Questions 5

66 year old male presents to clinic with complaints of a decreased force of the urinary stream, urinary hesitancy, urgency, and a sensation of incomplete bladder emptying. Rectal exam shows enlarged smooth, firm prostate. Urine dipstick is negative for leukocytes, nitrates, or blood. PSA is 1.2. The nurse practitioner recognizes this as: 1. BPH 2. Prostate Cancer 3. Acute Bacterial Prostatitis 4. Urinary tract infection

1 Clinical findings of BPH are obstructive urinary complaints (decreased force and caliber of stream, sensation of incomplete bladder emptying, hesitancy, double voiding, straining to void, and post void dribbling) or irritative urinary complaints (urgency, frequency, and nocturia).

An 18-month-old girl presents with a fever (> 39 degrees C), tachypnea, and a cough. No respiratory distress or hypoxemia noted. After chest x-ray are done, it is determined this patient has Community Acquired Pneumonia. She has no known allergies. First treatment option for this patient should consist of: 1. Ciprofloxacin 15 mg/kg PO BID for 5 days 2. Amoxicillin 50-90 mg/kg PO TID for 7-10 days 3. Azithromycin 10 mg/kg PO daily for 5 days 4. Clarithromycin 7.5 mg/kg PO BID for 10 days

2 All children over 6 months of age who do not have significant respiratory distress should be treated with Amoxicillin 50-90 mg/kg TID for 7-10 days. Macrolides such as Azithromycin or Clarithromycin should be used only if an atypical infection is suspected. Ciprofloxacin is not indicated in treatment of outpatient CAP management. Fluoroquinolones can be considered for the more severe, hospitalized cases of pneumonia.

58 year old male presents to clinic for a routine follow up, and he requests a refill on Tadalafil 10mg by mouth prn for erectile dysfunction. The NP educates the patient to not take Tadalafil with what medication? 1. Amoxicillin 2. Lisinopril 3. Nitroglycerin 4. Flomax

3 PDF-5 inhibitors such as sildenafil, tadalafil, vardenafil, or avanafil are contraindicated with nitrate medications due cause of cardiac preload reduction and hypotension.

A 1-year-old boy presents to your clinic with an acute inspiratory stridor and a barking cough. All the following should be included in your differential diagnoses except: 1. Viral Croup 2. Epiglottitis 3. Bacterial Tracheitis 4. Pneumonia

4 - New onset stridor in the setting of upper respiratory illness that includes a barking cough is most likely one of three conditions: Croup, Epiglottitis, Bacterial Tracheitis. Pneumonia affects the lower airways and does not cause a barking cough or stridor, but rather wheezing.

A 45 year old male presents to the clinic as a new patient. He has a history of hypertension and type II diabetes. At his last primary care, he was told that his cholesterol was high. He declined cholesterol medication at that time and opted to try diet and exercise instead. His lipid panel is as follows: Total Cholesterol- 243 mg/dL HDL- 67 mg/dL LDL- 129 mg/dL Triglycerides150 mg/dL. The nurse practitioner would recommend starting which of the following cholesterol medications? A. Atorvastatin 20 mg B. Ezetimibe 10 mg C. Fenofibrate 145 mg D. Atorvastatin 40 mg

A : Statins are the first line therapy for the treatment of hyperlipidemia. Based on the 2018 AHA/ACC/ multi-speciality guidelines this patient should be started on a moderate intensity statin, which includes low dose atorvastatin 10-20mg/day. Atorvastatin 40 mg is considered a high intensity statin. Ezetimibe would be added to this patients medication list only after initial statin therapy did not decrease LDL 30-50%. Fenofibrate can be used to lower LDL by 10-15% but again, would be used in adjuvant to a statin.

A 4-year-old girl comes into the clinic with her mother. The mother reports the child having fatiguability without any other symptoms. While auscultating the child's heart you might hear which type of murmur? A Atrial septal defect B Ventricular septal defect C Patent ductus arteriosus D Aortic Stenosis

A An atrial septal defect is the opening that permits the shunting of blood among the atria. It is most often in girls. Most children do not show signs of cardiovascular problems but have fatigue and intolerance to exercise.

An FNP working in a remote area sees both adult and pediatric patients, she is also precepting an NP student. She had a 10yrs old male at the clinic with creatinine result of 1.0mg/dl and 35yrs old male with creatinine result of 1.2mg/dl. The FNP was more concerned for 10yrs old than the 35yrs old, and her student asks her why so? Her best response would be: A.I am more concerned for 10yrs old with that result than the 35yrs old because the 10yrs old has less muscle mass than the 35yrs old. B. I am more concerned for the 10yrs old because he has a long life to live than the 35yrs old. C. The increase in creatinine result of 1.0 for 10yr old indicates a 90% decrease in GFR. D. Because the 35yrs old patient is not my regular patient.

A Answer "A" is correct because the norms for serum creatinine are related to muscle mass. The 35yrs old have a larger muscle mass than 10yrs old, so only larger adults or adolescents should have a level exceeding 1mg/dl. (Page 714). The rest of the answers are wrong because: B) we as healthcare professionals don't decide who gets to live longer, we must provide care for all ages. C) increase in creatinine from 0.5-1.0 indicates a 50% decrease in GFR not 90% and D) No matter whether the patient is our regular patient or not we still have to take care of everyone who walks to our clinic for care.

A provider is considering adding metoprolol to a 50-year-old male patient's antihypertensive therapy. Which of the following of the patient's medical conditions is a contraindication to metoprolol therapy? a. Mild persistent asthma b. Seasonal allergies c. Gastroesophageal reflux disease d. Migraine headache

A Beta blockers can cause or worsen bronchospasm in patients with lung disease. Therefore, it should be avoided in this patient due to diagnosis of asthma.

A six-year-old boy is brought to your clinic by his mother for urinating in his clothes at night and during the day at school. To make a diagnosis of enuresis you would look for a time frame of urination of how long? A. at least twice a week for 3 months B. more than twice a week for 3 months C. at least three times a week for 4 months D. at least twice a week for 2 months

A Enuresis is diagnosed in children who are developmentally and chronologically older than 5 years who are urinating into their clothes during the day and at night. This urination pattern must happen at least twice a week for 3 months to make a diagnosis. It is more common in boys than girls. Enuresis has a strong genetic factor. A complete history and physical must be complete to rule out underlying pathology, anatomical abnormalities, or issues with constipation. Behavioral strategies are the first line treatment, but DDAVP may be used if behavioral strategies fail.

You are caring for a 27-year-old nulliparous woman who states that she wishes to conceive. You advise her to stop her oral birth control pills along with what other medication on her list? A) Folic acid B) Enalapril C) Famotidine D) Docusate

B ACE inhibitors as well as alcohol, androgens, benzos, estrogens, lithium, NSAIDs, warfarin, and other medications are teratogenic or fetotoxic and thus are contraindicated in pregnancy. Folic acid supplementation and prenatal vitamins are encouraged during pregnancy. Famotidine and docusate are not contraindicated and are safe to take during pregnancy (Papadakis and McPhee 2020: Chapter 19: Obstetrics and Obstetric Disorders, page 816-820).

A 30.4 week pregnant patient presents to the women's health clinic as a new patient. She has been receiving prenatal care from an out of state provider. While reviewing her records, you know that she should have received all of the following prenatal screenings except: A. Screening for group B streptococcal colonization B. Quad screen test C. Glucose tolerance test D. Rubella antibody titer

A Guidelines recommend all pregnant women be screened for group B streptococcal colonization via a single, standard culture collected at 35-37 weeks. A rubella antibody titer is indicated as part of initial prenatal labs to be collected between 6-12 weeks. The serum quad screen should be collected during the second trimester, ideally between 16-20 weeks. Lastly, the glucose tolerance test is used as a screening for gestational diabetes and should be performed between 24-28 weeks.

During an examination of a 50-year-old male, the NP notices bilateral breast enlargement. The initial step for the NP should be to, a. Check for any discrete lumps in the breasts by palpating them. b. Explain that this is a transient symptom brought on by hormonal fluctuations. c. Send the patient for a mammogram and a breast tissue biopsy. d. Instruct the patient on how to make dietary adjustments to lessen the size of his breasts

A If the lumps are discrete and confined, the patient should be referred for additional testing to see if breast cancer is present.

Bob a 52-year-old male, presents to your clinic with complaints of difficulty starting and maintaining his urinary stream, increased frequency, and nocturia on occasion. PE with DRE is unremarkable. As the Nurse Practitioner, you know the most appropriate next step would be? A. Order urinalysis with serum PSA. B. Prescribe trimethoprim-sulfamethoxazole 150/800 mg po BID 10-14 days. C. Refer to urology for surgery options. D. Prescribe tamsulosin 0.4 mg po daily.

A Obstructive and irritative voiding can be a number of things ranging from infections, stones, or prostate hypertrophy. As you are thinking of differentials, it could be kidney stone, infection, or prostate in origin. The size of the prostate does not determine the severity of the symptoms and a serum PSA is considered more accurate, even though there is controversy surrounding PSA. The urinalysis can tell you if an infection or hematuria is present, however this could be a secondary cause of prostate hypertrophy. Without complaints of pain and fever I would steer more towards prostate hypertrophy. While all of the questions are potentially correct A is the best answer due to it being our NEXT step. Without perineal pain or abnormal urinalysis, we do not know if we need an antibiotic yet. We also do not have enough information in the question to determine if a referral is warranted at this time.

A 56-year-old male patient is following up from a recent hospitalization during which he had placement of two cardiac stents. You notice that he only takes Plavix 75 mg daily. He denies being prescribed any other new medications at discharged and has no known drug allergies. You anticipate prescribing which medications today? a. Lisinopril 10 mg and rosuvastatin 20 mg b. Lisinopril 10 mg and simvastatin 20 mg c. Losartan 50 mg and rosuvastatin 10 mg d. Lisinopril 40 mg and losartan 100 mg

A Patients who are at high risk for a vascular event, or have had one, should receive moderate to high intensity statin therapy regardless of cholesterol levels. Patients with vascular disease even with no evidence of left ventricular dysfunction or heart failure, should be treated with an ACE inhibitor. (Papadakis, M., & McPhee, S., 2020, pp. 372.)

A 45-year-old female presents to your clinic to establish care. She has a past medical history of tonsillectomy, rheumatic fever, and migraines without aura. Based on this information, you as the FNP should be sure to assess for which of the following: a.) Mitral valve stenosis b.) Splenomegaly c.) Transaminitis d.) Gout

A The FNP should know that any patient with a PMH of rheumatic fever is at risk of having valvular disease, most commonly Mitral Stenosis. Tonsillectomy and migraines are not associated with any of the listed answers.

A 55-year-old female smoker comes to clinic reporting a 12-pound weight loss in a one-month period and occasionally spitting up blood-tinged sputum with cough at night. Which of the following test would be most indicated to screen for lung cancer? A. CT lung scan B. Bronchoscopy C. Thoracentesis D. PET scan

A The current recommendation for screening current and former heavy smokers is to obtain a low dose CT scan yearly for 3 years. A Bronchoscopy, Thoracentesis, and PET scan may be needed for further evaluation in staging/cytology.

A 2-year-old female presents to the clinic with a temperature of 100.8 and flank pain that started yesterday. You suspect a urinary tract infection, and the parent states that she is not yet potty trained. Which specimen collection method do you order for a urinalysis and culture? A. Sterile catheterization B. Midstream clean-catch C. Diaper collection D. Bagged urine collection

A The standard for urine culture collection in infants and younger children not yet potty trained is sterile catheterization. A bagged urine sample and a diaper collection are only helpful if the culture is negative for infection because they are not sterile.

The nurse practitioner has diagnosed a 6-year-old child with community-acquired pneumonia. The parent reports that the child does not have any drug allergies. Which of the follow treatment options is appropriate in this situation? A. Amoxicillin 90mg/kg/day PO TID x 7 days B. Cefdinir 14mg/kg/day PO daily x 10 days C. Nitrofurantoin 100mg PO QID x 7 days D. Levofloxacin 10mg/kg/day PO Daily x 7 days

A The treatment of choice for children 6months or older is oral amoxicillin (50-90mg/kg/dose) TID for 7-10 days. The child does not have allergies to penicillin and thus does not require a substitute for amoxicillin therapy. The other antibiotic choices are not indicated or appropriate for the management of community acquired pneumonia.

A mother comes to your clinic with her 3 year old for persistent fever for 5 days with generalized rash and decreased oral intake. On exam, the child has a strawberry tongue, unilateral cervical lymphadenopathy, and redness and swelling of the hands and feet. You recognize this child has: A. Kawasaki disease B. Scarlet fever C. Acute rheumatic fever D. Streptococcal infection

A This child presents with fever for 5 days plus 4/5 of the hallmark signs of Kawasaki disease: generalized rash, strawberry tongue, unilateral cervical lymphadenopathy, and redness/swelling of the hands and feet. KD usually requires hospitalization for IV therapies. In scarlet fever, lips are spared from erythema and a positive group A strep culture confirms the diagnosis. Acute rheumatic fever presents 3-4 weeks after a group A streptococcal infection. Streptococcal infection presents with purulent tonsils and pharyngitis and responds well to antibiotic therapy.

A 67-year-old male comes to clinic reporting an inability to maintain erections and loss of libido. When conducting a medication review of his current medications which medication could possibly cause symptoms of erectile dysfunction? A. Sildenafil (Viagra) 25mg PRN B. Fluoxetine (Prozac) 20mg daily C. Aspirin 81mg daily D. Omeprazole (Prilosec) 20mg daily

B The answer is B) Fluoxetine (Prozac) 20mg daily. The most common medications to cause erectile dysfunction symptoms include antidepressants, antianginals, and anti-hypertensives. Sildenafil is a PDE-5 inhibitor which is used in the treatment of erectile dysfunction. Aspirin and Omeprazole are medications not known to cause decreased libido or loss of erections

A 35 year old female presents to the clinic with wheezing and chest tightness that wakes her up 2-3 times a week. In office, PFT's are performed with marked improvement in symptoms, after which she is diagnosed with moderate, persistent asthma. The nurse practitioner would know the following to be an appropriate plan of care. A. Prescriptions for a low dose ICS + LABA and a SABA, both daily with recommended follow up as needed for worsening symptoms. B. Prescriptions for a low dose ICS + LABA twice daily and a SABA PRN, with recommended follow up in 2 weeks to evaluate efficacy of treatment. C. Prescription for SABA PRN and follow up in 3 months to evaluate if symptoms have resolved. D. No prescriptions provided and immediate referral to pulmonology for specialty management of asthma.

B A) SABA medications should not be prescribed as a scheduled medication to treat moderate persistent asthma. The patient should also have a scheduled follow up to ensure the initial therapy is adequate to control her asthma symptoms. B) Moderate persistent asthma should be started on step 3 of the stepwise approach to managing asthma with a SABA PRN available for acute exacerbations. At follow up, if the patient is requiring her SABA more than twice weekly, this is an indicator of inadequate control of her asthma and the NP would then move the patient to step 4. C) Starting a patient on a SABA PRN only is step 1 and should be used for patients with a diagnosis of intermittent asthma only. D) The nurse practitioner is trained and capable of initiating asthma treatment for a newly diagnosed patient. If the patient fails to meet goals after 3-6 months or continues to have uncontrolled symptoms despite a LABA + high dose ICS, they should be referred to a pulmonologist for further evaluation.

A 45-year-old white male enters the clinic to review laboratory tests. He is diagnosed with type 2 diabetes at the visit. The laboratory tests also reveal an LDL level of 165 mg/dL. The 10-year CVD risk score is calculated to be 6%. LFT's are within normal limits. Implementation of which change is recommended for his plan of care? A. Educate on lifestyle modifications and do not add any medications. B. Initiate a moderate-intensity statin. C. Add ezetimibe. D. Long-term use of a low-intensity statin

B A) lifestyle modifications alone are not recommended. B) A moderate-intensity statin is recommended for persons with all the following: Age 40-75, diagnosed with diabetes, LDL ≥ 70. If also have CVD risk ≥ 7.5 % or other risk high risk criteria, then a high intensity statin is used. C) Ezetimibe is second-line treatment. Statins are first-line treatment in most situations. D) Recommendations do not call for a low intensity statin

A 60-year-old make presents to your clinic for an annual wellness exam. He is relatively healthy and only has a PMHx of GERD. His ROS and physical exam were unremarkable. At the end of the exam, the patient adds that he has had some difficulty in maintaining an erection with his wife of 30 years and asks for something to help him in the bedroom. After reviewing his history and eliminating any other causative factors, you decide to prescribe him Tadalafil (Cialis) 10 mg PRN. All of the following are things that you would educate your patient about the use of this medication EXCEPT: A. Do not take this medication with nitroglycerin or nitrates since they can cause hypotension and syncope. B. You should never combine this medication with alpha-receptor blockers such as Tamsulosin. C. Seek immediate medical attention if an erection persists for longer than 4 hours. D. The dose may be increased to 20mg or decreased to 5mg based on efficacy and side effects.

B All of the above are correct except for "B." While to combination of PDE-5 inhibitors (such as Tadalafil) and alpha receptor blockers (such as Tamsulosin) can cause a large reduction in blood pressure, they can be safely used together is they are started and titrated carefully.

An 11-year-old male presents today for his yearly check-up. During the physical exam, the NP notices reddening and thickening of the scrotum and straight hair at the penis base. Which SMR stage would the NP document? A. Stage 3 B. Stage 2 C. Stage 1 D. Stage 4

B B.) SMR 2 is the first sign of puberty in males. This usually occurs between the ages of 10-12. It includes reddening and thickening of the scrotal skin, increase in testicular volume, and straight hair at the penis base.

The NP sees a 4-weeks-old infant for a routine checkup. Baby was born at full term. Mother reports that infant is exclusively breast fed every 2-3 hours. Baby makes 6 - 8 wet & 3-4 dirty diapers per day. On physical assessment, the NP finds out that the baby has a widespread yellowish hint to her skin and her sclera are jaundiced, but otherwise meets all developmental milestones & gaining weight at a normal rate. What should the NP's action plan include? A. Jaundice is a normal finding at 4 weeks of life B. Review previous blood work and order a bilirubin level C. Advise mother to switch from breast milk to formula D. Advice mom to take baby out on the sun E. A & B

B Breast milk fed infants are at risk for breast milk jaundice & breast-feeding associated jaundice. However, in this case, child is getting enough intake, making appropriate amount of output and is gaining weight. The safest thing to do will be to check at total bilirubin level

When examining a newborn, you find decreased femoral pulses and a blowing systolic murmur heard in the left axillary region. These findings are consistent with: A. Patent ductus arteriosus B. Coarctation of the aorta C. Tetralogy of Fallot D. Atrial septal defect

B Coarctation of the aorta typically presents with decreased or absent femoral pulses with a blood pressure in the legs that is half of the arms. Children with COA may also present with a blowing systolic murmur heard in the left axilla or back. Patent ductus arteriosus presents with a machinery-type murmur. Tetralogy of Fallot presents with a systolic murmur heard at the upper left sternal border. Atrial septal defect is a grade I-III/VI systolic murmur at the left sternal border with normal peripheral pulses

Tyler, a 5-year-old boy, has been having nighttime episodes of stool incontinence a few times per month for the last three months. You diagnose him with encopresis. What is the most common cause of encopresis? A. Emotional stress B. Constipation C. Severe toilet phobia D. Rectal infections

B Constipation is the most common cause of encopresis and causes more than 90% of all cases (Hay et al., 2020, p. 75).

Which of the following is the leading cause of death in adolescents? a.) Suicide b.) Unintentional Injury c.) Homicide d.) Congenital Malformations

B Cultural and environmental factors, compared to organic factors, pose the highest threats to life for adolescents. The leading cause of deaths for adolescents 15-19 years is unintentional injuries at 38.5%. The main cause of unintentional deaths is MVAs at 52% with the second cause of death as poisoning. MVAs are attributed to more than ¼ of deaths in the adolescent age group, making it the leading cause of death in the US

All the following are non-pharmacologic interventions for blood pressure management in children except? a. Diet b. Limiting screen time c. Weight management d. Exercise

B Hays pg. 223 screen time is not a suggested recommendation for nonpharmacological management of blood pressure in pediatrics

At what ages is a universal lead screening recommended? a. 9 months and 12 months b. 12 months and 24 months c. 18 months and 24 months d. 12 months and 18 months

B Hays pg. 225 the CDC in Hays discusses how universal lead screenings should be performed at 12 months and again at 24 months. This screening should be performed for any older children living in communities where there may be a "high percentage of old housing."

All the following steps are appropriate for a newly diagnosed stable and asymptomatic 68-year-old female with atrial fibrillation without RVR except for what? a. order thyroid function tests, electrolyte panel, and electrocardiography b. admitting the patient to the hospital for immediate cardioversion c. determining the patient's CHA2DS2-VASc score d. prescribing a beta blocker and an anticoagulant

B Hospitalization is the incorrect answer because stable patients can be treated with rate control and anticoagulation as an outpatient. Hemodynamically unstable patients would require hospitalization. Afib can be the first sign of thyroid disorder. Correcting underlying causes such as thyroid disorder or electrolyte imbalance also corrects afib. The CHADS2 and CHA2DS2-VASc scores help determine risk of stroke, appropriate type of anticoagulation, and whether long term anticoagulation is beneficial. Betablockers and calcium channel blockers are first line agents for rate control. Anticoagulants should be initiated unless contraindicated.

A 43-year-old African American male with no medical history, is newly diagnosed with hypertension. As the NP, appropriate treatment options would include a thiazide diuretic and what other antihypertensive medication? A. Lisinopril B. Amlodipine C. Furosemide D. Losartan

B The correct answer is B. Black adults should first be treated with a thiazide diuretic, a calcium channel blocker, or both medications combined. If there is history of heart failure or chronic kidney disease, ACE inhibitors or ARBs may be useful adjuncts to manage hypertension. However, black adults are more at risk for developing a dry cough or angioedema while taking an ACE inhibitor, so an ARB is preferred. Furosemide is not a first-line therapy for hypertension.

You are examining a newborn full-term infant and you note a grade 2 systolic ejection murmur at the left midsternal border upon auscultation of the infant's heart. As the FNP, you know the following to be true regarding newborn cardiac murmurs EXCEPT: a. Murmurs are common in the first several days of life and do not usually indicate a structural abnormality. b. If the murmur persists beyond 24 hours of life but the infant shows no signs of congestive heart failure, no further evaluation is recommended. c. Transitional murmurs are usually auscultated between the left upper and midsternal border, usually 1 to 3 in grade, and are loudest within the first 24 hours of life. d. If the murmur persists beyond 24 hours of life, blood pressure should be evaluated in the infant's right arm and leg.

B If a murmur persists beyond 24 hours of life, further evaluation is warranted and should include blood pressure measurements taken in the infant's right arm and right leg. A difference of 15mmHg or if lower extremity pulses are difficult to palpate, a cardiology workup is recommended to evaluate for coarctation of the aorta

A mother brings her 5-month-old son in for clear nasal drainage, cough and low-grade fever for the fourth time since birth. She reports over the last month, he has started sweating more profusely while feeding and spitting up large volumes after almost every feed. On exam, a grade 4 harsh, pansystolic murmur at the lower left sternal border in the 4th intercostal space is heard. A referral to cardiology is made. You expect which diagnosis? A. Atrial Septal Defect B. Ventricular Septal Defect C. Patent Ductus Arteriosus D. Coarctation of the Aorta

B Large VSD with normal pulmonary blood flow are generally diagnosed between 3-6 months and present with failure to thrive, tachypnea and diaphoresis with feeding. Infants also experience frequent respiratory infections, dyspnea, and fatigue. Physical exam reveals a grade 3-4 harsh, pansystolic murmur heard loudest at the lower left sternal border in 4th intercostal space.

Newborns whose mothers are positive for HBsAG should receive ----------- and ---------- within the postpartum period. A. Active and Passive immunity B. Hep B vaccine and Hepatitis B immune globulin C. Hep C vaccine and MMR vaccine D. Vit K and Erythromycin eye drops

B Newborns whose mothers are positive for HBsAG are exposed to Hepatitis B at birth. Administering the Hepatitis B immune globulin provides antibodies against Hepatitis B, while the infant's immune system develops the Hep B antibodies from the Hepatitis B vaccine thereby reducing their risk of developing Hepatitis B infection

An adult patient receiving statin therapy has complaints of muscle aches. Serum creatine kinase levels are elevated. When reviewing the medication list, which medication would not likely be attributing to the muscle aches and elevated creatine kinase? A. Niacin B. Omega 3 fatty acids C. High dose simvastatin (80 mg) D. Fenofibrate

B Omega 3 is not a known cause of these symptoms. Muscle diseases, such as rhabdomyolysis myositis, are more common if a statin is taken along with niacin, fibrates, the highest dose of simvastatin (80mg), and other meds such as erythromycin, cyclosporine, nefazodone and antifungal medications

A 64-year-old male presents to the clinic with concerns about his decreased ability to maintain an erection during intercourse. He admits he recently heard from a friend about a drug called Cialis (tadalafil). As the NP, you know which medication class is contraindicated with PDE-5 Inhibitors? A. Androgens B. Nitrates C. Beta blockers D. These medication classes are all safe

B PDE-5 Inhibitors treat conditions such as Erectile Dysfunction and BPH. Nitrates, such as nitroglycerin are contraindicated with PDE-5 inhibitors since this combination can lead to a dangerous cardiac preload reduction. This essentially leads to hypotension and syncope (McPhee et al., 2020). Androgens are not contraindicated and cause hypertensive effects rather than hypotensive. Also, while betablockers are also not contraindicated, the patient should still be monitored carefully as this drug may lead to bradycardia.

A multigravida patient with a known history of cocaine abuse presents to your clinic with large amounts of bright red vaginal bleeding, uterine pain, and irregular contractions. The patient is 36.5 weeks today. Based on this information, what is your diagnosis? A. Placenta previa B. Placental abruption C. Preterm labor D. Urinary tract infection

B Risk factors for placental abruption include hypertension, multiple pregnancies, cocaine use, smoking, and history of previous abruption. Presenting symptoms often include vaginal bleeding, abdominal pain, and contractions. In contrast, placenta previa is most often characterized by painless vaginal bleeding. Preterm labor would be a less likely diagnosis given the amount of blood loss reported by the patient. 2-15% of pregnant women have asymptomatic bacteriuria; otherwise, urinary tract infection signs/symptoms do not differ in the pregnant population

When obtaining a health history from your sexual and gender minority (SGM) patients, you should do which of the following as the nurse practitioner? A. Use pronouns based on patients' gender alone. B. Approach patients individually, use patient preferred pronouns, and respect gender identity and associated treatments. C. Tell a patient they must go by their legal name and sex identifiers. D. Structure treatment around a patients' gender assigned to them at birth

B The H&P exam is not different for SGM in comparison to other routine patients. Providers should see each patient as an individual. This can be done by using the patients' preferred pronoun and making sure to use appropriate terminology when referring to the patient. Always respect the diversity of each patients' gender identity and their differing desires for gender affirming treatments. Be sure to perform a thorough physical exam noting anatomic bodily changes from any prior gender affirming treatment. Medical history should always include a thorough sexual history just like all other adult and child exams.

A 22 year old new patient presents to the clinic. Her vitals are: BP 141/87, HR 85, RR 18, SpO2 97%, T 98.8. Her BMI is 31. She reports that she has smoked ½ pack of cigarettes per day since she was 15. Additionally, she is sexually active and reports she is not in a monogamous relationship. She says that she hasn't been to a doctor in "years". Which of the following should the clinician screen for? A. Sexually transmitted infections B. High cholesterol C. Lung cancer D. Polycystic Ovarian Syndrome

B The United States Preventive Services Task Force (USPSTF) recommends that screening for high cholesterol should begin at age 20 only if there are other cardiovascular risk factors like tobacco use, obesity and hypertension. The USPSTF does not recommend routine screening in asymptomatic patients under the age of 50 for lung cancer, regardless of pack years. While you would screen the patient for sexually transmitted infections, it is not the most important screening at this time. Screening for PCOS is important but it is not the most important screening at this time. The question also offers no information on her menstrual cycle.

After evaluating your 38-year-old female patient you are considering that she may have hypothyroidism based on her symptoms of fatigue, menorrhagia, dry skin, cold intolerance, depression, and weight changes. You obtain a TSH and a FT4 and your suspicion is confirmed when you evaluate her labs and recognize her: A. FT4 and TSH is elevated. B. FT4 is low, and her TSH is elevated. C. TSH is low and her FT4 is elevated. D. TSH and FT4 are low.

B The correct answer is B. There is an inverse relationship with low thyroid and TSH. TSH is elevated when thyroid levels are low as thyroid stimulating hormone is compensating by attempting to stimulate the thyroid to produce more thyroid hormone and the Free T 4 continues to be low

What condition has been identified as the strongest predisposing risk factor in developing asthma? a. Chronic bronchitis b. Atopy c. COPD d. Obesity

B The strongest risk factor identified in the development of asthma is atopy. Sensitive patients who are exposed to allergens through inhalation, will have increased inflammation and hyper-responsiveness off the airways. Although obesity is not the strongest identifiable factor, it is a factor that is increasingly becoming recognized as a contributing factor to developing asthma.

A nurse practitioner is assessing a newborn patient. Which of the following findings is abnormal and requires further testing? A. Sucking when pacifier is in mouth. B. Positive red reflex in right eye; Negative red reflex in left eye. C. Newborn grasps nurse practitioner's finger when placed in the newborn's palm. D. Multiple white papules across nose ranging in 1-2 mm in size.

B Unilateral red reflex requires ophthalmologic evaluation

Sally arrives to your clinic with complaints of urinary frequency, urgency, and burning during urination. Physical exam is unremarkable. Urinalysis reveals >500 leukocytes, positive nitrates, and moderate blood. As the Nurse Practitioner your next step is which of the following? A. Wait until the patient becomes febrile before starting antibiotics. B. Prescribe Trimethoprim-sulfamethoxazole 150/800 mg po BID x 3 days. C. Prescribe Levofloxacin 750 mg po daily x 7 days. D. Order CT scan STAT.

B Urinary tract infections (UTI) are common in the outpatient setting. For uncomplicated UTIs first line treatment is trimethoprim-sulfamethoxazole, nitrofurantoin, Fosfomycin trometamol. Fever is a sign of a complicated UTI therefore you would not wait for a fever to treat the infection. Untreated UTIs can lead to decreased kidney function. Treatment is warranted with signs and symptoms of irritative voiding as well as abnormal urinalysis. Levofloxacin can be used to treat UTIs, however the FDA advises against its use in uncomplicated cystitis. The duration is also wrong, you would only treat longer due to complications. Imagining is only warranted if the patient is male due to uncomplicated cystitis being rare, female with a history of multiple UTIs, or with suspicion of pyelonephritis. Meng, Maxwell V., Walsh, Thomas J., Chi, Thomas D. (2019). Chapter 23. "Urologic Disorders." Current Medical Diagnosis & Treatment 2019 (pp 966- 989). New York, NY: McGraw Hill Medical

As an NP in a pediatric setting, it is beneficial to remember that likely organisms to cause UTIs in children include all the follow except: a. Klebsiella b. E. Coli c. Gram-positive bacteria d. Enterococcus

C : Most common causes of UTIs in children are fecal flora which includes gram-negative bacteria, enterococcus, klebsiella and E. coli.

A 43-year-old white male presents to the office for a routine follow-up visit. He has a history of type 2 diabetes and dyslipidemia. His current medications include metformin and atorvastatin. His vital signs today are: T 98.5, HR 80, RR 16, BP 150/95. His BP at his last visit was 145/90. What medication does the provider anticipate starting the patient on for a new diagnosis of stage 2 hypertension? a. Amlodipine 5 mg po daily b. HCTZ 12.5 mg po daily c. Lisinopril 10 mg po daily d. Metoprolol 100 mg po daily

C ACE inhibitors such as lisinopril should be prescribed for patients with a history of type 2 diabetes according to ACC/AHA guidelines. Amlodipine (a CCB) and HCTZ (a thiazide diuretic) are also appropriate initial treatment regimens but are not the correct answer due to the patient's medical history. Beta-blockers such as metoprolol are not indicated for 1st line hypertensive therapy.

A 60-year-old woman walks into your clinic and tells the nurse practitioner that mammograms hurt her. She says she does a monthly breast self-examination and wonders if a yearly mammogram is essential. The best answer from the NP to the patient is, a. "It's particularly important to get a mammogram every year if your last one was excruciating." b. "A mammography can be replaced with an ultrasound examination of the breasts, which is neither unpleasant nor a source of radiation." c. "It's much more vital for you to have annual mammograms now that you're older and more prone to fibrocystic breast tissue changes." * d. "After the age of 60, a mammography every two years is suggested unless you notice a lump while checking your breasts."

C As long as women are in excellent health, annual mammograms are encouraged for women over the age of 40. Breast cancer is more common in women over the age of 60

When starting a child of any age on a stimulant medication to manage attention-deficit/hyperactivity disorder (ADHD) the nurse practitioner should perform a complete history and physical assessment of what system to prevent the risk of sudden death? A. Musculoskeletal system B. Respiratory system C. Cardiovascular system D. Neurological system

C Beginning a stimulant medication for ADHD requires the clinician to obtain a complete history and physical exam of the cardiovascular system to identify children who have a risk of sudden death due to stimulants. Children without underlying risks have not shown to be at risk for sudden death, but these children with risks must be properly identified. Asking questions about symptoms of syncope, chest pain, palpitations, and family history of sudden death prior to age 30 may help the clinician identify these patients. Children who see a cardiologist need consultation before starting a stimulant. A child's BP and HR should be monitored for changes while on stimulants. The FDA places a warning on stimulants about the risk of sudden death to children with serious heart problems or structural cardiac abnormalities.

A 13-year-old male patient comes into the clinic with concerns about his new breast development. He is worried that he will be teased by his classmates. All of the following are appropriate responses EXCEPT: a. "Gynecomastia is a common benign breast enlargement that occurs in pubertal boys." b. "Gynecomastia in pubertal boys will usually resolve on its own within 1 -3 years." c. "Gynecomastia at your age is often abnormal." d. "Pubertal gynecomastia is caused by an imbalance of estrogen and androgens.

C Gynecomastia is usually a benign finding that occurs in puberty from the imbalance of estrogen and androgen hormones. Up to 65% of boys will experience it during puberty. The breast tissue will regress on its own within 1-3 years for most males. Watchful waiting is appropriate if the physical exam and history are negative. Further testing should be conducted if unilateral breast enlargement, hard tissue, skin changes, or masses are found on the physical exam.

A 2-year-old girl with Turners syndrome comes to the clinic with her mother. She has been diagnosed with coarctation of the aorta. While evaluating her blood pressure on both legs and arms. What is the correct findings? A Blood pressure is higher in legs than arms B Both arms and legs have the same blood pressure measurement C Blood pressure is higher in the arms than the legs D All the above are incorrect

C In coarctation of the aorta, the blood pressure in the upper extremities are often greater than the lower extremities by 15 mm Hg. Coarctation of the aorta is often seen in females with turns syndrome. Coarctation of the aorta Is the narrowing of the aortic arch.

A 60-year-old male with known left heart failure reports new symptoms of swelling to his legs, fullness in his abdomen, and intermittent nausea. He admits to forgetting to take his medications several days a week. Upon examination the NP will likely find which of the following? a. warm, erythematous extremities and elevated temperature b. expiratory wheezing c. crackles in the lung bases and ascites d. absent bowel sounds

C LV dysfunction is a known cause of right sided heart failure. Non-adherence to medications increases the risk for disease progression. Signs of RV dysfunction are related to fluid volume overload in the lungs causing crackles not wheezing, extremities, and ascites. Bowels are not altered. Extremities are cool with pallor due to fluid overload

A mother brings a 1-week-old infant to clinic with a complaint of an ulceration/ blister around the baby's mouth that is interfering with latching. Mother reports that baby has been irritable. Denies fever, vomiting and any other systemic symptoms. Physical finding confirms the presence of a fluid filled blister at the corner of baby's mouth. What is the most likely diagnosis ? A. Congenital syphilis B. This could be an early sign of HIV infection C. Herpes virus infection D. Congenital zika infection

C Presentation is consistent with localized neonatal herpes simplex virus infection. Lesions of herpes simplex appear usually 5-14 day of life. Newborns with congenitally acquired HIV infection are usually asymptomatic. Clinical presentation of congenital zika syndrome has been described as constellation of congenital anomalies including microcephaly & intracranial calcification or other brain abnormalities. Even though congenital syphilis may involve skin lesions, newborns are often asymptomatic.

Which of the following assessments should healthcare providers use to gather a psychosocial history for adolescents? a.) CAGE b.) CRAFTT c.) HEADSS d.) SBIRT

C The HEADSS assessment is a tool that is utilized by healthcare providers to gather a psychosocial history for adolescents. HEADSS stands for Home and environment, Education and employment, Activities, Drugs, Sexuality/relationships, Suicide/depression. The assessments should be obtained with just the adolescent if possible. The structure of the HEADSS assessment is to organize a screening so that the healthcare provider can facilitate communication while creating a compassionate, respectful and confidential atmosphere for the adolescent to disclose concerns related to their health.

A 48-year-old female started enalapril 5 mg after being diagnosed with hypertension 3 weeks ago. She is now complaining of a dry cough. Her blood pressure today is 118/79. What is the most appropriate action by the nurse practitioner? A. Continue the medication and tell the patient that a dry cough is an expected side effect B. Continue the medication and add losartan C. Stop the medication and start losartan D. Stop the medication and start metoprolol

C The correct answer is C. 10% of patients treated with an ACE inhibitor are likely to develop a dry cough. If a cough develops, the ACE inhibitor must be discontinued and a different medication, such as an ARB, should be initiated. An ACE inhibitor and an ARB should not be combined due to increased risk of hypotension and hyperkalemia. Beta blockers are not a first-line therapy for hypertension.

In your primary care practice, you have diagnosed your 72-year-old patient with osteoporosis based on her DXA T score of -2.5. Your treatment plan includes the incorporation of bisphosphonates as pharmacotherapy. When prescribing this medication, you include what key education: A. Take this medication with food to avoid gastric upset. B. This medication is best absorbed at night. C. Take this medication with a 1 full cup of water on an empty stomach and remain upright for a minimum of 30 minutes after taking medication to avoid esophageal upset. D. Avoid the use of NSAIDS while on bisphosphonates.

C The correct answer is C. This medication can cause esophagitis, and this may be avoided by remaining upright for at least 30 minutes after taking. This medication should be taken with a minimum of 8 ounces of water to support gastrointestinal absorption. This medication should not be taken with food. NSAIDS are not contraindicated. This medication should be taken in the morning.

As a nurse practitioner, you can create a welcoming environment for sexual and gender minorities (GSM) by doing all of the following EXCEPT? A. Ensuring nondiscrimination policies are in place and enforced across the clinic. B. Visitation policies in place that allow for open patient preferences when choosing visitors. C. Avoid routinely asking patients about their sexual health histories. D. Having staff that are diversely trained in culturally competent care of sexual and gender minorities.

C When caring for GSM patients (like any other patient) it is important to ensure that (1) leadership is always involved in GSM education and care; (2) nondiscrimination policies are set forth upon hire of all staff, are strictly maintained, and are prominently displayed across the office; (3) visitation policies are upheld and visitors are congruent with patients desires; (4) staff receive thorough cultural training with emphasis on the GSM population; (5) office forms, procedures, reading materials, and artwork show the diversity of LGBTQ community; (6) patients should be routinely asked about sexual health histories just like when obtaining history of heterosexual patients

A mother presents with her 3-year-old daughter today at the clinic. The mother states that her child has been coughing and wheezing all afternoon after playtime. She reports that the child's symptoms have abruptly started without any forewarning. Upon physical examination the child has a non-productive cough and right lower lobe wheezing upon chest examination. The nurse practitioner should expect which of following diagnose? A. Pneumonia B. Acute asthma exacerbation C. Foreign-body aspiration D. Croup

C Young children have an extremely high risk for foreign-body aspiration due to poor chewing abilities. This age group also have a tendency to put foreign object into their mouth. Essentials of diagnosis include sudden onset of wheezing, coughing or respiratory distress. Physical examination can illicit decreased unilateral breath sounds or wheezing

A 87-year-old female comes into the clinic with complaints of palpitations. While auscultating, you hear a pansystolic murmur that has a blowing, musical sound. You hear it best at the apex and radiating to the axilla. What would this finding indicate? a. Tricuspid regurgitation b. Aortic regurgitation c. Aortic stenosis d . Mitral regurgitation

D A mitral regurgitation murmur is heard maximally at the apex but can radiate to the axilla and base areas. Mitral regurgitation is characterized by a pansystolic murmur with a blowing, high-pitched sound that is sometimes harsh or musical (Papadakis, M., &McPhee, S., 2020, pp. 348-352.)

A 42 year old male presents to the clinic with fever, nonproductive cough and shortness of breath who went to a community event last week. He has no pertinent medical history and only surgery was an appendectomy when he was 19 years old. His CXR is positive for a left lower lobe opacity and he is diagnosed with community acquired pneumonia (CAP). The nurse practitioner would know the following to be the most appropriate initial therapy for treatment of CAP. A. Ciprofloxacin 400mg IV q8 hrs for 10 days. B. Cefuroxime 500mg PO BID x 5 days. C. Amoxicillin 1gm PO TID x 10 days. D. Azithromycin 500mg PO as first dose and then 250mg PO daily for 4 more days

D A) Intravenous therapy is reserved for inpatient treatment. A 42 year old man with no PMHx and single lobar pneumonia should be appropriate for outpatient treatment if assessment and vitals are otherwise appropriate. B) Patients with comorbid conditions would need to be started on a macrolide plus a beta-lactam. C) Amoxicillin alone is also not an appropriate first line treatment for an individual without comorbidities and no macrolide prescribed. D) The nurse practitioner will recognize that 2/3 of CAP will be from S. pneumoniae and appropriate first line treatment in a healthy individual who has not been on antibiotics in the past 3 months is a macrolide, such as Azithromycin.

The NP knows that large for gestational age (LGA) babies whose mothers are diabetic are at high risk of - -------------- in the postpartum period and should monitor their -----------closely. A. Hyperglycemia, glucose B. Hypoglycemia, AIC C. Hyperglycemia, HCG D. Hypoglycemia, glucose

D After delivery, LGA babies of diabetic mothers lose the supply of high glucose content in the blood from maternal supply. As such, they are at risk of low blood sugar levels.

A 2-month-old, uncircumcised male is brought to your clinic with the chief complaint of foul smelling urine. While taking the history from his caregiver, you discover he has been irritable with poor feedings. Physical exam reveals the patient temperature is 101 but no other abnormalities noted by the NP. Your next step should include: a. Prescribing amoxicillin for treatment of a UTI. b. Ordering a urinalysis and urine culture. c. Refer patient to nephrology since UTIs are uncommon in males under 3 months. d. Admit the patient to the hospital to have him treated with parenteral antimicrobials

D Although amoxicillin, augmentin or first generation cephalosporins are antibiotics of choice for uncomplicated cystitis, antibiotics should not be given prior to collecting a specimen for culture and urinalysis. Males, specifically uncircumcised males, are more common to have UTIs that females under the age of three. Due to the patient's age, first step of treatment should include admission to the hospital for parenteral antimicrobials and hydration.

The nurse practitioner is interviewing the parents of a 1-week-old newborn. The NP is inquiring about the infant's feeding routine and urine output. Which option indicated normal feeding and urinary output for a 1- week-old infant? A. Feeds every 1-4 hours; 3-4 wet diapers per day. B. Feeds every 5 hours; 2-3 wet diapers per day. C. Feeds every 6 hours; 6-8 wet diapers per day. D. Feeds every 1-4 hours; 6-8 wet diapers per day

D Babies must be fed every 1-4 hours or as often as wanted but at least 8-12 times a day. Infants 1 week of age should have six to eight wet diapers with colorless or light-yellow urine per day

What clinical finding would not be consistent with early pregnancy in the 22-year-old G1P1 patient? A) Softening of the cervicouterine junction B) Vascular engorgement of breast tissue C) Cyanosis of vaginal and cervical tissues D) Cervical dilation of 2 cm

D Breast changes, Chadwick's sign, and softening of the cervicouterine junction are all common clinical findings of early pregnancy (Weeks 7-15) and will continue throughout the pregnancy. Cervical dilation of 2cm is typically a finding in late pregnancy, not early (Papadakis and McPhee 2020: Chapter 19: Obstetrics and Obstetric Disorders, page 815-818)

A mother of a child recently diagnosed with autism spectrum disorder wants to know what co-occurring conditions occur in children with ASD. Which of the following is not a co-occurring condition? A. Anxiety B. ADHD C. Obesity D. Myopia

D Children with ASD can often have co-occurring conditions such as obesity, seizures, sleep problems, anxiety, gastrointestinal problems, feeding/limited diet, irritability, aggression, and self-inj

A 15-year-old female who is not sexually active presents to the clinic with complaints of extremely painful periods. Pain is described as cramping in the lower abdomen. She also reports associated symptoms of nausea and vomiting with the cramping. What would be the appropriate treatment plan for this patient? A. Oral contraceptive pills (OCP) B. Tylenol extra strength 500mg 1-2 tablets every 4-6 hours as needed for pain C. Refer to gynecology for pelvic exam D. Ibuprofen 600mg every 6 hours, beginning 1-2 days prior to bleeding

D D.) Ibuprofen 400-600mg every 6 hours or Naproxen 500mg twice a day is recommended. Start 1-2 days prior to anticipated period or with the first sign of discomfort and continue 2-3 days after on-set of pain. If patient does not respond well to NSAIDs, OCPs can be effective to suppress ovulation. Pelvic examination can be deferred in non-sexually active adolescents if primary dysmenorrhea is suspected.

Choose the appropriate antibiotic therapy for a patient with CAP who you have determined is at risk for antibiotic resistance. a. Dual treatment with doxycycline and a beta-lactam antibiotic b. Dual therapy with azithromycin and a beta-lactam antibiotic c. Dual therapy with a respiratory fluoroquinolone and doxycycline d. Treat with a respiratory fluoroquinolone or dual treatment therapy with a macrolide and a beta-lactam antibiotic (amoxicillin or Augmentin preferred

D For patients who have risk factors for drug resistance ( age >65, antibiotic use in previous 90 days, immunocompromised, existence of comorbidities such as diabetes mellitus), first line treatment of CAP is either a respiratory fluoroquinolone (moxifloxacin, levofloxacin) or dual antibiotic therapy using a macrolide such as azithromycin plus a beta-lactam antibiotic (amoxicillin or Augmentin is preferred over cephalosporins)

All of the following are correct about Autosomal dominant polycystic kidney disease (ARPKD) except: A. ARPKD is diagnosed by prenatal ultrasound. B. Hypertension is an early problem in ARPKD. C. Many children with ARPKD reach end-stage renal disease by school age. D. Even in a severe form of ARPKD kidney functions remain normal in utero

D Kidneys are dysfunctional in utero if ARPD is severe. Therefore, newborns demonstrate Potter sequences such as abnormal facies and limb anomalies due to fetal compression and perinatal death due to pulmonary hypoplasia. (Page 719)

When assessing a child diagnosed with patent ductus arteriosus you would expect to find all of the following except? A. Machine-like systolic murmur at second left intercostal space B. Split S2 C. Normal S1 D. Split S1

D Moderate to Large PDA presents with a rough, machine-like systolic murmur loudest at the second left intercostal space. The murmur radiates well to the anterior lung fields, but poorly to the posterior lung fields. The S1 is normal and the S2 is either narrowly or paradoxically split.

Which clinical electrolyte laboratory value abnormality would most likely suggest a possible neoplasm present in a patient? A. Serum Sodium (Na 130 mmol/L) B. Serum Potassium (K 3.2 mmol/L) C. Serum Magnesium (Mg 1.5mg/dL) D. Serum Calcium (Ca 11.3 mg/dL)

D Neoplasm is clinically apparent in nearly all cases of hypercalcemia. Normal serum calcium range is 8.5-10.2mg/dL.

A 75-year-old male presents to your clinic with urinary frequency & dark colored urine. The symptoms began three days ago and have progressively worsened. Vitals are Temp: 100.8°F, RR 22, BP 99/70, HR 105. He states that he has a history of UTI's and figures that this is just another one. He has been trying to drink more water and has taken D-mannose, but nothing is helping. On exam, he complains of feeling nauseous and cold with visible shaking. He is positive for costovertebral angle tenderness. What should you do next as the clinician? A. Order a CBC and urinalysis with culture to see what antibiotic will be sensitive to the organism. B. Prescribe Ciprofloxacin 500mg PO BID for 7 days and have the patient follow up in clinic C. Refer him to Urology to obtain a CT urogram for suspected urolithiasis. D. Call an ambulance to have the patient taken to the nearest Emergency Department.

D Patient is showing signs of severe infection and sepsis as evidenced by his symptoms and vital signs. He will be needing next level of care including parenteral antibiotics before he goes into septic shock. A CBC and urinalysis would be appropriate laboratory tests to order if the patient was stable. In addition, giving the patient Ciprofloxacin would also be appropriate if the patient had an uncomplicated infection that did not warrant hospitalization. Referral to a Urologist would be applicable if the patient was stable and had complicating factors or if there was failure of clinical improvement after 48 hours

When evaluating a male patient for Benign Prostatic Hyperplasia (BPH) which of the following symptoms would be the least indicative of this diagnosis? A. Postvoid dribbling B. Nocturia C. Decreased force of urine stream D. Abdominal pain

D Postvoid dribbling, Nocturia, and decrease force of urine stream would all be common symptoms indicative of Benign Prostatic Hyperplasia. Abdominal pain is not a symptom that would be typically reported for BPH

A 6-month-old female presents to the clinic with a temperature of 101.4, poor PO intake and irritability x2 days. Urinalysis screening indicates pyuria (10-20 WBCs/hpf). As the FNP, you know that medical management will include all the following EXCEPT: A. Acetaminophen (Tylenol) every 4-6 hours as needed for fever or discomfort B. Sulfamethoxazole/trimethoprim (Bactrim) x7-10 days C. Urine culture D. Nitrofurantoin (Macrobid) x5 days

D Sulfamethoxazole/trimethoprim x7-10 days is one of the first-line treatment options for children > 3 months of age with uncomplicated cystitis. Nitrofurantoin is not recommended for children < 12 years of age. The gold standard for diagnosis is a urine culture. Fever is common in children with a UTI and can be treated as needed.

As the FNP, you are aware that all of the following conditions place an infant at an increased risk for the development of neonatal hypoglycemia EXCEPT: a. Large for gestational age (LGA) b. Small for gestational age (SGA) c. Preterm delivery d. Polyhydramnios

D The LGA infant has abundant stores of glucose in the form of glycogen and is therefore at risk for hypoglycemia. Similarly, the SGA infant has reduced stores of glucose in the form of glycogen and is therefore also at risk for hypoglycemia. Premature infants are also at risk for hypoglycemia due to decreased glycogen stores. Amniotic fluid levels do not play a role in the development of abnormal serum glucose values.

A 63-year-old male patient presents to your clinic for a hospital follow up visit. He was recently discharged from the hospital after suffering from a MI. He has a PMH of diabetes type 2 and hypertension. The FNP knows that which of the following medications are recommended for this patient: a.) Simvastatin 20 mg b.) Pravastatin 40 mg c.) Lovastatin 20 mg d.) Atorvastatin 80 mg

D The entry level FNP knows that all patients with a history of acute coronary syndrome should be on a high intensity statin. Only one of the listed answers is a high intensity statin.

A 16-year-old patient is at the clinic for a well visit with her mother and appears to be closed off. Which of the following will assist in developing a rapport with the teenager? a. Discuss the patient's health and wellness directly with the mother. b. Assume the patient has no concerns if none were voiced. c. Dismiss any complaints as the patient is being dramatic. d. Show sincere interest in the patient by asking her about her hobbies

D The teenage years are often hard for patients. They are discovering who they are and are trying to figure out how to handle different situations, including interactions with the provider. Teenagers often appear sullen and closed off during exams. There are various techniques that will assist in helping the patient communicate and feel comfortable. Clinicians should speak directly to the patient to encourage them to participate in their care. Often, teenagers will not voice any concerns unless they are directly asked about it. If they do voice concerns, take the time to listen. Teenagers will be vague or overstate concerns to in an attempt to be taken seriously. Do not dismiss these concerns and assume the patient is being dramatic. Speak to the patient according to their emotional maturity and not just their chronological age. Showing sincere interest in the teenagers and acknowledging positive accomplishments will help them open up to you.

A 69-year old male presents to the clinic with complaints of urinary frequency, a sensation of incomplete bladder emptying, and a decreased force of urinary stream. He denies abdominal pain, painful urination, or a disturbance in performing his ADLs as a result of his symptoms. Upon rectal examination you note his prostate to be slightly enlarged and firm, smooth, and elastic in consistency. Based upon this information, what should the initial treatment be for Benign Prostatic Hyperplasia (BPH) with mild symptoms? A. Doxazosin 4 mg PO for 7 days initially B. Transurethral resection of the prostate (TURP) C. Order a CT D. Watchful waiting

D Watchful waiting is the initial treatment for this patient. The patient's symptoms are mild and not bothersome, making him a good candidate for watchful waiting. This answer is also correct because the progression of BPH and risks associated with the disease are unknown and uncertain. While Doxazosin is used to treat BPH, it wouldn't be the initial treatment for this patient and the starting dosage is wrong. Initially, the patient should be started at 1 mg for 7 days. A CT would only be ordered if the patient was also experiencing a UTI, had a history of a kidney stone or CKD, or had hematuria. According to the Choosing Wisely (ABIM Foundation), CTs should not be routinely ordered for BPH. Lastly, a TURP would not be initial treatment as it is much more invasive (McPhee et al., 2020