periodic eye exams may be helpful in screening for glaucoma. An eye exam will reveal cupping of the optic disc. Individuals with glaucoma may notice patchy blind spots in their peripheral vision, which progress to central vision loss during the later stages of the disease. Laser therapy may be used as initial treatment or as an adjunct to topical therapy. Surgical intervention is indicated for those whose IOP is uncontrolled despite maximized medical therapy.

A 17-year-old boy presents with intermittent diarrhea with blood in the stool for the past 2 months. He states the symptoms have been gradually worsening, and now he is having more than six bowel movements per day. He reports abdominal pain and urgency with bowel movements. Colonoscopy reveals erythematous and swollen mucosa with areas of friability from the rectum to the transverse colon. Which of the following is the most likely diagnosis? A. Crohn disease B. Diverticulitis C. Infectious colitis D. Ulcerative colitis

Ulcerative colitis Inflammatory bowel disease (IBD) includes both Crohn disease and ulcerative colitis (UC) (D), which is a relapsing and remitting chronic condition that causes inflammation of the mucosal layer of the colon. UC most commonly affects adolescents and adults < 40 years of age. Symptoms include colicky abdominal pain, diarrhea, blood in the stool, frequent bowel movements, fecal urgency, and stool incontinence. The symptom onset is usually gradual and occurs over weeks. In contrast to Crohn disease, which can affect any area of the GI tract from the mouth to the anus and is noncontiguous, UC commonly affects the rectum but may extend proximally throughout the colon and will have continuous involvement of the area.