Fitzgerald All Part 1

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40. Which is most consistent with the diagnosis of COPD? A. FEV1/forced vital capacity (FVC) ratio equal to or less than 0.70 after properly timed SABA use B. dyspnea on exhalation C. elevated diaphragms noted on x-ray D. polycythemia noted on complete blood cell count Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

A. FEV1/forced vital capacity (FVC) ratio equal to or less than 0.70 after properly timed SABA use

26. When discussing the use of immunoglobulin (IG) with a 60-year-old woman who was recently exposed to the hepatitis A virus, you consider that: A. IG is derived from pooled donated blood.B. the product must be used within 1 week of exposure to provide protection.C. its use in this situation constitutes an example of active immunization.D. a short, intense, flu-like illness often occurs after its use.

A. IG is derived from pooled donated blood.

98. Bacterial pathogens implicated in causing acute bronchitis include all of the following except: A. S. pneumoniae. B. M. pneumoniae. C. C. pneumoniae. D. B. pertussis. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 157). F.A. Davis Company. Kindle Edition.

A. S. pneumoniae.

C. this medication will likely afford clear, although minor and time-limited benefits.

101. When discussing the use of a cholinesterase inhibitor with a 72-year-old woman with a recent diagnosis of Alzheimer's type dementia and her family, you report that A. this medication will help return memory to her pre-illness baseline B. this risk associated with the use of this medication outweighs its benefits C. this medication will likely afford clear, although minor and time-limited benefits. D. the medication should have been started earlier to help prevent any change in cognition.

C. in patients with mild-to-moderate AD

102. When managing dementia, cholinesterase inhibitors offer the greatest benefit: A. for prevention of Alzheimer's-type dementia B. in patients with mild cognitive impairment. C. in patients with mild-to-moderate AD D. in patient with severe AD

B. PET scan

103. When assess a 76 year old man with new-onset mental status change, all of the following diagnostic tests are essential except: A. serum glucose B. PET scan C. CBC with white blood cell differential D. ECG.

C. Advanced directives are legally binding in all states FYI: It is important to note that advanced directives are not legally binding and not all states recognize them in a legal sense. States that do recognize advanced directives only do so when the patient is, in the opinion of the healthcare provider, hopelessly and terminally ill.

116. When considering end-of-life decisions, which of the following statements is false? A. Advanced directives include living wills and do not resuscitate (DNR) orders. B. A video or audiotaped discussion may include advanced directives C. Advanced directives are legally binding in all states D. Advanced directives are only recognized when the patient is hopelessly and terminally ill.

A. Hyposmia

12. Decline in the sense of smell is an age related change in the senses reported by the older adult. It is known as: A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

C. one or more latent harmful genes become activated

6. Match Gene theory with it's key aspect. A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

C. the patient's home

60. Most falls in older adults occur in: A. a healthcare institution. B. a public place C. the patient's home D. an outdoor setting

B. tolterodine (Detrol).

73. Pharmacological intervention for patients with urge incontinence includes the use of: A. doxazosin (Cardura). B. tolterodine (Detrol). C. finasteride (Proscar). D. psuedoephedrine (Sudafed).

B. Crashes with elderly drivers tend to involve diminished speed of visual processing

80. Which of the following is a true statement with regard to driving and the elderly? A. The number of elderly drivers will decrease over the next decade. B. Crashes with elderly drivers tend to involve diminished speed of visual processing C. There is a greater incidence of accidents involving right-hand turns compared with left-hand turns D. There is no evidence to suggest, if the elder's health is preserved, that the skills needed for safe driving deteriorate with age.

D. The National Transportation and Safety Board recommends surrendering the driver's license for all individuals with an AD diagnosis.

81. Which of the following is a false statement with regard to driving and Alzheimer's-type dementia (AD)? A. Patients with AD typically continue to drive for at least 3 years following the diagnosis. B. Those with mild-to-moderate AD have an eight-fold increase in the number of accidents. C. Those at early stages of AD can continue to drive safely, though driving should be monitored regularly D. The National Transportation and Safety Board recommends surrendering the driver's license for all individuals with an AD diagnosis.

dementia

91. Is insidious onset over months to years is more likely associated with delirium or dementia?

A program of regular aerobic physical activity can yield which of the following changes in the lipid profile? A. increases HDL, lowers VLDL and triglycerides B. lowers VLDL and LDL C. increases HDL, lowers LDL D. lowers HDL, VLDL, and triglycerides

According to DSM-5 a diagnosis of depression must include either depressed mood or which of the following? A. loss of interest or pleasure B. recurrent thoughts of death C. feelings of worthlessness D. weight change (either increase or decrease) (Ch. 14 Fitzgerald)

All of the following are associated with secondary Raynaud phenomenon except: A. hypertension B. scleroderma C. repeated use of vibrating tools D. use of beta adrenergic antagonists

All of the following are common symptoms of wrist tendonitis except: A. muscle cramping. B. reduced ROM C. swelling of the wrist. D. muscle weakness. (Ch. 9 Fitzgerald)

As part of the evaluation in a febrile 3-year-old boy, the following white blood cell count with differential is obtained: ● WBCs = 22,100/mm3 ● Neutrophils = 75% (normal 40% to 70%) with toxic granulation ● Bands = 15% (normal 0% to 4%) ● Lymphocytes = 4% (normal 30% to 40%) Which of the following best describes the WBC with differential results? A. Leukocytosis with neutrophilia B. Leukopenia with lymphocytosis C. Lymphopenia with neutropenia D. Leukopenia with neutropenia

At what age is it appropriate to recommend dietary changes to parents if overweight or obesity is a concern? A. 12 months old B. 5 years old C. 10 years old D. 18 years old

At which of the following ages in a young child's life is parental anticipatory guidance about protection from falls most helpful? A. birth B. 2 months C. 4 months D. 6 months

Common physical findings of SLE incude all of the following except: A. weight gain B. joint pain and swelling C. fatigue D. facial rash (Ch. 9 Fitzgerald)

Compared with unfractionated heparin, characteristics of low-molecular-weight heparin (LMWH) include all of the following except: A. more antiplatelet effect. B. decreased need for monitoring of anticoagulant effect. C. longer half-life. D. superior bioavailability.

Complications of Achilles tendonitis include: A. tendon rupture. B. neurological sequelae. C. stress fracture. D. bursitis. (Ch. 9 Fitzgerald)

Early neurological changes in patients with lumbar radiculopathy include: A. loss of keep tendon reflexes. B. poor two-point discrimination. C. reduced muscle strength. D. footdrop. (Ch. 9 Fitzgerald)

Evaluation for disease progression is a patient with sarcoidosis can involve: A. pulmonary function test and carbon monoxide capacity test. B. skin biopsy. C. check for WBCs in the urine D. the Phalen test (Ch. 9 Fitzgerald)

Family members and caregivers of an international adoptee should be given the hepatitis A vaccine per the following schedule: A. two doses 6 months apart, one dose before the child arrives. B. two doses 3 months apart, one dose before the child arrives. C. two doses 1 year apart, one dose before the child arrives. D. one dose before the child arrives into the USA.

For a Grade I ankle sprain, weight-bearing should be avoided for at least: A. 24 hours B. 72 hours C. 1 week D. until full ROM is restored. (Ch. 9 Fitzgerald)

Gina is 2 years old and presents with a 3-day history of fever, crankiness, and congested cough. Her respiratory rate is more than 50% of the upper limits of normal for age. Tubular breath sounds are noted at the right lung base. Skin turgor is normal, and she is wearing a wet diaper. She is alert, is resisting the examination as age appropriate, and engages in eye contact. Temperature is 38.3°C (101°F). Gina's diagnostic evaluation should include: A. chest x-ray. B. urine culture and sensitivity measurement. C. lumbar puncture. D. sputum culture.

In prescribing Niacin, the NP considers that: A. postdose flushing is often reported B. hepatic monitoring is not needed C. low dose therapy is usually effective in increasing LDL D. drug induced thrombocytopenia is common

Milia are treated by the following method: A. no special skin care B. a topical retinoid. C. cryotherapy. D. a topical antimicrobial

Possible consequences of excessive levothyroxine use include: A. bone thinning B. fatigue C. renal impairment D. constipation

Problems after tetanus immunization typically include: A. localized reaction at site of injection B. myalgia and malaise C. low-grade fever D. diffuse rash

The preferred urinary tract imaging study for a 22-month-old girl with first-time febrile UTI is: A. renal-bladder ultrasound (RBUS). B. renal scan. C. voiding cystogram (VCUG). D. none unless a second UTI occurs.

The presumptive diagnosis of fragile X syndrome can be confirmed by a blood test. A. true B. false

The use of which of the following drugs often mimics generalized anxiety disorder? A. sympathomimetics B. antipsychotics C. anticholinergics D. alpha-beta antagonists (Ch. 14 Fitzgerald)

Treatment for reactive arthritis (also known as Reiter syndrome) in a sexually active man usually includes: A. antimicrobial therapy. B. corticosteroid therapy. C. antirheumatic medications. D. immunosuppressive drugs (Ch. 9 Fitzgerald)

What is the most common adverse effect noted with alpha-glucosidase inhibitor use? A. GI upset B. hepatoxicity C. renal impairment D. symptomatic hypoglycemia

When taken concomitantly with warfarin, which causes a possible decreased anticoagulant effect? A. cholestyramine B. allopurinol C. cefpodoxime D. zolpdem

Which of the following medications is a helpful treatment option for relief of tremor and tachycardia seen with untreated hyperthyroidism? propranolol diazepam carbamazepine verapamil

Which of the following servings of fish (3.5 oz.) contains the greatest amount of vitamin D? A. fresh wild salmon B. fresh farmed salmon C. canned tuna D. canned mackerel. (Ch. 9 Fitzgerald)

D. Anterior uveitis

A 48-year-old man presents with a new-onset right eye vision change accompanied by dull pain, tearing, and photophobia. The right pupil is small, irregular, and poorly reactive. Vision testing obtained by using the Snellen chart in 20/30 OS and 20/80 OD. The most likely diagnosis is: A. Unilateral herpetic conjunctivitis B. open-angle glaucoma C. Angle-closure glaucoma D. Anterior uveitis

Prediabetes in children is defined as: A. IFG >/=100 but </=125 B. IGT >/=140-199 C. BMI in the 85th percentile D. BMI in the 60th percentile

A, B

When counseling the family of an otherwise healthy 2 yo who just had a febrile seizure, you consider the following regarding whether the child is at risk for future febrile seizures. A. The occurrence of one febrile seizure is predictive of having another B. Intermittent diazepam can be used to prophylactically during febrile illness to reduce risk of recurrence C. A milder temperature elevation in a child with a history of a febrile seizure poses a significant risk for future recurrent febrile and nonfebrile seizures D. Consistent use of antipyretics during a febrile illness will significantly reduce the risk of a future febrile seizure

A, B

Signs of severe dehydration include: A. anuria B. tears absent C. capillary refill of approximately 3 seconds D. elevated BP

A, B, C

Fruit juice intake is acceptable in children 6 months and older per the following recommendations: A. The juice is mixed in small amounts to flavor water. B. Only 100% juice is used. C. Juice replaces no more than 1 serving of milk. D. The juice is consumed in the morning with breakfast. E. No more than 6 oz per day is recommended for children 6 months to 5 yo.

A, B, E

Acne neonatorum treatment options include which of the following? A. no special skin care is needed because these lesions are self resolving B. topical retinoids C. oral antibiotic D. low dose benzoyl peroxide

A, D

In evaluating a 9 yo child with a healthy BMI during a well visit, a comprehensive CV evaluation should be conducted by: A. Obtain fasting lipid profile B. Screen for T2DM by measuring HBA1C C. Assess for family history of thyroid disorder. D. Assess diet and physical activity.

A, D

D. long-term use of contact lenses

20. All of the following are risk factors for angle-closure glaucoma except: A. Asian ethnicity B. female gender C. far-sightedness D. long-term use of contact lenses

Which of the following are possible consequences of obesity? (More than one can apply) Obstructive apnea Steatohepatitis Female infertility Endometrial cancer

A,B,C,D

A. Erickson

5. During a routine assessment of a 73 year old man with back pain, he reveals that he has become increasingly concerned about the physical changes related to aging. He misses the ability to do physical and recreational activities that he once enjoyed. He feels that this realization has made him "cranky," which his children have mentioned to him on several occasions. You realize that this patient may be having difficulty accepting the inevitability of physical decline and death as described by: A. Erickson. B. Peck C. Butler. D. Levinson

A major purpose of the Privacy Rule is to: A. define and limit the circumstances in which an individuals protected health information can be used or disclosed by covered entities B. set standards for the distribution and selling of health information to third parties C. Define accountability by healthcare providers that can be used in courts when there is suspected breach of information D. protect individuals health information when access to electronic medical records is illegally obtained

A. define and limit the circumstances in which an individuals protected health information can be used or disclosed by covered entities

A 24-year-old woman presents with hive-form linear lesions that develop over areas where she has scratched. These resolve within a few minutes. This most likely represents: A. dermographism B. contact dermatitis C. angioedema D. allergic reaction

A. dermographism

152. You see a 48-year-old woman who has been taking a COX-2 inhibitor for the past 3 years. In counseling her, you mention that long-term use of COX-2 inhibitors is associated with all of the following except: A. hepatic dysfunction. B. gastropathy. C. cardiovascular events. D. cerebrovascular events.

A. hepatic dysfunction.

A Tzanck smear that is positive for giant multinucleated cells was taken from a lesion caused by: A. herpes virus B. S. aureus C. streptococci D. allergic reaction

A. herpes virus

A 38-year-old woman with advanced human immunodeficiency virus (HIV) disease presents with a chief complaint of a painful, itchy rash over her trunk. Examination reveals linear vesicular lesions that do not cross the midline and are distributed over the posterior thorax. This presentation is most consistent with: A. herpes zoster B. dermatitis herpetiformis C. molluscum contagiosum D. impetigo

A. herpes zoster

128. The gastric parietal cells produce: A. hydrochloric acid. B. a protective mucosal layer. C. prostaglandins. D. prokinetic hormones.

A. hydrochloric acid.

The goals of quality and performance improvement initiatives in healthcare institutions include all of the following except: A. identifying poor-performing institutions B. improving patient care experience C. improving population health D. reducing healthcare costs

A. identifying poor-performing institutions

The use of which of the following medications contributes to the development of acne vulgaris? A. lithium B. propranolol C. sertraline D. clonidine

A. lithium

17. The psoas sign can be best described as abdominal pain elicited by: A. passive extension of the hip.B. passive flexion and internal rotation of the hip.C. deep palpation.D. asking the patient to cough.

A. passive extension of the hip

All of the following are components of medical decision making according to CPT except: A. patient history taking B. diagnosing C. deciding a course of treatment D. performing treatments

A. patient history taking

28. Your next best action in caring for Ms. Lane in the previous question is to: A. refer to the acute care hospital for admission.B. attempt office hydration after administration of an analgesic agent.C. initiate therapy with ranitidine (Zantac®) and an antacid.D. obtain serum electrolyte levels.

A. refer to the acute care hospital for admission. for the anal fissure?

66. Choose the therapy for: a 69-year-old man with heart failure, prior myocardial infarction, and type 2 diabetes? A. respiratory fluoroquinolone B. amoxicillin with a beta-lactamase inhibitor C. cephalosporin D. beta-lactam plus macrolide Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

A. respiratory fluoroquinolone

105. Murphy's sign can be best described as abdominal pain elicited by: A. right upper quadrant abdominal palpation. B. asking the patient to stand on tiptoes and then letting body weight fall quickly onto the heels. C. asking the patient to cough. D. percussion.

A. right upper quadrant abdominal palpation.

Which of the following represents the most effective method of cancer screening? A. skin examination B. stool for occult blood C. pelvic examination D. chest radiography

A. skin examination

You see a 34-year-old man with atopic dermatitis localized primarily on the arms who complains of severe itching. The condition becomes worse at night and interferes with his sleep. You recommend: A. taking a bedtime dose of antihistamine B. taking a bedtime dose of acetaminophen C. taking a hot shower prior to bedtime D. applying a warm compress to the affected areas 30 minutes prior to bedtime

A. taking a bedtime dose of antihistamine

115. The clinical indication for the use of lubiprostone (Amitiza®) is for: A. the treatment of constipation that is not amenable to standard therapies. B. intervention in intractable diarrhea. C. control of intestinal inflammation. D. the relief of intestinal spasms.

A. the treatment of constipation that is not amenable to standard therapies.

First-line treatment of impetigo with less than 5 lesions of 1-2 centimeters in diameter on the legs in a 9-year-old girl is: A. topical mupirocin. B. topical neomycin. C. oral cefixime. D. oral doxycycline

A. topical mupirocin.

The "quad screen" is used to help detect increased risk for which of the following conditions in the fetus? A. trisomy 21 and open neural tube defects B. cystic fibrosis and Angelman syndrome C. Tay-Sachs disease and trisomy 18 D. sickle cell anemia and beta-thalassemia major

A. trisomy 21 and open neural tube defects

154. Which of the following imaging studies potentially exposes the patient being evaluated for abdominal pain to the lowest ionizing radiation burden? A. ultrasound B. barium enema C. CT scan D. abdominal flat plate

A. ultrasound

73. Which of the following is not an "alarm" finding in the person with GERD symptoms? A. weight gain B. dysphagiaC. odynophagiaD. iron-deficiency anemia

A. weight gain

When prescribing pulse dosing with itraconazole for the treatment of fingernail fungus, the clinician realizes that: A. a transient increase in hepatic enzymes is commonly seen with its use. B. drug-induced leukopenia is a common problem. C. the patient needs to be warned about excessive bleeding because of the drug's antiplatelet effect. D. its use is contraindicated in the presence of iron-deficiency anemia

A. a transient increase in hepatic enzymes is commonly seen with its use

114. Patients with celiac disease present with similar signs and symptoms of all of the following conditions except: A. acute appendicitis. B. small bowel bacterial overgrowth. C. cow's milk intolerance. D. tropical sprue.

A. acute appendicitis.

A 23-year-old woman is breastfeeding her healthy newborn. She wishes to start using hormonal contraception. Which of the following represents the best regimen? A. combined oral contraception initiated at 2 weeks B. progesterone-only oral contraception initiated at 3 weeks C. medroxyprogesterone acetate (Depo-Provera) given day 1 postpartum D. use of all forms of hormonal contraception is discouraged during lactation

A 44 year old man who admits to drinking "a few beers now and then" presents for examination. After obtaining a health history and performing a physical examination, you suspect he is a heavy alcohol user. Your next best action is to: A. obtain liver enzymes. B. administer the CAGE questionnaire C. confront the patient with your observations. D. advise him about eh hazards of excessive alcohol use. (Ch. 14 Fitzgerald)

A 47 year old woman with lupus erythematosus is diagnosed with acute glomerulonephritis. Treatment options include all of the following except: A. systemic corticosteroids B. systemic antimicrobials C. immune suppressors D. plasmapheresis (Ch. 12 Fitzgerald)

A 48 year old woman with newly diagnosed hypothyroidism asks about a natural thyroid medication she read about online and provides the drug's name, dessicated thyroid. As you counsel her about this medication, you consider all of the following except: This product contains a fixed dose of T3 and T4 The medication is a plant based product. Its pharmacokinetics differ significantly when compared to levothyroxine. The majority of the study on treatment for hypothyroidism has been done using levothyroxine.

A 5-year-old girl presents with ABRS. She has a penicillin allergy but is otherwise well and is going to be treated with an antimicrobial. You prescribe: A. no medication; continue observation. B. cefdinir. C. levofloxacin. D. amoxicillin.

A 63 year old man presents with abdominal pain, pain during urination, and red urine. Imaging reveals a renal stone in the ureter. An appropriate treatment option would be: A. percutaneous nephrolithotomy B. shock wave lithotripsy C. insertion of a nephrostomy tube D. insertion of a catheter (Ch. 12 Fitzgerald)

A 78 yo woman with HTN, a 100 pack/yr smoking history, PVD, and reduced renal function GFR=47. TG=280, HDL=48, LDL=135. Which represents the most appropriate intervention for her lipid disorder? A. Due to her age and comorbidity, no further intervention is required. B. Moderate intensity statin C. A resin D. Ezetimibe will likely be sufficient

A healthy 3 yo is able to: A. name five colors B. alternate feet when climbing stairs C. speak in 2 word phrases D. tie shoelaces

A patient with a lumbosacral strain will typically report: A. numbess in the extremities B. stiffness, spasm, and reduced ROM C. "electric" sensation running down one or both legs D. pain at its worst when in sitting position (Ch. 9 Fitzgerald)

A positive ANA test is a sensitive marker for the presence of: A. hyperparathyroidism B. systemic lupus erytematosus (SLE). C. Kawasaki disease, D. leukocytosis. (Ch. 9 Fitzgerald)

A positive Homans sign is present in approximately what percentage of patients with DVT? A. 25% B. 33% C. 50% D. 75%

A risk factor for sacoidosis is: A. male gender B. African American race C. age older than 60 D. type II diabetes mellitus (Ch. 9 Fitzgerald)

A significant adverse effect of biologic therapy for treating RA is: A. myopathy. B. infections C. renal impairment. D. elevated liver enzymes. (Ch. 9 Fitzgerald)

All of the following are risks for statin-induced myositis except: A. advanced age. B. use of a low-intensity statin therapy with a resin. C. low body weight. D. high-intensity statin therapy.

An Asian couple comes in with their 4-week-old infant, who has blue-black macules scattered over the buttocks. These most likely represent: A. benign mottling. B. mongolian spots. C. ecchymosis. D. hemangioma.

An adverse effect associated with the use of glucosamine is: A. elevated ALT and AST. B. bronchospasm C. increased bleeding risk. D. QT prolongation (Ch. 9 Fitzgerald)

An alternative to methadone that can be used to curb opioid withdrawal symptoms is the use of: A. gabapentin B. buprenorphine plus naloxone. C. methylnaltrexone. D. topiramate. (Ch. 14 Fitzgerald)

Consideration should be given to setting A1C goal in a 22 yo man with a 8 year hx of T1DM who has no comorbid conditions equal to or less than: 5.5 6 6.5 7

Diagnostic criteria for generalized anxiety disorder include all of the following except: A. difficulty concentrating. B. consistent early morning wakening C. apprehension D. irritability. (Ch. 14 Fitzgerald)

For patients with documented coronary heart disease, the American Heart Association advises intake of approximately ____ of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day, preferably from oily fish. A. 500 mg B. 1 g C. 2 g D. 4 g

Generally, testing for T2DM in asymptomatic undiagnosed individuals older than 45 yo should be conducted every: A. year B. 3 years C. 5 years D. 10 years

HA1C should be tested: A. at least annually in all patients B. at least two times a year in patients who are meeting treatment goals and who have stable glycemic control C. monthly in patients whose therapy has changed or who are not meeting glycemic goals D. only via standard lab testing because of inaccuracies with POS testing

Hepatitis B vaccine should not be given to a child with a history of anaphylactic reaction to: A. egg. B. baker's yeast. C. neomycin. D. streptomycin.

High doses or prolonged use of kava kava has been associated with cases of: A. renal impairment. B. hepatotoxicity C. iron-deficiency anemia D. hyperthyroidism (Ch. 14 Fitzgerald)

In caring for a child with an acute asthma flare, the NP considers that, according to the National Asthma Education and Prevention Program, Expert Panel Report 3 guidelines, antibiotic use is recommended: A. routinely. B. with evidence of concomitant bacterial infection. C. when asthma flares are frequent. D. with sputum production.

In general, pharmacological intervention for patients with depression should: A. be given for about 4 months average. B. continue for a minimum of 6 months after remission is achieved. C. be continued indefinitely with a first episode of depression D. be titrated to a lower dose after symptom relief is achieved. (Ch. 14 Fitzgerald)

In healthy children, the second and third doses of the HBV vaccine should be separated by at least how much time? A. 4 weeks B. 8 weeks C. 6 months D. 1 year D. 1 year

In men with reactive arthritis and associated urethritis, a common finding is: A. ANA positive B. HLA-B27 positive C. RF positive D. ACPA positive (Ch. 9 Fitzgerald)

In providing care for a patient with superficial thrombophlebitis, the NP considers that: A. it is a benign, self-limiting disease. B. the linear pattern of induration can help differentiate the process from cellulitis or other inflammatory processes. C. a chest radiograph should be obtained. D. limited activity enhances recovery.

In teaching a patient with T2DM about using rapid acting insulin to help with the management of post-prandial hyperglycemia, the NP advises that the usual dose is _____unit per grams of carbohydrates. A. 1 B. 2 C. 3 D. 4

In the treatment of asthma, leukotriene modifiers should be used as: A. long-acting bronchodilators. B. an inflammatory inhibitor. C. a rescue drug. D. intervention in acute inflammation.

Infants who have been infected perinatally with HBV have an estimated ___% lifetime chance of developing hepatocellular carcinoma or cirrhosis. A. 10 B. 25 C. 50 D. 75

Medications known to increase the risk of renal stones include all of the following except: A. hydrochlorothiazide B. moxifloxiacin C. topiramate D. indinair (Ch. 12 Fitzgerald)

Mrs. Sanchez is a 42 year old mother of three who report pain and stiffness in multiple joints that have hasted for more than 6 months. She is diagnosed with rheumatoid arthritis. She has no other clinical conditions of significance. You recommend which of the following treatments for first-line therapy? A. topical analgesics and oral NSAIDs B. methotrexate plus oral NSAIDs C. acetaminophen plus leflunomide D. anakinra and systemic corticosteroids. (Ch. 9 Fitzgerald)

Physical examination findings in patients with bulimia nervosa often include: A. body mass index (BMI) less than 75% of anticipated B. dental surface erosion C. tachycardia D. hair that is easily plucked. (Ch. 14 Fitzgerald)

The IDF diagnostic criteria for metabolic syndrome includes: A. an obligatory finding of persistent hyperglycemia B. notation of ethnic-specific waist circumference measurement C. Documentation of microbaluminuria D. Family history of T2DM

The hepatitis A vaccine should be administered in childhood per the following schedule: A. two doses 3 months apart. B. two doses 6 months apart. C. two doses 1 year apart. D. two doses are not recommended because of efficacy of a single dose.

The hormone cortisol plays a role in all of the following processes except: A. maintaining glucose control. B. maintenance of thyroid function. C. suppressing the immune response. D. helping the body respond to stress.

The maximum recommended dose of citalopram for patients older than 60 years of age is: A. 10mg/day B. 20mg/day C. 30mg/day D. 40mg/day (Ch. 14 Fitzgerald)

The most effective strategy for preventing renal stones is: A. daily exercise B. adequate hydration C. limiting coffee consumption D. smoking cessation (Ch. 12 Fitzgerald)

The murmur of atrial septal defect is usually: A. found in children with symptoms of cardiac disease. B. first found on a 2- to 6-month well-baby examination. C. found with mitral valve prolapse. D. presystolic in timing.

The notation of alkaline urine in a patient with a UTI may point to infection caused by: A. Klebsiella apecies B. P. mirabilis C. E. coli D. S. saprophyticus (Ch. 12 Fitzgerald)

The onset of symptoms of food poisoning caused by Staphylococcus species is typically how many hours after the ingestion of the offending substance? A. 0.5 to 1 B. 1 to 4 C. 4 to 8 D. 8 to 12

The preferred screening test for osteoporosis is: A. quantitative ultrasound measurement B. dual-energy x-ray absorptiometry. C. qualitative CT. D. wrist, spine, and hip radiographs. (Ch. 9 Fitzgerald)

The use of exenatide has been associated with the development of: A. leukopenia B. pancreatitis C. lymphoma D. vitiligo

Treatment for anorexia nervosa usually includes: A. referral for parenteral nutrition evaluation. B. antidepressant therapy. C. use of psychostimulants. D. psychoanalysis. (Ch. 14 Fitzgerald)

What advice should you give to the parents of a toddler with gastroenteritis? A. Give the child sips of room temperature cola. B. Give the child sips of an oral rehydration solution. C. Give the child sips of a sports drink such as Gatorade. D. Try sips of apple juice mixed 1;1 with tap water.

What is the average LDL reduction achieved with a change in diet as a single lifestyle modification? A. less than 5% B. 5% to 10% C. 11% to 15% D. 16% to 20% or more

What is the international normalized ratio range recommended during warfarin therapy as part of the management of a patient with DVT? A. 1.5 to 2 B. 2 to 3 C. 2.5 to 3.5 D. 3 to 4

When evaluating a child who has aseptic or viral meningitis, the NP expects to find CSF results of: A. low protein. B. predominance of lymphocytes. C. glucose at about 30% of serum levels. D. low opening pressure.

When initiating SSRI therapy for a patient with panic disorder, the NP should consider all of the following except: A. start with a low dose and slowly escalate doses as necessary. B. preferable to use agents that are more energizing than less energizing. C. select agents with a low rate of insomnia and akathisia D. SSRI therapy can precipitate panic attacks with early use. (Ch. 14 Fitzgerald)

When providing car for a patient taking a statin initial evaluation when starting the med includes checking: A. K B. alanine aminotransferase C. bilirugin D. alkaline phosphatase

Which form of urinary incontinence is most common in elderly persons? A. stress B. urge C. iatogenic D. overflow (Ch. 12 Fitzgerald)

Which of the following can be used to differentiate pertussis from acute bronchitis or asthma exacerbation? A. presence of fever B. PCR assay C. presence of productive cough D. evidence of consolidation on chest x-ray

Which of the following drugs is likely to be the most dangerous when taken in overdose? A. a 4 week supply of fluoxetine B. a 2 week supply of nortriptyline C. a 3 week supply of venlafaxine D. a 3 day supply of diazepam (Ch. 14 Fitzgerald)

Double sickening is defined as: A. nasal discharge progressing form clear to purulent to clear without antibiotic use B. acute worsening of respiratory symptoms C. new fever occurring 6 to 7 days after signs of URI D. persistent cough

B, C

Which groups with no history of varicella infection or previous immunization should be targeted for vaccination? A. those born before 1980 B. > 8 yo with HIV and CD4 > 200 C. adults and children with history of anaphylactic reaction to neomycin D. day care workers

B, D

Approximately ___% of all clinically recognized pregnancies end in spontaneous abortion. A. 10 B. 20 C. 30 D. 40

B. 20

A 40-year-old woman with pyelonephritis is taking 2 medications: ciprofloxacin and ferrous sulfate (for IDA). She asks about taking both medications. You advise that: A. She should take the medications with a large glass of water B. An inactive drug compound is potentially formed if the 2 medications are taken together C. She can take the medications together to enhance adherence to therapy D. The ferrous sulfate potentially slows GI motility and results in enhanced ciprofloxacin absorption

B. An inactive drug compound is potentially formed if the 2 medications are taken together

You examine a 57-year-od woman with RA who is on DMARDs but continues to have poor disease control and find the following results on hemogram: Hgb=10.5g (12-14 g) Hct=33% (36-42%) RBC=3.1 million mm3 (3.2-4.3 million) MCV=88 fL (80-96 fL) MCHC=32.8 g/dL (32-36 g/dL) RDW= 12.2% (</= 15%) Reticulocytes: 0.8% The laboratory findings are most consistent with: A. Pernicious anemia B. Anemia of chronic disease C. Beta-thalassemia minor D. Folate-deficiency anemia

B. Anemia of chronic disease Normocytic (MCV 80-96): - Acute blood loss - Anemia of chronic disease

One month into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a: A. Schilling test B. Hgb measurement C. Reticulocyte count D. Serum cobalamin

B. Hgb measurement The hematological response is generally rapid after therapy is begun.

131. Is the following statement most consistent with IBD, with IBS, or with both conditions? The condition is often referred to as spastic colon by the general population. A. IBD B. IBS C. Both IBD and IBS

B. IBS

A. Unexplained vaginal bleeding

Absolute contraindications to postmenopausal HT include: A. Unexplained vaginal bleeding B. Seizure disorder C. Dyslipidemia D. Migraine headache

First-degree burn

Affected skin blanches with ease

C. 30 to 50 days

An 18-year-old woman presents with a chief complaint of a 3 day history of "sore throat and swollen glands." Her physical examination includes exudative pharyngitis, minimally tender anterior and posterior cervical lymphadenopathy, and maculopapular rash. She is diagnosed with infectious mononucleosis and was likely infected with the causative organism how many days ago? A. 5 to 10 B. 20 to 30 C. 30 to 50 D. More than 100

B. Action on the histamine-1 (H1) receptor sites

Antihistamines work primarily through: A. Vasoconstriction B. Action on the histamine-1 (H1) receptor sites C. Inflammatory mediation D. Peripheral vasodilation

flat discoloration greater than 1 cm in diameter

patch

netlike cluster

reticular

loss of epidermis and dermis

ulcer

A. Social Security

3. Which of the following is most commonly reported as the largest single source of income for elderly people? A. Social Security B. public/private pension earnings C asset income D. family financial support

C. increased GI surface area

30. Age-related changes in the gastrointestinal system include all of the following except: A. decreased gastric acid production B. decreased GI motility C. increased GI surface area D. decreased gastric emptying

D. avoiding antacid therapy when symptoms flare.

32. To avoid rebound gastric hyperacidity following discontinuation of long-term PPI use, all of the following methods can be used except: A. gradually tapering the PPI dose B. switch to every-other-day dosing of PPI C. switch to a low-dose H2RA therapy D. avoiding antacid therapy when symptoms flare.

38. (yes/no) Confusion is associated with the use of anticholinergic agents in older adults

A. detrusor overactivity

71. Factors that contribute to urge incontinence include: A. detrusor overactivity B. pelvic floor weakness C. urethral stricture D. UTI

C. periurethral bulking agent injection

74. Intervention for patients with stress incontinence includes: A. establishing a voiding schedule B. gentle bladder-stretching exercises C. periurethral bulking agent injection D. restricting fluid intake.

B. urge

75. Which form of urinary incontinence is most common in older adults? A. stress B. urge C. iatrogenic D. overflow

delirium

92. Is acute onset of change in mental status most likely associated?

An acceptable level of total cholesterol (mg/dL) in children and teens is: A. <170 mg/dL or 9.4 mmol/L. B. <130 mg/dL or 7.2 mmol/L. C. 110-130 mg/dL or 6.2 mmol/L-7.2 mmol/L. D. 130-199 mg/dL or 7.2 mmol/L-11 mmol/L.

An example of an appropriate question to pose to a person with obesity who is in the pre-contemplation change stage is: How do you feel about your weight? What are barriers you see to losing weight? What is your personal goal for weight loss? How do you envision my helping you meet your weight loss goal?

Characteristics of M. catarrhalis include: A. high rate of beta-lactamase production. B. antimicrobial resistance because of altered protein binding sites. C. difficult to eradicate even with antimicrobial therapy. D. gram-positive organism.

Clinical presentation of T1DM usually includes all of the following except: A. report of recent unintended weight gain B. ketosis C. thirst D. polyphagia

Clinical presentation of lower extremity atherosclerotic arterial disease most likely includes: A. pain and paresthesia B. pallor and pulselessness C. poikilothermy D. paralysis and loss of limb strength

Concomitant use of an SSRI with which of the following herbal products can potentially lead to serotonin syndrome? A. St. John's wort B. kava kava C. gingko biloba D. valerian root (Ch. 14 Fitzgerald)

First-line therapy for prepatellar bursitis should include: A. bursal aspiration B. intrabursal corticosteroid injection C. acetaminophen D. knee splinting (Ch. 9 Fitzgerald)

Hemorrhagic cystitis is characterized by: A. irritative voiding symptoms B. persistent microscopic hematuria C. the presence of hypertension D. elevated creatinine and BUN levels (Ch. 12 Fitzgerald)

How is the varicella virus most commonly transmitted? A. droplet transmission B. contact with inanimate reservoirs C. contact transmission D. waterborne transmission

In children and the elderly, which of the following conditions can contribute to bladder instability and increase the risk of a UTI? A. constipation B. upper respiratory tract infection C. chronic diarrhea D. efficient bladder emptying (Ch. 12 Fitzgerald)

In counseling a postmenopausal woman, you advise her that systemic estrogen therapy users can possible experience: A. an increase in breast cancer rates with long-term use. B. reduction in high-density lipoprotein cholesterol. C. a 10% increase in bone mass. D. no change in the occurrence of osteoporosis. (Ch. 9 Fitzgerald)

More common etiologies of PAD include: A. arterial embolism and underlying atrial fibrillation B. chronic venous insufficiency C. extension of venous thrombosis D. vessel trauma

Routine adolescent vaccination against HBV was recommended in what year? A. 1996 B. 1991 C. 1982 D. 1978

Sources of lead that can contribute to plumbism include select traditional remedies such as azarcon and greta. A. true B. false

Taking a high dose of aspirin or ibuprofen causes: A. an increase in the drug's half-life B. enhanced renal excretion of the drug C. a change in the drug's mechanism of action D. a reduction of antiprostaglandin effect. (Ch. 9 Fitzgerald)

The 5-HT2 receptor site is associated with the following activity when stimulated A. agitation, anxiety, panic B. antimigraine effect C. antidepressant D. cerebral spinal fluid production E. nausea, diarrhea (Ch. 14 Fitzgerald)

Treatment of superficial venous thrombophlebitis in a low-risk, stable patient includes use of: A. compression stockings. B. acetaminophen. C. warfarin. D. heparin.

Typically, the earliest sign of venous insufficiency is: A. edema B. altered pigmentation C. skin atrophy D. shiny skin

Untreated Cushing's syndrome can lead to all of the following except: A. rheumatoid arthritis. B. hypertension. C. type 2 diabetes. D. osteoporosis.

Use of laxatives and diuretics by persons with bulimia nervosa will most commonly result in: A. hypokalemia B. hypercalcemia C. proteinuria D. hypernatremia. (Ch. 14 Fitzgerald)

Which is most appropriate in examination of a healthy 5 yo? A. being able to name a best friend B. giving gender correctly C. naming an intended career D. hopping on one foot

Which of the following daily doses has the lowest lipid-lowering effect? A. simvastatin 10 mg B. rosuvastatin 5 mg C. atorvastatin 10 mg D. pravastatin 40 mg

Which of the following is a first-line therapy option for the treatment of ABRS in an otherwise well child? A. amoxicillin-clavulanate. B. clindamycin with cefixime. C. doxycycline. D. levofloxacin.

Which of the following is not seen during body temperature increase found in fever? A. lower rate of viral replication B. toxic effect on select bacteria C. negative effect on S. pneumoniae growth D. increased rate of atypical pneumonia pathogen replication

Which of the following is the least helpful test for the assessment of thyroid disease? Total T4 TSH Free T4 Antithyroid antibodies

Which of the following is the most appropriate antimicrobial for treatment of CAP in a 2 year old who is clinically stable and able to be treated in the outpatient setting? A. amoxicillin. B. doxycycline C. TMP-SMX D. levofloxacin

Which of the following is the most compelling reason to use RBUS instead of VCUG? A. This is a noninvasive test. B. Results are available more rapidly. C. The test is less technically demanding. D. RBUS is less expensive.

Which of the following statements concerning panic disorder is false. A. Panic disorder rarely occurs with depression. B. Up to 4% of the general population suffers from panic disorder C. New onset panic disorder rarely occurs after 45 years of age. D. Family history of panic disorder is a risk factor for the condition (Ch. 14 Fitzgerald)

Which of the following statements regarding vitamin D is false? A. diminishes secretion of insulin. B. inhibits abnormal cellular growth C. encourages the absorption and metabolism of calcium and phosphorus. D. reduces inflammation. (Ch. 9 Fitzgerald)

You see an obese 25 yo man with acanthosis nigricans and consider ordering: A. FBS B. LFT C. RPR D. ESR

M. Pneumoniae

A 17-year-old man with a bothersome dry cough, lymphadenopathy, and tonsillar enlargement

C. Mucopurulent vaginal discharge

A 22-year-old woman complains of pelvic pain. Physical examination reveals cervical motion tenderness and uterine tenderness. Which of the following would further support a diagnosis of PID? A. Temperature less than 100 degrees F (37.8 degrees C) B. Absence of white blood cells in vaginal fluid C. Mucopurulent vaginal discharge D. Laboratory documentation of cervical infection with E. coli

D. Vaginal diaphragm

A 38-year-old nulliparous woman who smokes two and a half packs a day is in an "on-and-off" relationship. The woman presents seeking contraception. Which of the following represents the most appropriate method? A. Contraceptive ring (NuvaRing) B. COC C. Contraceptive patch (Ortho Evra) D. Vaginal diaphragm

A. Tubal thickening with or without free pelvic fluid

A transvaginal ultrasound in the woman with PID will likely show: A. Tubal thickening with or without free pelvic fluid B. Cervical thickening C. Endometrial thinning D. Inflammation of the ovaries

You examine a 10 yo boy with suspected strep pharyngitis. his mother asks if he can get a "shot of penicillin". Which of the following statements is true regarding the use of intramuscular penicillin? A. Injectable benzathine PCN, oral amoxicillin, and cephalexin are each strongly recommended for as treatment of Strep pyogenes pharyngitis. B. Injectable benzathing PCN would be indicated for treatment of GAS if poor adherence to recommended therapy or inability to take full course of oral antibiotics is anticipated. C. The risk of severe allergic reaction with IM products is similar to that of oral preparations. D. Injectable penicillin has a superior spectrum of antimicrobial coverage compared with the oral form of the drug

A, B

The most common human papillomavirus types associated with cutaneous, nongenital warts include: A. 1, 2, and 4. B. 6 and 11. C. 16 and 18. D. 32 and 36.

A. 1, 2, and 4

You see a kindergartner with impetigo and advise that she can return ________ hours after initiating effective antimicrobial therapy. A. 24 B. 48 C. 72 D. 96

A. 24

62. Which of the following is most likely to be reported in a patient on long-term use of a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin)? A. AST, 22 U/L; ALT, 28 U/L B. AST, 320 U/L; ALT, 190 U/L C. AST, 32 U/L; ALT, 120 U/L D. AST, 440 U/L; ALT, 670 U/L

A. AST, 22 U/L; ALT, 28 U/L

The PCNs are ranked as FDA pregnancy risk category: A. B B. C C. D D. X

A. B

Elevated inhibin-A is noted when a pregnant woman is at increased risk of having an infant with: A. Down syndrome B. Edward syndrome C. open neural tube defect D. hemolytic anemia

A. Down syndrome Inhibin-A is a hormone produced by the placenta; levels of hCG and inhibin-A are higher than normal when a woman has an increased risk of carrying a fetus with Down syndrome.

25. A serological marker for acute hepatitis A virus (HAV) infection is: A. HAV IgM.B. HAV viral RNA.C. TNF-a.D. IL-10.

A. HAV IgM.

136. Is the following statement most consistent with IBD, with IBS, or with both conditions? Potential complications include fistula formation and perineal disease. A. IBD B. IBS C. Both IBD and IBS

A. IBD

64. Risk factors for pancreatic cancer include all of the following except: A. hypertension.B. history of chronic pancreatitis.C. tobacco use.D. diabetes mellitus.

A. hypertension.

Which of the following plays an essential role in type 1 hypersensitivity? A. immunoglobulin E B. immunoglobulin A C. immunoglobulin G D. immunoglobulin F

A. immunoglobulin E

Treatment options in postherpetic neuralgia include all of the following except: A. injectable methylprednisolone B. oral pregabalin C. oral nortriptyline D. topical lidocaine

A. injectable methylprednisolone

Characteristics of onychomycosis include all of the following except: A. it is readily diagnosed by clinical examination B. nail hypertrophy C. brittle nails D. fingernails respond more readily to therapy than toenails

A. it is readily diagnosed by clinical examination

Which of the following is not a potential adverse effect with long-term high-potency topical corticosteroid use? A. lichenification B. telangiectasia C. skin atrophy D. adrenal suppression

A. lichenification

122. What is the equivalent amount of background radiation as an abdominal MRI? A. no radiation B. 62 to 88 days C. 3 years

A. no radiation

142. What is the equivalent amount of background radiation as an abdominal ultrasound? A. no radiation B. 62 to 88 days C. 3 years

A. no radiation

19. A potential adverse effect from ICS use is: A. oral candidiasis. B. tachycardia. C. gastrointestinal upset. D. insomnia. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

A. oral candidiasis.

All of the following SSRIs are pregnancy risk category C except: A. paroxetine B. fluoxetine C. citalopram D. sertraline

A. paroxetine

19. Crohn's disease is associated with increased risk of malignancy involving the: A. small bowel.B. large intestine.C. duodenum.D. stomach.

A. small bowel

Signs that bed bugs are present in a home include all of the following except: A. small drops of fresh blood on floorboards. B. blood smears on bed sheets. C. presence of light brown exoskeletons. D. dark specks found along mattress seams.

A. small drops of fresh blood on floorboards.

Patients with rosacea are recommended to use daily: A. sunscreen B. astringents C. exfoliant D. antimicrobial cream

A. sunscreen

C. 50%

About ______ of patients with genital warts have spontaneous regression of the lesions? A. 10% B. 25% C. 50% D. 75%

C. Oral decongestant

According to the latest evidence, all of the following have demonstrated efficacy in relieving symptoms of ABRS except: A. Saline nasal spray B. Nasal corticosteroid C. Oral decongestant D. Acetaminophen

A. 1 to 2 years

Adults at high risk for POAG should undergo a complete eye exam every: A. 1 to 2 years B. 3 to 4 years C. 5 to 6 years D. 3 to 6 months

Third-degree burn

Affected area is white and leathery

A. Infection with a strain of streptococcal pharyngitis producing beta-lactamase

All of the following are common causes of penicillin treatment failure in streptococcal pharyngitis except: A. Infection with a strain of Streptococcus producing beta-lactamase B. Failure to initiate or complete the antimicrobial course C. Concomitant infection or carriage with an organism producing beta-lactamase D. Inadequate penicillin dosage

C. Distension of the tympanic membrane causing low-tone roaring tinnitus

Alterations in the ear involved in Meniere's disease include all of the following except: A. Change in endolymphatic pressure B. Breakage in the membrane separating the endolymph and perilymph fluids C. Distension of the tympanic membrane causing low-tone roaring tinnitus D. Sudden change in the vestibular nerve firing rate

B. Sexually active women 25 years of age and younger

An annual screening for C. trachomatis infection is recommended for: A. All sexually active women B. Sexually active women 25 years of age and younger C. Sexually active women who have had 2 or more partners in the past 12 months D. Sexually active men 25 years of age and younger

B. Human papillomavirus type 16

An independent risk factor of oral cancer is infection with: A. Human herpes virus type 1 B. Human papillomavirus type 16 C. Adenovirus type 16 D. Epstein-Barr virus

C. "Avoid using potassium-containing salt substitutes."

As you prescribe COC containing the progestin drospirenone (Loryna, Ocella, Vestura, Yasmin, Yaz), you offer the following advice: A. "Always take this pill on a full stomach." B. " You should not take acetaminophen when using this birth control pill." C. "Avoid using potassium-containing salt substitutes." D. "You will likely notice that premenstrual syndrome symptoms might become worse."

A 36 year old afebrile woman with no health problems presents with dysuria and frequency of urination. Her urinalysis findings include results positive for nitrites and leukocyte esterase. You evaluate these results and consider that she likely has: A. purulent vulvovaginitis B. a gram-negative UTI C. cystitis caused by Staphylococcus saprophyticus D. urethral syndrome (Ch. 12 Fitzgerald)

It is a developmental red flag if a child does not respond to his name by 9 months old. A. true B. false

The incubation period for measles caused by the rubeola virus is: A. 7-10 days. B. 10-14 days. C. 1-2 weeks. D. 2-3 weeks.

Which is most consistent with a normal developing 3 month old infant born at 40 weeks gestation? A. sitting briefly with support B. experimenting with sound C. rolling over D. having a social smile

Which is most consistent with a normal developing 5 month old born at 32 weeks gestations? A. sitting briefly with support B. experimenting with sound C. rolling over D. performing hand to hand transfers

Which of the following describes prescriptions for antidepressant medications written by primary care providers? A. dose too high B. dose too low C. excessive length of therapy D. appropriate length of therapy (Ch. 14 Fitzgerald)

Which of the following is most likely to be part of the clinical presentation of UTI in a 20-month-old child? A. urinary frequency and urgency B. fever C. suprapubic tenderness D. nausea and vomiting

Which of the following is not consistently performed as part of the workup for sepsis? A. CBC with WBC differential B. stool culture C. blood culture D. urine culture

Which of the following is often reported by anxious patients? A. constipation B. muscle tension C. hive-form skin lesions D. somnolence (Ch. 14 Fitzgerald)

Which of the following is the most prudent first-line treatment choice for an otherwise well toddler with acute otitis media (AOM) who requires antimicrobial therapy? A. ceftibuten B. amoxicillin C. cefuroxime D. azithromycin

Which of the following medications should be used with caution in a person with suspected or known sulfa allergy? A. metformin B. glyburide C. rosiglitazone D. NPH insulin

Which precursor of vitamin D is the form that is commonly measured in laboratory tests to determine vitamin D status? A. vitamin D2 B. 25 hydroxyvitamin D C. vitamin D3 D. 1, 25-dihydroxyvitamin D (Ch. 9 Fitzgerald)

With ezetimibe (Zetia) the NP expects to see: A. a marked increase in HDL cholesterol. B. a reduction in LDL cholesterol. C. a significant reduction in triglyceride levels. D. increased rhabdomyolysis when the drug is used in conjunction with HMG-CoA reductase inhibitor.

With fluoroquinolone use, length of antimicrobial therapy during uncomplicated pyelonephritis is typically: A. 5 days B. 1 week C. 2 weeks D. 3 weeks (Ch. 12 Fitzgerald)

With the use of weight loss medications, if the patient has not achieved a 5% weight loss by week _____ of treatment, the therapy should be discontinued. 6 12 18 24

You are examining an 18 year old man who is seeking a sports clearance physical examination. You note a mid-systolic murmur that gets lounder when he stands. This most likely represents: A. aortic stenosis. B. hypertrophic cardiomyopathy. C. a physiologic murmur. D. A still murmur. (Ch. 9 Fitzgerald)

You examine a 15-year-old boy who has infectious mononucleosis with marked tonsillar hypertrophy, exudative pharyngitis, significantly difficulty swallowing, and a patent airway. You consider prescribing a course of oral: A. amoxicillin. B. prednisone. C. ibuprofen. D. acyclovir.

You examine a 2-month-old infant with a port-wine lesion over her right cheek. You advise the parents that this lesion: A. needs to be surgically excised. B. grows proportionally with the child. C. becomes lighter over time. D. can become malignant.

You see a 67 year old woman who has been treated for pain due to OA of the hip for the past 6 months and who asks about hip replacement surgery. She complains of pain even at night when sleeping and avoids walking even moderate distances unless absolutely necessary. In counseling the patient, you mention all of the following except: A. arthoplasty can be considered when pain is not adequately controlled. B. arthoplasy is not needed if the patient can walk even short distances C. arthoplasty candidates must be able to tolerate a long surgical procedure. D. rehailitation following surgery is essential to achieve maximal function of the joint. (Ch. 9 Fitzgerald)

The benchmarks that indicate normal development in a healthy child born at term who is now 12 months old are: A. talking in 2 word sentencs B. pointing to a desired object C. reaching for a desired object D. walking backward

B, C

The most helpful tests to support the diagnosis of pertussis include which of the following? A. CXR B. nasopharyngeal culture C. blood culture D. PCR testing

B, D

When prescribing fluconazole, the NP considers that it is a cytochrome P-450: A. 3A4 inhibitor B. 2CP inhibitor C. 2D6 inducer D. 1A2 inducer

B. 2CP inhibitor

144. According to current American Cancer Society data, colorectal cancer is the number _______ cause of cancer death in men and women. A. 1 B. 3 C. 5 D. 7

B. 3

45. When using the Ranson criteria to evaluate the severity of acute pancreatitis, a severe clinical course is predicted with a score of: A. less than 2.B. 3 or greater.C. 6 or greater.D. 8 or greater.

B. 3 or greater.

Recommended length of antimicrobial therapy for a pregnant woman with asymptomatic bacteruria is: A. 1 to 3 days B. 3 to 7 days C. 8 to 10 days D. 2 weeks

B. 3 to 7 days

For a healthy woman with a desirable or healthy pre-pregnancy BMI, daily caloric requirements during pregnancy are typical baseline caloric needs plus _____ kcal. A. 100 B. 300 C. 60 D. 1000

B. 300

76. According to the ATS/IDSA guidelines, what is the usual length of antimicrobial therapy for the treatment of CAP for outpatients? A. fewer than 5 days B. 5 to 7 days C. 7 to 10 days D. 10 to 14 days Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

B. 5 to 7 days

Treatment options for actinic keratoses include topical: A. vitamin D derivative cream B. 5-fluorouracil C. acyclovir D. doxepin

B. 5-fluorouracil

For a healthy woman with a healthy or desirable pre-pregnancy BMI, daily caloric requirements during lactation are typical baseline caloric needs plus _____ kcal. A. 250 B. 500 C. 750 D. 1000

B. 500

For women who have previously given birth vaginally, first-stage and second-stage labor usually lasts a total of ___ hours. A. 3 to 5 B. 6 to 8 C. 9 to 10 D. 11 to 13

B. 6 to 8

111. What is the equivalent amount of background radiation as an abdominal x-ray? A. no radiation B. 62 to 88 days C. 3 years

B. 62 to 88 days

9. What is the equivalent amount of background radiation as an abdominal CT scan? A. no radiationB. 62 to 88 daysC. 3 years

B. 62 to 88 days

First-time mothers usually have an average of ___ hours of active first-stage labor. A. 6 to 8 B. 9 to 12 C. 13 to 15 D. 16 to 18

B. 9 to 12

You examine a patient with a red, tender thermal burn that has excellent capillary refill involving the entire surface of the anterior right thigh. The estimated involved body surface area (BSA) is approximately: A. 5% B. 9% C. 13% D. 18%

B. 9%

What is the impact of the Affordable Care Act (ACA) on Medicaid coverage? A. ACA increases Medicaid coverage for the elderly (over 65 years of age) B. ACA increases coverage for uninsured adults younger than 65 years of age C. There is no impact on Medicaid coverage as a result of the ACA D. More individuals will switch from Medicaid to Medicare coverage

B. ACA increases coverage for uninsured adults younger than 65 years of age

You examine a 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram: Hgb=15 g (12-14 g) Hct=45% (36-43%) RBC=4.2 million mm3 (4.2-5.4 million) MCV=108fL (80-96 fL) MCHC=33.2 g/dL (31-37 g/dL) These values are most consistent with: A. Pernicious anemia B. Alcohol abuse C. Thalassemia minor D. Fanconi disease

B. Alcohol abuse Macrocytic anemia (MCV > 96) - Pernicious anemia - B12 deficiency - Folate deficiency - Drug-induced (without anemia; only MCV will be elevated)

A drug that has not been shown to be harmful to the fetus in animal studies, but for which no human study is available, is assigned FDA risk category: A. A B. B C. C D. D

B. B

Bupropion is FDA pregnancy risk category: A. B B. C C. D D. X

B. C

Most SNRI are FDA pregnancy risk category: A. B B. C C. D D. X

B. C

Most tricyclic antidepressant are FDA pregnancy risk category: A. A or B B. C or D C. X D. Unrated as these are older medications

B. C or D

24. An 18-year-old man with a BMI = 40 kg/m2 presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. Physical examination reveals rebound tenderness, and laboratory analysis shows the presence of bandemia and a total WBC of 28,000/mm3. To support the diagnosis of acute appendicitis with suspected appendiceal rupture, you consider obtaining the following abdominal imaging study: A. magnetic resonance image (MRI).B. computed tomography (CT) scan.C. ultrasound.D. flat plate.

B. CT

49. In a 28-year-old man who presents with a 6-month history of involuntary weight loss, recurrent abdominal cramping, loose stools, and anterior and posterior anal fissure, which of the following diagnoses should be considered? A. ulcerative colitisB. Crohn's diseaseC. C. difficile colitisD. condyloma acuminata

B. Crohn's disease

11. Is the following statement most consistent with IBD, with IBS, or with both conditions? The patient population is predominately female. A. IBDB. IBSC. Both IBD and IBS

B. IBS

163. Laboratory evaluation during an IBD flare will reveal elevated levels of all of the following except: A. CRP. B. SeCr. C. ESR. D. WBC.

B. SeCr.

Match the clinical presentation of the following. Incomplete abortion A. Uterine contents include a nonviable pregnancy that is in the process of being expelled B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable C. The products of conception have been completely expelled D. US evaluation shows a viable pregnancy, although vaginal bleeding is present

B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable

Common physical exam findings in patients with pernicious anemia include? A. Hypoactive bowel sounds B. Stocking-glove neuropathy C. thin, spoon shaped nails D. Retinal hemorrhages

B. Stocking-glove neuropathy

When prescribing erythropoietin supplementation, the NP considers that: A. The adrenal glands are its endogenous source B. The addition of micronutrient supplementation needed for erythropoiesis is advisable C. Its use is as an adjunct in treating thrombocytopenia D. With its use, the RBC lifespan is prolonged

B. The addition of micronutrient supplementation needed for erythropoiesis is advisable

Which of the following statements concerning funding for Medicaid is accurate? A. Federal funding of Medicaid for each state is based primarily on the state population size B. The federal government matches at least 50% of state Medicaid spending C. States are not requires to provide funding for Medicaid as long as they meet guidelines to receive federal funding D. Federal funding typically accounts for less than 20% of all Medicaid funding

B. The federal government matches at least 50% of state Medicaid spending

Your priority in caring for Tom, the aforementioned patient, is to: A. administer a rapidly acting oral antihistamine B. administer parenteral epinephrine C. initiate vasopressor therapy D. administer a parenteral systemic corticosteroid

B. administer parenteral epinephrine

Preferred antimicrobials for the treatment of adultswith Lyme disease include all of the following except: A. a tetracycline B. an aminoglycoside C. a cephalosporin D. a penicillin

B. an aminoglycoside

Medicare Part A: A. allows beneficiaries to enroll in private plan as an alternative to the traditional fee-for-service plan B. covers inpatients and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, NP, outpatient, home health, and preventive services

B. covers inpatients and hospital services

In medical coding, the abbreviation CPT stands for: A. current pricing tier B. current procedural terminology C. clinical practice terminology D. compendium of procedures and therapy

B. current procedural terminology

When specific identifiers have been removed from protected health information so that it no longer can be used to identify an individual, the information is said to be: A. cleansed B. de-identified C. deprivatized D. HIPAA-certified

B. de-identified

When counseling a person who has a 2-mm verruca-form lesion on the hand, you advise that: A. bacteria are the most common cause of these lesions. B. lesions usually resolve without therapy in 12 to 24 months. C. there is a significant risk for future dermatologic malignancy. D. surgical excision is the treatment of choice

B. lesions usually resolve without therapy in 12 to 24 months

96. Therapy for hemorrhoids includes all of the following except: A. weight control. B. low-fat diet. C. topical corticosteroids. D. the use of a stool softener.

B. low-fat diet.

A common site for atopic dermatitis in an infant is: A. the diaper area. B. the face. C. the neck. D. the posterior trunk

B. the face.

20. To avoid the development of acute diverticulitis, treatment of diverticulosis can include: A. avoiding foods with seeds.B. the use of fiber supplements.C. ceasing cigarette smoking.D. limiting alcohol intake.

B. the use of fiber supplements.

Goiter

BOTH

atypical presentation in elderly

BOTH

Is hypokalemia associated with anorexia nervosa, bulimia nervosa, or both disorders (Ch. 14 Fitzgerald)

Both

A 44 year old woman presents with pyelonephritis. The report of her urinalysis is least likely to include: A. WBC casts B. positive nitrites C. 3+ protein D. rare RBCs (Ch. 12 Fitzgerald)

Acroparesthesia, frequently reported in patients with CTS, is best described as: A. constant pain radiating from the elbow. B. a transient inability to move the fingers C. waking up at night with numbness and burning pain in the fingers. D. muscle spasms that cause fist clenching. (Ch. 9 Fitzgerald)

Activities that commonly contribute to the development of rotator cuff tendonitis include all of the following except: A. swimming. B. throwing a football. C. bowling. D. Pitching a baseball. (Ch. 9 Fitzgerald)

Analgesic approaches used in the management of fibromyalgia include all of the following except: A. acetaminophen B. NSAIDs C. fentanyl patch. D. topical capsaicin. (Ch. 9 Fitzgerald)

As part of the evaluation of patients with OA, the NP anticipates finding: A. anemia of chronic disease. B. elevated CRP level. C. no disease-specific laboratory abnormalities. D. elevated antinuclear antibody (ANA) titer. (Ch. 9 Fitzgerald)

As you develop the initial treatment plan for a woman with panic disorder, you consider prescribing: A. carbamazepine (Tegretol) B. risperidone (Risperdal) C. citalopram (Celexa) D. bupropion (Wellbutrin) (Ch. 14 Fitzgerald)

At what point after childbirth can a combined oral contraceptive be started without other risk factors for venous thrombosis in a woman who is not breastfeeding? A. 1 day B. 1 week C. 3 weeks D. 6 weeks

Common clinical findings in a young child with bronchiolitis include all of the following except: A. pharyngitis. B. tachypnea. C. bradycardia. D. conjunctivitis.

Cyclooxygenase-2 (COX-2) contributes to all of the following except: A. inflammatory response B. pain transmission C. maintenance of gastric protective mucosal layer. D. renal arteriole constriction (Ch. 9 Fitzgerald)

DSM-5 criteria for bulimia nervosa include all of the following except: A. eating an excessively large amount of food within a discrete amount of time. B. a sense of lack of control during binge eating episode. C. binge eating and compensatory behavior occurring at least three times per week. D. self-worth heavily influenced by body shape and weight. (Ch. 14 Fitzgerald)

Depression often manifests with all of the following except: A. psychomotor retardation. B. irritability. C. palpitations. D. increased feelings of guilt (Ch. 14 Fitzgerald)

Eczema is thought to be caused by: A. overactive mucous glands. B. allergic reaction. C. degradation of mast cells. D. dry air.

Girls typically grow to their adult height by: A. menarche. B. 1 year before menarche. C. 1 year after onset of menstruation. D. by their sixteenth birthday.

Guidelines recommend considering initiating treatment with an erythropoiesis-stimulating agent (ESA) for patients with chronic renal failure and a hemoglobin (Hg) level: A. less than 8.5 mg/dL B. less than 9.0 mg/dL C. less than 10 mg/dL D. less than 11.5 mg/dL (Ch. 12 Fitzgerald)

How much daily calcium is recommended for women older than 50 years of age? A. 800 mg B. 1000 mg C. 1200 mg D. 1500 mg (Ch. 9 Fitzgerald)

In caring for a patient with DM, microalbuminuria measurement should be obtained: A. annually if urine protein is present B. periodically in relationship to glycemia control C. yearly D. with each office visit related to DM

In caring for a patient with OA of the knee you advise that: A. straight-leg raising should be avoided B. heat should be applied to painful joints after exercise. C. quadriceps-strengthening exercises should be performed. D. physical activity should be avoided (Ch. 9 Fitzgerald)

In children 2 months to 2 years old with UTI, antimicrobial therapy should be prescribed for: A. 3 to 5 days. B. 5 to 10 days. C. 7 to 14 days. D. 14 to 21 days.

In whom is serological documentation of immunity to rubella advised? A. school-aged children B. government employees C. pregnant women and women of childbearing age who could become pregnant D. healthcare workers

Infection with Corynebacterium diphtheriae usually causes: A. a diffuse rash. B. meningitis. C. pseudomembranous pharyngitis. D. a gastroenteritis-like illness.

Intervention for a child with a lead level of 5 to 44 mcg/dL usually includes all of the following except: A. removal from the lead source. B. iron supplementation. C. chelation therapy. D. encouraging a diet high in vitamin C.

Laboratory findings in Kawasaki disease include all of the following except: A. sterile pyuria. B. elevated liver enzyme levels. C. blood cultures positive for offending bacterial pathogen. D. elevated erythrocyte sedimentation rate.

One of the most prominent clinical features of bronchiolitis is: A. fever. B. vomiting. C. wheezing. D. conjunctival inflammation.

Secondary gout can be caused by all of the following conditions except: A. psoriasis B. hemolytic anemia C. bacterial cellulitis D. renal failure (Ch. 9 Fitzgerald)

To remove a drug from breast milk through "pump and dump," the nursing mother should refrain from taking the offending medication and the process must be continued for: A. two infant feeding cycles. B. approximately 8 hours. C. three to five half-lives of the drug. D. a period of time that is highly unpredictable.

Treatment of dysthymia involves: A. psychotherapy alone. B. antidepressants alone. C. psychotherapy plus antidepressants. D. electroconvulsive therapy (ECT) (Ch. 14 Fitzgerald)

When caring for a patient with DM, HTN, and persistent proteinuria, the NP prioritizes the choice of antiHTN and prescribes: A. furosemide B. methyldopa C. fosinopril D. nifedipnie

Which of the following dietary supplements is associated with increased risk for gout? A. vitamin A B. gingko biloba C. brewer's yeast D. glucosamine (Ch. 9 Fitzgerald)

Which of the following is absent in otitis media with effusion (OME)? A. fluid in the middle ear B. otalgia C. fever D. itch

Which of the following represents a therapeutic option for ABRS in an otherwise well 7-year-old child who has not had significant clinical improvement but is not worse after 72 hours of observation? A. continued observation B. oral levofloxacin C. oral clindamycin and cefixime D. injectable ceftriaxone

Which of the following signs indicates possible AOM diagnosis in a preverbal child? A. loss of appetite B. colic C. tugging on the ear D. fever

Match the stage of pregnancy with the appropriate term. Up to 2 weeks postconception A. Embryo B. Fetus C. Blastocyst D. Zygote

C. Blastocyst

102. Abdominal palpation that yields rebound tenderness is also known as a positive _______ sign. A. Markel's B. Murphy's C. Blumberg's D. Nikolsky's

C. Blumberg's

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption? A. Take with other medications B. Take on a full stomach C. Take on an empty stomach D. Do not take with vitamin C

C. Take on an empty stomach

169. Routine testing for the presence of HBsAb after immunization with the HBV vaccine is recommended for all of the following except: A. healthcare providers. B. immunocompromised patients. C. restaurant workers. D. dialysis patients.

C. restaurant workers.

3. A 44-year-old man has a long-standing history of moderate persistent asthma that is normally well controlled by fluticasone with salmeterol (Advair®) via metered-dose inhaler, one puff twice a day, and the use of albuterol 1 to 2 times a week as needed for wheezing. Three days ago, he developed a sore throat, clear nasal discharge, body aches, and a dry cough. In the past 24 hours, he has had intermittent wheezing that necessitated the use of albuterol, two puffs every 3 hours, which produced partial relief. Your next most appropriate action is to obtain a: A. chest radiograph. B. measurement of oxygen saturation (SaO2). C. spirometry measurement. D. sputum smear for white blood cells (WBCs). Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition.

C. spirometry measurement.

First-line therapy for angular cheilitis therapy includes the use of: A. metronidazole gel B. hydrocortisone cream C. topical nystatin D. oral ketoconazole

C. topical nystatin

D. Pseudomonas aeruginosa

Common causative organisms of acute suppurative conjunctivitis include all of the following except: A. Staphylococcus influenzae B. Haemophilus influenzae C. Streptococcus pneumoniae D. Pseudomonas aeruginosa

B. Candida albicans

Common causative organisms of peritonsilar abscess include all of the following except: A. Fusobacterium necrophorum B. Candida albicans C. Group C or G streptococcus D. Group A beta-hemolytic streptococcus (GABHS)

Risk factors for lateral epicondylitis include all of the following except: A. repetitive lifting. B. playing tennis C. hammering D. gout (Ch. 9 Fitzgerald)

Usual treatment option for a child with hepatitis A includes: A. interferon alpha. B. ribavirin. C. acyclovir. D. supportive care.

When advising parents about injectable influenza immunization, the clinician considers the following about the vaccine: A. The vaccine is contraindicated with a personal history of an anaphylactic reaction to eggs. B. Its use is limited to children older than 2 years. C. The vaccine contains live virus. D. Its use is recommended for members of households of high-risk patients.

You see a 46 year old woman diagnosed with vitamin D deficiency with a 25 (OH) D level of 18 ng/mL. Treatment should be initiated with which of the following vitamin D dosing regimens? A 400 IU twice daily B. 1000 IU twice daily C. 10,000 IU twice a week D. 50,000 IU weekly (Ch. 9 Fitzgerald)

Down syndrome is the clinical manifestation of trisomy ______. A. 13 B. 15 C. 18 D. 21

D. 21

Approximately _____% of fetuses are in vertex position by the 36th week of pregnancy. A. 30 B. 50 C. 75 D. 95

D. 95

A mother brings to the clinic her 3-year-old daughter,who presents with dry red patches on her face around the eyes. The mother has observed her daughter constantly rubbing the area, which has caused swelling around the eyes. Physical examination is consistent with atopic dermatitis. The NP considers that this is adiagnosis that: A. requires a skin culture to confirm contributing bacterial organisms. B. should be supported by a biopsy of the affected area. C. necessitates obtaining peripheral blood eosinophil level D. Is usually made by clinical assessment alone

D. Is usually made by clinical assessment alone

Erythropoietin is a glycoprotein that influences a stem cell to become a: A. lymphocyte B. PLT C. Neutrophil D. RBC

D. RBC

Match uterine size with stage of pregnancy. 8 weeks A. Size of a baseball B. Size of a softball or grapefruit C. Size of a large lemon D. Size of a tennis ball or orange E. Uterine fundus at umbilicus F. Uterine fundus halfway between symphysis pubis and umbilicus

D. Size of a tennis ball or orange Hegar sign, Goodell sign, and Chadwick sign often present by this time

16. Immune modulators are often used for intervention in: A. ulcerative colitis.B. irritable bowel syndrome.C. Crohn's disease.D. ulcerative colitis and Crohn's disease.

D. UC and Crohn's.

Subjective perception of altered equilibrium

Dizziness

A. 10%

During asymptomatic HSV-2 infections, genital shedding of virus occurs during approximately ___________ of days. A. 10% B. 25% C. 50% D. 100%

Most common perennial allergen

Dust mites

An abnormally elevated D-Dimer is highly sensitive and specific for VTE.

FALSE

T/F? Phentermine's mechanism of action in weight loss is as a product that reduces GI motility.

FALSE

amenorrhea or oligomenorrhea

HYPER

What is this? TSH=24, Free T4=3

Hypothyroid

A. Cephalexin

In a person with a well-documented history of systemic cutaneous reaction without airway impingement following penicillin use, the use of which of the following cephalosporins is most likely to result in an allergic response? A. Cephalexin B. Cefprozil C. Ceftriaxone D. Cefpodoxime

A. Prompt referral to an ophthalmologist

In caring for Mrs. Murphy, the most appropriate next action is: A. Prompt referral to an ophthalmologist B. To provide analgesia and repeat the evaluation when the patient is more comfortable C. To instill a corticosteroid ophthalmic solution D. To patch the eye and arrange for follow up in 24 hours

C. Warm compresses of the affected area

Initial treatment for a chalazion is: A. Topical fluoroquinolone B. Topical corticosteroid C. Warm compresses of the affected area D. Surgical excision

36. The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen? A. epigastriumB. left lower quadrantC. right lower quadrantD. suprapubic

LLQ

Most common indoor allergen

Mold spores

D. Retinal detachment

Mrs. Allen is a 67-year-old woman with type 2 diabetes who complains of seeing flashing lights and floaters, decreased visual acuity, and metamorphosis in her left eye. The most likely diagnosis is: A. Open-angle glaucoma B. Central retinal artery occlusion C. Anterior uveitis D. Retinal detachment

"Does this patient have a reactive TST?" 57. a 21-year-old man with no identifiable TB risk factors and a 10-mm induration Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

C. Cervicitis

Noncontraceptive benefits of COC use include a decrease in all of the following except: A. Iron-deficiency anemia B. Pelvic inflammatory disease (PID) C. Cervicitis D. Ovarian cancer

Rhythmic oscillations of the eyes

Nystagmus

B. Increased ear pain with tragus palpation

Physical examination findings in otitis externa include: A. Tympanic membrane immobility B. Increased ear pain with tragus palpation C. Tympanic membrane erythema D. Tympanic membrane bullae

Present in Meniere's Disease

Pneumatic otoscopy in the affected ear can elicit symptoms or cause nystagmus.

Most common seasonal allergen

Pollens

C. A reduction in the frequency and severity of vasomotor symptoms

Postmenopausal HT use can result in: A. A reduction in the rate of cardiovascular disease B. An increase in the rate of rheumatoid arthritis C. A reduction in the frequency and severity of vasomotor symptoms D. A disturbance in sleep patter

C. Hepatitis A

Recommended comprehensive STI testing includes testing for all of the following except: A. Hepatitis B B. Syphilis C. Hepatitis A D. HIV

B. At regularly scheduled dental visits

Screening for oral cancer is recommended: A. For high-risk patients only B. At regularly scheduled dental visits C. Every two years D. To be conducted by qualified healthcare providers only

What is this? TSH=8.9 (.4-4), Free T4=15 (10-27)

Subclinical hypothyroid

Second-degree burn

Surface is raw and moist

C. At the secondary stage

Syphilis is most contagious during which of the following? A. Before onset of signs and symptoms B. At the primary stage C. At the secondary stage D. At the tertiary stage

(T/F) Access to a firearm increases the risk for a completed suicide. (Ch. 14 Fitzgerald)

T/F in a normal pregnancy Blood volume increases by 40% to 50%, peaking at week 32

Not present in Meniere's disease

The Weber tuning test lateralizes to the affected ear.

C. 7 to 14 days

The incubation period for C. trachomatis is approximately: A. 24 hours B. 3 days C. 7 to 14 days D. 24 days

D. 3 weeks

The incubation period for M. Pneumoniae is usually: A. Less than 1 week B. 1 week C. 2 weeks D. 3 weeks

B. 3 to 5 days

The incubation period for S. Pyogenes is usually: A. 1 to 3 days B. 3 to 5 days C. 6 to 9 days D. 10 to 13 days

B. S. Pneumoniae

The most common causative bacterial pathogen in ABRS in a 40 year-old adult is: A. M. Pneumoniae B. S. Pneumoniae C. M. catarrhalis D. E. Coli

B. Hypertension

The most common clinical finding in patients with severe or refractory epistaxis is: A. Type 2 diabetes mellitus B. Hypertension C. Acute bacterial sinusitis D. Anemia

B. 1" x 3" x 5"

The size of a normal spleen is approximately: A. 1" x 1" x 3" B. 1" x 3" x 5" C. 2" x 4" x 6" D. 3" x 5" x 7"

B. Carditis and arthritis

The symptoms of rheumatic fever include: A. Severe, intermittent headaches B. Carditis and arthritis C. Hepatic dysfunction D. Generalized rash

B. One-fourth

The typical HT regimen contains ________ or less of the estrogen dose of COC. A. One-eighth B. One-fourth C. One-half D. Three-fourths

C. Polymyxin

Treatment options in suppurative conjunctivitis include all of the following ophthalmic preparations except: A. Polymyxin B plus trimethoprim B. Levofloxacin C. Polymyxin D. Azithromycin

B. No more than 2 years

With DMPA in depot injection (Depo-Provera), the recommended length of use is usually: A. Less than 1 year B. No more than 2 years C. As long as the woman desires this form of contraception D. As determined by her lipid response to the medication

22. Regarding the use of long-acting beta2-agonists (LABAs), which of the following is true? A. LABAs enhance the ant-iinflammatory action of corticosteroids. B. Use of LABAs is associated with a small increase in risk of asthma death. C. LABA use reduces the risk of asthma exacerbations. D. LABAs can be used as monotherapy to relieve bronchospasms in asthma. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

B. Use of LABAs is associated with a small increase in risk of asthma death.

Prior to day 31 post-LMP, the embryo is best described as: A. a single, undifferentiated cell B. a group of poorly differentiated cells C. a conglomerate of highly differentiated cells and primitive organs D. a small fetus with developed organs

B. a group of poorly differentiated cells

Potential consequences of failing an audit because of upcoding, that is, applying an artificially high level code to a visit, include all of the following except: A. repaying the money to the payer B. a malpractice lawsuit C. a dismissal as a reimbursable provider D. a mandated education

B. a malpractice lawsuit

during asymptomatic HSV-2 infection, genital shedding of the virus occurs during approximately ____ of days a. 10% b. 25% c. 50% d. 100%

a. 10%

a likely causative pathogens in a 25 y/o with acute epididymitis who has sex with men is: a. Escherichia coli b. mycoplasma spp. c. chlamydia trachomatis d. acinetobacter baumannii

a. Escherichia coli

during acute bacterial prostatitis, the digital rectal exam usually reveals a gland described as: a. boggy b. smooth c. irregular d. cystic

a. boggy

which of the following is representative of the presentation of secondary syphilis? a. generalized rash b. chancre c. pupillary alterations d. aortic regurgitation

a. generalized rash

in the personw ith HSV-2 infection, the virus can spread via contact through which of the following methods? more than one can apply a. genital secretions b. oral secretions c. intact skin

a. genital secretions b. oral secretions c. intact skin

the most common causative organisms in chronic bacterial prostatitis include: a. gram-negative rods b. gram-positive cocci c. gram-negative cocci d. gram-positive coccobacilli

a. gram-negative rods

first-line txment options for primary syphilis include: a. penicillin b. ciprofloxacin c. erythromycin d. ceftriaxone

a. penicillin

158. Tenesmus is defined as which of the following? A. rectal burning with defecation B. a sensation of incomplete bowel emptying that is distressing and sometimes painful C. weight loss that accompanies many bowel diseases D. appearance of frank blood in the stool

B. a sensation of incomplete bowel emptying that is distressing and sometimes painful

Which of the following is not a recommended option to make cosmetic improvements for phymatous rosacea?A. laser peel B. ablative laser surgery C. surgical shave technique D. mechanical dermabrasion

B. ablative laser surgery

124. A 43-year-old woman has a 12-hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is: A. hepatoma. B. acute cholecystitis. C. acute hepatitis. D. cholelithiasis.

B. acute cholecystitis.

75. The most common form of esophageal cancer in the United States is: A. squamous cell cancer. B. adenocarcinoma. C. basal cell carcinoma. D. melanoma.

B. adenocarcinoma.

61. Which of the following is least likely to be found in a patient with gastric ulcer? A. history of long-term naproxen use B. age younger than 50 years C. previous use of H2RA or antacids D. cigarette smoking

B. age younger than 50 years

70. Common symptoms of community-acquired pneumonia in otherwise well adults include all of the following except: A. cough. B. altered mental status. C. dyspnea. D. pleuritic chest pain. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

B. altered mental status.

Among the most commonly used medications by women in the first trimester of pregnancy are: A. antiepileptic drugs B. antibiotics C. antihypertensives D. opioids

B. antibiotics

130. You see a 62-year-old man diagnosed with esophageal columnar epithelial metaplasia. You realize he is at increased risk for: A. esophageal stricture. B. esophageal adenocarcinoma. C. gastroesophageal reflux. D. H. pylori colonization.

B. esophageal adenocarcinoma.

Treatment of postpartum psychosis typically includes all of the following except: A. hospitalization B. estrogen replacement therapy C. antipsychotic therapy D. ECT

B. estrogen replacement therapy HRT is an appropriate treatment for postpartum depression.

sxs in chronic bacterial prostatitis often include: a. fever b. GI upset c. low back pain d. penile discharge

c. low back pain

pt education about the use of sildenafil (viagra) includes the following: a. spontaneous erection occurs about 1 hr after taking the medication b. this med helps regain erectile function in nearly all men who use it c. with the use of the med, sexual stimulation also is needed to achieve an erection d. nitrates can be safely used concurrently

c. with the use of the med, sexual stimulation also is needed to achieve an erection

multiple lesions blending together

confluent or coalescent

which of the following is not a common risk factor for erectile dysfunction? a. diabetes mellitus b. hypertension c. cigarette smoking d. testosterone deficiency

d. testosterone deficiency

chronic liver disease spectrum

fibrosis (none, mild, mod, advanced) to cirrhosis inflammation

narrow linear crack into epidermis, exposing dermis

fissure

Indicate (yes or no) if eligible for Medicare: a 68 y.o undocumented resident

A Grade II ankle sprain is best described as: A. minor swelling and minimal joint instability. B. moderate joint instability without swelling or ecchymosis. C. moderate swelling, mild to moderate ecchymosis, and moderate joint instability. D. complete ankle instability, significant swelling and moderate to severe ecchymosis. (Ch. 9 Fitzgerald)

A child must consume _____ oz of fortified milk each day to receive the recommended 400IU daily of vitamin D. A. 8 B. 16 C. 32 D. 48 (Ch. 9 Fitzgerald)

A diagnosis of fibromyalgia requires detecting at least how many tender points? A. 4 B. 7 C. 11 D. 18 (Ch. 9 Fitzgerald)

A healthy child with no evidence of immunity is exposed to chickenpox at school. How soon after exposure will a dose of the varicella vaccine prevent or modify the disease in the child? A. only if given the same day B. only if given within 2 to 3 days C. if given within 3 to 5 days D. if given within 1 week

A healthy infant at age 9 to 11 months is expected to: A. roll from back to stomach B. imitate bye-bye C. play peek a boo D. hand toy on request

An 11-year-old well child presents with no documented primary tetanus immunization series. Which of the following represents the immunization needed? A. three doses of DTaP (diphtheria, tetanus, acellular pertussis) vaccine 2 months apart B. tetanus immune globulin now and two doses of tetanus-diphtheria (Td) 1 month apart C. one dose of Tdap (tetanus, diphtheria, acellular pertussis vaccine) followed by two doses of Td (tetanus, diphtheria) in 1 and 6 months D. Td (tetanus, diphtheria) as a single dose

An early indicator of hypoperfusion is: A. an elevation in total white blood cell count. B. dehydration. C. capillary refill of >2 seconds. D. nonresponsive child.

An example of a first-line therapeutic agent for the treatment of pyelonephritis is: A. amoxicillin with clavulanate B. trimethoprim-sulfamethoxazole C. ciprofloxacin D. nitrofurantoin (Ch. 12 Fitzgerald)

An important part of the treatment of Kawasaki disease includes the use of: A. antibiotics. B. antivirals. C. immune globulin. D. antifungals.

At which of the following ages in a young child's life is parental anticipatory guidance about toilet-training readiness most helpful? A. 12 months B. 15 months C. 18 months D. 24 months

Common signs of high-grade aortic stenosis in an individual during exercise include all of the following except: A. dyspnea. B. angina. C. seizure. D. syncope. (Ch. 9 Fitzgerald)

Common symptoms of renal stones include all of the following except: A. pink, red, or brown urine B. shart pain in the back or lower abdomen C. marked febrile response D. pain while urinating (Ch. 12 Fitzgerald)

Cushing's disease is the specific type of Cushing's syndrome that is caused by: A. long-term exposure to corticosteroids. B. a benign tumor of the adrenal gland. C. a benign pituitary tumor. D. an ectopic tumor that produces ACTH.

Differentiation between gout and pseudogout can involve all of the following diagnostic approaches except: A. analysis of mineral in the blood B. analysis of joint fluid. C. x-ray of the affected joint D. measuring thyroid function. (Ch. 9 Fitzgerald)

Expected outcomes with the use of varicella vaccine include a reduction in the rate of all of the following except: A. shingles. B. Reye syndrome. C. aspirin sensitivity. D. invasive varicella.

Five years or more after T2DM diagnosis, which of the following medication is less likely to be effective in controlling glucose? A. metformin B. pioglitazone C. glipizide D. insulin

For adults 70 years and younger, what is the recommended daily intake of vitamin D? A. 200 IU B. 400IU C. 600IU D. 1000IU (Ch. 9 Fitzgerald)

Guidelines recommend that a breastfeeding mother waits until breastfeeding is well established for approximately 6 months before using combined oral contraceptives (COC) because: A. in early breastfeeding, the amount of hormone in COC could cause significant harm to the nursing infant. B. efficacy of COC could be compromised by breastfeeding. C. milk flow could be compromised by COC. D. COC oral contraceptive use could affect mother's sleep patterns.

Hypothyroidism most often develops as a result of: Primary pituitary failure Thyroid neoplasia Autoimmune thyroiditis Radioactive iodine exposure

In a healthy person, what percentage of the body's total daily physiological insulin secretion is released basally? A. 10% B. 25% C. 50% D. 75%

Most episodes of low back pain are caused by: A. an acute precipitating event. B. disk herniation. C. muscle or ligamentous strain. D. nerve impingement. (Ch. 9 Fitzgerald)

NSAIDs cause gastric injury primarily by: A. direct irritative effect. B. slowing gastrointestinal motility. C. thinning of the protective gastrointestinal mucosa D. enhancing prostaglanding synthesis (Ch. 9 Fitzgerald)

Nondairy sources of calcium include all of the following except: A. tofu B. spinach C. brown rice D. sardines (Ch. 9 Fitzgerald)

Presentation of superficial venous thrombophlebitis usually includes: A. positive Homans sign. B. diminished dorsalis pedis pulse. C. a dilated vessel. D. dependent pallor.

Pseudogout has been linked with abnormal activity of the: A. liver. B. kidneys. C. parathyroid D. adrenal gland. (Ch. 9 Fitzgerald)

Radiographic findings of osteoarthritis of the knee often reveal: A. microfractures. B. decreased density of subchondral bone. C. osteophytes. D. no apparent changes to the joint structure. (Ch. 9 Fitzgerald)

The 5-HT1A receptor site is associated with the following activity when stimulated A. agitation, anxiety, panic B. antimigraine effect C. antidepressant D. cerebral spinal fluid production E. nausea, diarrhea (Ch. 14 Fitzgerald)

The diagnosis of fibromyalgia involves: A. A CT scan of the head. B. MRI of various joints throughout the body. C. identifying multiple tender points throughout the body. D. a positive ANA or RF test result. (Ch. 9 Fitzgerald)

The incidence of AOM has decreased in the past decade in part because of: A. earlier detection and treatment. B. more effective treatment options. C. an increase in select vaccination use. D. lower rates of viral infections.

The megltinides analogues are particularly helpful adjuncts in T2DM care to minimize the risk of: A. fasting hypoglycemia B. nocturnal hyperglycemia C. postprandial hyperglycemia D. postprandial hypoglycemia

The most appropriate behavioral intervention for a patient with stress incontinence would be A. having an assistant who is aware of voiding cues and helps with toileting activities B. establishing a voiding schedule and gentle bladder stretching C. Kegel exercises and pelvic floor rehabilitation with biofeedback (Ch. 12 Fitzgerald)

The most important aspect of skin care for children with eczema is: A. frequent bathing with antibacterial soap. B. consistent use of medium- to high-potency topical steroids. C. application of lubricants. D. treatment of dermatophytes

The most likely causative organism in community acquired UTI in women during the reproductive years is A. Klebsiella species B. Proteus mirabilit C. Escherichia coli D. Staphylococcus saprophyticus (Ch. 12 Fitzgerald)

The preferred method to identify the location of small renal stones is A. x-ray B. abdominal ultrasound C. CT scan D. radionuclide scan (Ch. 12 Fitzgerald)

The preferred treatment option for a 6-year-old boy with pertussis is: A. amoxicillin. B. ceftriaxone. C. azithromycin. D. levofloxacin.

This chromosomal syndrome is a common etiology of social and verbal developmental delays in boys: A. Tay-Sachs B. cystic fibrosis C. Fragile X D. Trisomy 18

Treatment of psuedogout can include all of the following except: A. NSAIDs B. colchicine C. allopurinal D. oral corticosteroids. (Ch. 9 Fitzgerald)

Typical distribution of acne neonatorum consists of open and closed comedones and pustules: A. on the hands and wrists. B. on the neck and chest. C. on the forehead and cheeks. D. on the neck and ears.

Untreated hypothyroidism can result in which of the following changes in the lipid profile? A. increased HDL and decreased triglycerides B. increased LDL and total cholesterol C. increased LDL, total cholesterol, and triglycerides D. decreased LDL and HDL

When advising a woman with varicose veins about the use of support stockings, you consider that the preferred type: A. can be purchased in the hosiery section of a department store. B. is a lightweight pair and available over-the-counter. C. is a medium-weight to heavy-weight prescription product. D. is used in the form of panty hose.

When counseling a breastfeeding woman about alcohol use during lactation, you relate that: A. drinking a glass of wine or beer will enhance the let-down reflex. B. because of its high molecular weight, relatively little alcohol is passed into breast milk. C. maternal alcohol use causes a reduction in the amount of milk ingested by the infant. D. infant intoxication can be seen with mother's having as few as one to two alcoholic drinks.

When providing care for a middle-aged man with acute cocaine intoxication, you inquire about: A. feelings of anxiety. B. difficulty maintaining sleep. C. chest pain. D. abdominal pain. (Ch. 14 Fitzgerald)

When providing primary care for a middle-aged woman with a history of prescription benzodiazepine dependence, you consider that: A. she is unlikely to have a problem with misuse of other drugs or alcohol B. rapid detoxification is the preferred method of treatment for this problem C. she likely has an underlying untreated or under-treated mood disorder D. she is at significant risk for drug-induced hepatitis. (Ch. 14 Fitzgerald)

When using trazodone to aide sleep, the drug should be optimally taken _____ prior to sleep. A. immediately B. 15 minutes C. 1 hour D. 2 hours (Ch. 14 Fitzgerald)

Which group is shown to have the highest rate of varicella mortality? A. children aged 6 and younger B. teenagers aged 12-19 C. adults aged 30-49 D. health-care workers

Which is the most cost effective method of distinguishing a malignant from a benign thyroid nodule? A. US B. MRI C. fine needle aspiration D. radioactive iodine scan

Which of the following best describes the presentation of a patient with complete medial meniscus tear? A. joint effusion B. hear over the knee C. inability to kneel D. loss of smooth joint movement (Ch. 9 Fitzgerald)

Which of the following children is most likely to have lead poisoning? A. a developmentally disabled 5-year-old child who lives in a 15-year-old house in poor repair B. an infant who lives in a 5-year-old home with copper plumbing C. a toddler who lives in an 85-year-old home D. a preschooler who lives nears an electric generating plant

Which of the following hemograms would be expected for a 75 year old woman with anemia and chronic renal failure? A. Hg=9.7 g/dL (12 to 14 g/dL); MCV=69 fL (80 to 98 fL); reticulocytes = 0.8% (1% to 2%) B. Hg=10.2 g/dL (12 to 14 g/dL); MCV=104 fL (80 to 98 fL); reticulocytes = 1.2% (1% to 2%) C. Hg=9.4 g/dL (12 to 14 g/dL); MCV=683 fL (80 to 98 fL); reticulocytes = 0.7% (1% to 2%) D. Hg=10.4g/dL (12 to 14 g/dL); MCV=94 fL (80 to 98 fL); reticulocytes = 2.6% (1% to 2%) (Ch. 12 Fitzgerald)

Which of the following is inconsistent with the diagnosis of asthma? A. a troublesome nocturnal cough B. cough or wheeze after exercise C. morning sputum production D. colds "go to the chest" or take more than 10 days to clear

Which of the following is often found with rotator cuff tendonitis? A. osteoarthritis B. tendon rupture C. bursitis D. joint effusion (Ch. 9 Fitzgerald)

Which of the following is the most appropriate way to relieve fever and discomfort in a child with varicella? A. ibuprofen B. aspirin C. acetaminophen D. cold bath

Which of the following medications is approved by the U.S. Food and Drug Administration (FDA) for pain management in a person with fibromyalgia? A. trazodone B. nortriptyline C. pregabalin D. gabapentin (Ch. 9 Fitzgerald)

Which of the following provides the most abundant source of vitamin D? A. fortified dairy products B. fatty fish C. exposure of the skin to the sun D. leafy green vegetables. (Ch. 9 Fitzgerald)

Which of the following statements is most consistent with fibromyalgia? A. It is predominantly diagnosed in African Americans B. It affects less than 1% of the general population C. It is four to seven times more common in women than in men. D. It is most often initially diagnosed in adults younger than 20 years old and older than 50years old. (Ch. 9 Fitzgerald)

Which of the following statements is true about the hepatitis B virus (HBV) vaccine? A. The vaccine contains live HBV. B. Children should have hepatitis B surface antibody (HBsAb, anti-HBs) titers drawn after three doses of vaccine. C. Hepatitis B immunization series should be offered to all children. D. Serological testing for HBsAb should be checked before HBV vaccination is initiated in children.

Which of the following therapeutic agents is commonly used to help with sleep difficulties such as insomnia associated with PTSD? A. duloxetine B. bupropion C. mirtazapine D. zolpidem (Ch. 14 Fitzgerald)

With the straight-leg-raising test, the NP is evaluating tension on which of the following nerve roots? A. L1 and L2 B. L3 and L4 C. L5 and S1 D. S2 and S3 (Ch. 9 Fitzgerald)

You examine a 15-year-old presenting with a 1-day history of sore throat, low-grade fever, maculopapular rash, and posterior cervical and occipital lymphadenopathy. The most likely diagnosis is: A. scarlet fever. B. roseola. C. rubella. D. rubeola.

You examine a healthy 9 month old and expect to find: A. sits without support B. cruises C. has the ability to recognize his own name D. imitates a razzing noise

Match the at-risk ethnic groups for the following genetically based conditions. Sickle cell trait A. Ashkenazi Jewish ancestry B. Norther European ancestry C. African ancestry

C. African ancestry

27. Which of the following is the most likely patient report with anal fissure? A. "I have anal pain that is relieved with having a bowel movement."B. "Even after having a bowel movement, I feel like I still need to 'go' more."C. "I have anal pain for up to 1 to 2 hours after I have a bowel movement."D. "I itch down there almost all the time."

C. "I have anal pain for up to 1 to 2 hours after I have a bowel movement.

90. Approximately what percentage of the population will develop diverticulosis by the time they reach 50 years of age? A. 10%B. 20%C. 33%D. 50%

C. 33%

Along with the Children's Health Insurance Program (CHIP), Medicaid provides coverage for approx. what percentage of all children in the U.S? A. 10% B. 20% C. 33% D. 55%

C. 33%

The classic clinical triad of ectopic pregnancy is found in no more than ___% of women presenting with this condition. A. 10 B. 25 C. 50 D. 75

C. 50

Approximately ___% of spontaneous abortions associated with chromosomal defects. A. 20 B. 40 C. 60 D. 80

C. 60

The duration of antimicrobial therapy for treatment of symptomatic UTI in a pregnant woman is: A. 3 days B. 5 days C. 7 days D. 10 days

C. 7 days Duration of antimicrobial therapy for treatment of asymptomatic UTI in pregnant women is 3-7 days.

What is the molecular weight requirement for a drug to be unable to pass through the placental barriers? A. > 250 daltons B. > 500 daltons C. > 1000 daltons D. > 5000 daltons

C. > 1000 daltons

31. Which of the following statements is true concerning hepatitis C infection? A. It usually manifests with jaundice, fever, and significant hepatomegaly.B. Among healthcare workers, it is most commonly found in nurses.C. At least 50% of persons with acute hepatitis C go on to develop chronic infection.D. Interferon therapy is consistently curative.

C. At least 50% of persons with acute hepatitis C go on to develop chronic infection.

7. Is the following statement most consistent with IBD, with IBS, or with both conditions? Patients should be advised to avoid trigger foods. A. IBDB. IBSC. Both IBD and IBS

C. Both IBD and IBS

94. The most sensitive and specific test for H. pylori infection from the following list is: A. stool Gram stain, looking for the offending organism. B. serological testing for antigen related to the infection. C. organism-specific stool antigen testing. D. fecal DNA testing.

C. organism-specific stool antigen testing.

The human papillomavirus responsible for non genital warts is mainly passed through: A. contact with infected surfaces. B. exposure to saliva from infected person. C. person-to-person contact. D. exposure to infected blood

C. person-to-person contact

Common triggers for anaphylaxis include exposure to certain types of all of the following except: A. medications B. food C. pet dander D. insect bites

C. pet dander

45. Which of the following systemic corticosteroid doses is most potent? A. methylprednisolone 8 mg B. triamcinolone 10 mg C. prednisone 15 mg D. hydrocortisone 18 mg Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

C. prednisone 15 mg

The use of NSAIDs during pregnancy can potentially increase the risk for: A. premature birth B. neural tube defects C. premature closure of ductus arteriosis D. ventricular septal defects

C. premature closure of ductus arteriosis

Which of the following is the most important part of care of a woman with preeclampsia? A. antihypertensive therapy B. anticonvulsant therapy C. prompt recognition of the condition D. induction of labor

C. prompt recognition of the condition

Medicare Part D: A. allows beneficiaries to enroll in private plan as an alternative to the traditional fee-for-service plan B. covers inpatients and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, NP, outpatient, home health, and preventive services

C. provides outpatient prescription drug benefits

What is the most effective protection against shingles? A. previous episode of chickenpox as a child B. prior episode of shingles C. receipt of varicella-zoster immunization D. avoiding children and daycare centers

C. receipt of varicella-zoster immunization

33. When discussing immunizations with a 67-year-old woman with chronic obstructive pulmonary disease (COPD), you advise that she: A. receive live attenuated influenza virus vaccine. B. avoid immunization against influenza because of the risk associated with the vaccine. C. receive inactivated influenza virus vaccine. D. take an antiviral for the duration of the influenza season. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 143). F.A. Davis Company. Kindle Edition.

C. receive inactivated influenza virus vaccine.

39. What is the desired therapeutic action of inhaled corticosteroids when used to treat COPD? A. reversal of fixed airway obstruction B. improvement of central respiratory drive C. reduction of airway inflammation D. mucolytic activity Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

C. reduction of airway inflammation

"Mandatory services" defined by federal law for inclusion in Medicaid include all of the following except: A. laboratory and x-ray services B. family planning services C. rehab therapy D. nurse practitioner (NP) services

C. rehab therapy

83. Risk factors for death resulting from pneumonia include: A. viral origin. B. history of allergic reaction to multiple antimicrobials. C. renal insufficiency. D. polycythemia. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

C. renal insufficiency.

Funding for Medicare include all of the following sources except: A. payroll taxes B. monthly premiums from beneficiaries C. sales taxes on alcohol and tobacco products D. taxes from social security benefits

C. sales taxes on alcohol and tobacco products

In counseling a patient with scabies, the NP recommends all of the following methods to eliminate themite from bedclothes and other items except: A. wash items in hot water. B. run items through the clothes dryer for a normal cycle. C. soak items in cold water for at least 1 hour. D. place items in a plastic storage bag for at least 1 week

C. soak items in cold water for at least 1 hour

When billing medicaid, NP's authority to bill for their services comes from: A. state law only B. federal law only C. state and federal law D. neither state nor federal law

C. state and federal law

When billing commercial insurance, NP's authority to bill for their services comes from: A. state law only B. federal law only C. state law and/or the commercial payers D. federal law and/or commercial payers

C. state law and/or the commercial payers

Biological agents to treat psoriasis, such as infliximab and etanercept, work by blocking the action of: A.IL-9 B.CD4 C.TNF-a D.IgG

C.TNF-a

109. Which of the following would be an acceptable food choice, using standard products, for a person with celiac disease? A. beer and popcorn B. vegetarian pizza C.steak with mashed potatoes D. chicken nuggets

C.steak with mashed potatoes

159. Which of the following statements about Helicobacter pylori is false? A. H. pylori is a gram-negative, spiral-shaped bacterium. B. Infection with H. pylori is the most potent risk factor for duodenal ulcer. C. The organism is often resistant due to the production of beta-lactamase. D. H. pylori is transmitted via the oral-fecal or oral-oral route.

C. The organism is often resistant due to the production of beta-lactamase.

181. Which of the following patients should be evaluated for possible surgical intervention for hemorrhoids? A. a 28-year-old woman with symptomatic external hemorrhoids who gave birth 6 days ago B. a 48-year-old man with Grade II internal hemorrhoids and improvement with standard medical therapy C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse D. a 58-year-old man who has Grade I internal hemorrhoids and improvement with psyllium supplements

C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse

78. The pathophysiology of IBS can be best described as: A. sharing the same pathophysiology as inflammatory bowel disease.B. a patchy inflammatory process in the small bowel that most adolescents will outgrow with vigorous exercise and a low-residue diet. C. a condition that is the result of abnormal gut motor/sensory activity. D. an overstimulation of pancreatic beta cell production.

C. a condition that is the result of abnormal gut motor/sensory activity.

You examine a 24 yo with mild intermittent asthma who is 24 weeks pregnant and has an acute asthma flare. her medication regimen should be adjusted to include: A. titration to a therapeutic theophylline level B. addition to timed salmeterol (Serevent) use C. a short course of oral prednisone D. use of montelukast (Singular) on a regular bases

C. a short course of oral prednisone Oral corticosteroids should be used only to treat an asthma flare.

123. Which of the following groups should be screened for hepatitis B surface antigen (HBsAg)? A. pregnant women with no history of receiving HBV vaccine B. pregnant women with documented prior HBV infection C. all pregnant women regardless of HBV vaccine history D. all newborn infants born to mothers with chronic HBV infection

C. all pregnant women regardless of HBV vaccine history

18. Monitoring for hepatoma in a patient with chronic hepatitis B or C often includes periodic evaluation of: A. erythrocyte sedimentation rate.B. HBsAb.C. alpha-fetoprotein.D. bilirubin.

C. alpha-fetoprotein

73. The mechanism of resistance of DRSP is through the cell's: A. beta-lactamase production. B. hypertrophy of cell membrane. C. alteration in protein-binding sites. D. failure of DNA gyrase reversal. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

C. alteration in protein-binding sites.

An antimicrobial that is FDA pregnancy risk category D is: A. amoxicillin B. levofloxacin C. doxycycline D. TMP-SMX

C. doxycycline

During type I hypersensitivity reactions, histamine re-leased from degraded mast cells causes all of the following except: A. vasodilation B. mucous gland stimulation C. enhanced sebum production D. tissue swelling

C. enhanced sebum production

55. Which of the following is most consistent with the presentation of a patient with colonic diverticulosis? A. diarrhea and leukocytosis B. constipation and fever C. few or no symptoms D. frank blood in the stool with reduced stool caliber

C. few or no symptoms

Which of the following best describes seborrheic dermatitis lesions? A. flaking lesions in the antecubital and popliteal spaces B. greasy, scaling lesions in the nasolabial folds C. intensely itchy lesions in the groin folds D. silvery lesions on the elbows and knees

B. greasy, scaling lesions in the nasolabial folds

The likely causative organisms of nonbullous impetigo in a 6-year-old child include: A. H. influenzae and S. pneumoniae. B. group A streptococcus and S. aureus. C. M. catarrhalis and select viruses. D. P. aeruginosa and select fungi

B. group A streptococcus and S. aureus.

65. Choose the therapy for: a 78-year-old woman with a history of COPD, hypertension, and dyslipidemia who is taking lovastatin and a dihydropyridine calcium channel blocker? A. clindamycin B. high-dose amoxicillin with doxycycline C. clarithromycin D. ceftriaxone Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

B. high-dose amoxicillin with doxycycline

117. In caring for a patient with symptomatic gastroesophageal reflux, you prescribe a PPI to: A. enhance motility. B. increase the pH of the stomach. C. reduce lower esophageal pressure. D. help limit H. pylori growth.

B. increase the pH of the stomach.

129. Risk factors for the development of hemorrhoidal symptoms include all of the following except: A. prolonged sitting. B. insertive partner in anal intercourse. C. chronic diarrhea. D. excessive alcohol use.

B. insertive partner in anal intercourse.

149. After a decade of disease, a person with ulcerative colitis is at increased risk of malignancy involving the: A. small bowel. B. large intestine. C. duodenum. D. stomach.

B. large intestine.

The most common causative organisms in cellulitis are: A. Escherichia coli and Haemophilus influenzae. B. Bacteroides species and other anaerobes. C. group A beta-hemolytic streptococci and S. aureus. D. pathogenic viruses

C. group A beta-hemolytic streptococci and S. aureus.

HIPAA stands for: A. Health information planning and accessibility amendment B. health information protection and accountability act C. health insurance portability and accountability act D. healthcare initiative for patient access amendment

C. health insurance portability and accountability act

Match each hypertensive disorder with its characteristic. Chronic HTN A. high BP diagnosed after 20th week of pregnancy B. presence of tonic-clonic seizures or other alteration in mental status C. high BP diagnosed before pregnancy D. preeclampsia accompanied by elevated hepatic enzymes and low platelets E. high BP diagnosed after the 20th week of pregnancy and accompanied by significant proteinura

C. high BP diagnosed before pregnancy

A woman was treated as an inpatient for a serious soft tissue infection with parenteral linezolid and now is being seen on day 3 of her illness and is being discharged to home. She is feeling better and appears by examination to be clinically improved. Culture results reveal MRSA, sensitive to trimethoprim-sulfamethoxazole, linezolid, daptomycin, vancomycin,and clindamycin and resistant to cephalothin and erythromycin. Her antimicrobial therapy should be completed with: A. oral cephalexin. B. oral trimethoprim-sulfamethoxazole. C. parenteral vancomycin. D. oral linezolid

B. oral trimethoprim-sulfamethoxazole

Medications most commonly pass through the placenta via: A. facilitated transport B. passive diffusion C. capillary pump action D. mechanical carrier state

B. passive diffusion

164. The obturator sign can be best described as abdominal pain elicited by: A. passive extension of the hip. B. passive flexion and internal rotation of the hip. C. deep palpation. D. asking the patient to cough.

B. passive flexion and internal rotation of the hip.

Coverage of services from all of the following healthcare center is considered mandatory for inclusion in Medicaid by federal law except: A. rural health clinical (RHC) B. acute care hospital C. hospice D. federally qualified health center (FQHC)

C. hospice

Match each hypertensive disorder with its characteristic. Eclampsia A. high BP diagnosed after 20th week of pregnancy B. presence of tonic-clonic seizures or other alteration in mental status C. high BP diagnosed before pregnancy D. preeclampsia accompanied by elevated hepatic enzymes and low platelets E. high BP diagnosed after the 20th week of pregnancy and accompanied by significant proteinura

B. presence of tonic-clonic seizures or other alteration in mental status

All of the following are not typically covered by Medicare except: A. long-term care services B. preventive care C. hearing exams and hearing aids D. routine vision care and eyeglasses

B. preventive care

8. A 36-year-old man with asthma also needs antihypertensive therapy. Which of the following products should you avoid prescribing? A. hydrochlorothiazide B. propranolol C. amlodipine D. enalapril Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

B. propranolol

17. Compared with albuterol, levalbuterol (Xopenex®) has: A. a different mechanism of action. B. the ability potentially to provide greater bronchodilation with a lower dose. C. an anti-inflammatory effect similar to that of an inhaled corticosteroid. D. a contraindication to use in elderly patients. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

B. the ability potentially to provide greater bronchodilation with a lower dose.

You see a 42-year-old woman with a cluster of red,itchy spots on her left arm. She informs you that she recently stayed at a hotel that she later discovered was infested with bed bugs. You advise her that: A. she should immediately begin a regimen of oral antibiotics. B. the reaction is usually self-limiting and should resolve in 1 to 2 weeks. C. given that bed bug bites are usually not itchy, an alternative diagnosis should be considered. D. she should wash all of her clothes in cold water

B. the reaction is usually self-limiting and should resolve in 1 to 2 weeks

change in mental status

BOTH

In medical coding the abbreviation ICD stands for: A. insurance code for diagnoses B. integrated clinical dilemmas C. international classification of diseases D. initial classification of the diagnosis

C. international classification of diseases

15. A 62-year-old woman who reports frequent constipation is diagnosed with an anal fissure. First-line therapy includes all of the following except: A. stool-bulking supplements.B. high-fiber diet.C. intra-anal corticosteroids.D. the periodic use of oral mineral oil.

C. intra-anal corticosteroids.

B. At least 1 month

Because of a risk for splenic rupture, persons who have recovered from infectious mononucleosis should wait how long before participating in collision or contact sports? A. At least 2 weeks B. At least 1 month C. At least 3 months D. At least 6 months

B,. Urinary tract infection

By using a diaphragm with spermicide nonoxynol-9 during sexual intercourse, a woman is likely at increased risk for: A. Cervical stenosis B. Urinary tract infection C. Increased perivaginal lactobacilli colonization D. Ovarian malignancy

The zoster vaccine (Zostavax) is a(n): A. inactivated/killed virus vaccine B. conjugate vaccine containing a virus-like particle (VLP) C. live, attenuated vaccine D. inactivated toxin vaccine

C. live, attenuated vaccine

10. Cyclooxygenase-1 (COX-1) contributes to: A. the inflammatory response.B. pain transmission.C. maintenance of gastric protective mucosal layer.D. renal arteriole constriction.

C. maintenance of gastric protective mucosal layer.

The use of sunscreen has minimal impact on reducing the risk of which type of skin cancer? A. squamous cell carcinoma B. basal cell carcinoma C. malignant melanoma D. all forms of skin cancer

C. malignant melanoma

Topical therapies for the treatment of rosacea include all of the following except: A. metronidazole cream B. azelaic acid gel C. medium-potency corticosteroid cream D. benzoyl peroxide

C. medium-potency corticosteroid cream

132. Which of the following best describes the hemogram results in a person with anemia of chronic disease that often accompanies IBD? A. microcytic, hypochromic B. macrocytic, normochromic C. normocytic, normochromic D. hyperproliferative

C. normocytic, normochromic

21. Which of the following best describes the mechanism of action of short-acting beta2-agonists? A. reducer of inflammation B. inhibition of secretions C. modification of leukotrienes D. smooth muscle relaxation Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

D. smooth muscle relaxation

GBS culture should be obtained form: A. the cervix B. the urethra C. urine D. the lower vagina and rectum

D. the lower vagina and rectum

Examples of "individually identifiable health information" can include all of the following except: A. an individuals past history of schizophrenia B. the type of prescription written for an individual C. a patients diagnosis of prostate cancer D. the percentage of patients with type 2 diabetes at a clinic

D. the percentage of patients with type 2 diabetes at a clinic

Shingles most commonly involve the dermatomes of the: A. legs and pubic area. B. face. C. upper arms and shoulders. D. thorax

D. thorax

Which of the following is an oral antimicrobial option for the treatment of a community-acquired methicillin-resistant S. aureus cutaneous infection? A. amoxicillin B. dicloxacillin C. cephalexin D. trimethoprim-sulfamethoxazole

D. trimethoprim-sulfamethoxazole

Federal core groups that states must cover to receive federal matching Medicaid funding include all of the following except: A. pregnant women B. elderly C. children D. undocumented immigrants

D. undocumented immigrants

104. Diagnostic criteria for irritable bowel syndrome include abdominal pain that is associated with all of the following except: A. improvement with defecation. B. a change in frequency of stool. C. a change of stool form. D. unexplained weight loss.

D. unexplained weight loss.

A 49-year-old man presents with a skin lesion suspicious for malignant melanoma. You describe the lesion as having: A. deep black-brown coloring throughout. B. sharp borders. C. a diameter of 3 mm or less. D. variable pigmentation

D. variable pigmentation

A. High rate of beta-lactamase production

Characteristics of M. Catarrhalis include: A. High rate of beta-lactamase production B. Antimicrobial resistance resulting from altered protein-binding sites C. Often being found in middle ear exudate in recurrent otitis media D. Gram-positive organisms

A. Younger than 25 years

Chlamydial infections occur most frequently among women in which age group? A. Younger than 25 years B. 25 to 35 years C. 40 to 50 years D. Over 60 years

A 43-year-old man is experiencing an acute adrenal crisis and presents with prominent nausea, vomiting, and low blood pressure. He appears cyanotic and confused. The most appropriate treatment is an injection of: A. epinephrine. B. insulin. C. adrenaline. D. hydrocortisone.

A 78 year old man presents with fatigue and difficulty with bladder emptying. Examination reveals a distended bladder but is otherwise nremarkable. The blood urea nitrogen (BUN) is 88mg/dL (3.14 mmol/L); the creatininge is 2.8 mg/dL (247.5 umol/L). This clinical assessment is most consistent with A. prerenal azotemia B. acute glomerulonephritis C. acute tubular necrosis D. postrenal azotemia (Ch. 12 Fitzgerald)

A person with a Grade III ankle sprain presents with: A. minor swelling and minimal joint instability. B. moderate joint instability without swelling or ecchymosis. C. moderate swelling, mild to moderate ecchymosis, and moderate joint instability. D. complete ankle instability, significant swelling and moderate to severe ecchymosis. (Ch. 9 Fitzgerald)

AAOS strongly recommends all of the following therapeutic agents for the management of symptomatic OA of the knee except: A. oral NSAIDs. B. topical NSAIDs C. tramadol D. opioids. (Ch. 9 Fitzgerald)

All of the following are common sites of fracture in patients with osteoporosis except: A. the proximal femur. B. the distal forearm C. the vertebrae D. The clavicle. (Ch. 9 Fitzgerald)

All of the following are risk factors for relapse except: A. current episode lasts more than 2 years B. onset of depression occurs at younger than 20 years of age. C. poor recovery between episodes. D. absence of dysthymia preceding the episode. (Ch. 14 Fitzgerald)

All of the following are risks for lactic acidosis in individuals taking metformin except: A. presence of chronic renal insufficiency B. acute dehydration C. radiographic contrast dye use D. history of allergic reaction to sulfonamides

Diagnostic confirmation of glomerulonephritis typically requires: A. urinalysis plus a CBC with diff B. abdominal CT scan C. kidney ultrasound D. kidney biopsy (Ch. 12 Fitzgerald)

In providing primary care for a patient with posttraumatic stress disorder (PTSD), you consider that all of the following are likely to be reported except: A. agoraphobia B. feeling of detachment. C. hyperarousal. D. poor recall of the precepitating event. (Ch. 14 Fitzgerald)

Milia is usually marked by white pinpoint papular lesions found: A. on the back and buttocks. B. across the chest. C. in the underarms. D. on the nose and cheeks.

Objective findings in patients with glomerulonephritis include all of the following except: A. edema B. urinary red blood cell (RBC) casts C. proteinuria D. hypotension (Ch. 12 Fitzgerald)

Risk factors for heatstroke include all of the following except: Obesity Use of beta adrenergic antagonists Excessive activity Use of a vasodilator

The cause of Kawasaki disease is: A. fungal. B. viral. C. bacterial. D. unknown.

The initial diagnostic evaluation of a clinically stable patient with suspected DVT most often includes obtaining a/an: A. impedance plethysmography. B. iodine 125 fibrinogen scan. C. contrast venography. D. duplex ultrasonography.

The mechanism of action of glucosamine and chondroitin is: A. via increased production of synovial fluid B. through improved cartilage repair C. via inhibition of the inflammatory response in the joint D. largely unknown. (Ch. 9 Fitzgerald)

The most common locations for tophi include all of the following except: A. the auricles B. the elbows C. the extensor surfaces of the hands D. the shoulders. (Ch. 9 Fitzgerald)

The most common reason for precocious puberty in girls is: A. ovarian tumor. B. adrenal tumor. C. exogenous estrogen. D. early onset of normal puberty.

The most common site for cervical radiculopathy is: A. C3 to C4. B. C4 to C5. C. C5 to C6. D. C6 to C7. (Ch. 9 Fitzgerald)

The most commonly recommended treatment of Cushing's disease is: A. tapering or ceasing corticosteroid use. B. eliminating trigger medications. C. antineoplastic therapy. D. surgical intervention.

The use of a thiazolidinedione is not recommended in all of the following scenarios except: A. 57 yo man taking a nitrate B. 62 yo woman with heart failure C. 45 yo man who is using insulin D. 35 yo patient with newly diagnosed T2DM

The use of which medication has the potential for causing the greatest reduction in HA1C? A. Biguanide B. TZD C. Sulfonylurea D. Insulin form

Which is possible reason for delayed onset of puberty in a 13-year-old girl? A. history of abdominal irradiation B. obesity. C. report of a high level of physical activity D. Turner syndrome

Which of the following is not a contributing factor to development of venous thrombophlebitis? A. venous status B. injury to vascular intima C. malignancy-associated hypercoagulation states D. isometric exercise

Which of the following is the preferred method of preventing NSAID-induced gastric ulcer? A. a high-dose histamine 2 receptor antagonist B. timed antacid use C. sucralfate (Carafate) D. misoprostol (Cytotec) (Ch. 9 Fitzgerald)

Which of the following is usually not part of treatment of a sprain? A. immobilization B. applying ice to the area C. joint rest D. local corticosteroid injection (Ch. 9 Fitzgerald)

Which of the following joints is most likely to be affected by osteoarthritis (OA)? A. wrists B. elbows C. metacarpophalangeal joint D. distal interphalangeal joint (Ch. 9 Fitzgerald)

Which of the following patients has impaired glucose tolerance? A. 70 yo man with FPG of 109 B. 84 yo woman with 1 hour PPG of 98 C. 33 yo man with HA1C of 5.4 D. 58 yo woman with a 2 hour PPG of 152

Which of the following should be periodically monitored with the use of a biguanide? A. creatinine kinase CK B. alkaline phosphatase ALP C. alanine aminiotransferase ALT D. creatinine Cr

Which of the following statements is true about oral poliovirus vaccine (OPV)? A. It contains killed virus. B. It is the preferred method of immunization in North America. C. Two doses should be administered by a child's fourth birthday. D. After administration of OPV, attenuated live poliovirus can be shed from the stool.

Which patient presentation is most consistent with the diagnosis of depression? A. recurrent diarrhea and cramping B. difficulty initiating sleep C. diminished cognitive ability D. consistent early morning wakening. (Ch. 14 Fitzgerald)

With ezetimibe (Zetia), which of the following should be periodically monitored? A. ALP B. LDH C. CPK D. No special laboratory monitoring is recommended.

With the use of a lipid-lowering resin, which of the following enzymes should be periodically monitored? A. ALP B. LDH C. AST D. No particular monitoring is recommended.

You are examining a 19 year old man who is diagnosed with a murmur of mitral regurgitation. When he asks about participation in sports activities, you counsel that: A. participation in sports activities should not be affected by his condition. B. he should refrain from any activities requiring physical exertion. C. participation will depend on the degree of atrial atrophy. D. participation will depend on the degree of ventricular enlargement. (Ch. 9 Fitzgerald)

You are making rounds in the nursery and examine the neonate of a mother who is HBsAg-positive. Your most appropriate action is to: A. administer hepatitis B immune globulin (HBIG). B. isolate the infant. C. administer hepatitis B immunization. D. give hepatitis B immunization and HBIG.

32. Risk factors for Barrett esophagus include all of the following except: A. a history of cigarette smoking.B. being older than 50 years of age.C. male gender.D. African American ethnicity.

D. African American ethnicity.

A drug shown to cause teratogenic effects in human study, but the benefit of which could outweigh the risk of use in a life-threatening situation, is assigned FDA risk category: A. A B. B C. C D. D

D. D

All of the following can cause an elevated maternal alpha-fetoprotein (AFP) except: A. underestimated gestational age B. open neural tube defect C. meningomyelocele D. Down syndrome

D. Down syndrome Maternal levels can be elevated for many reasons, including an open NTD (meningomyelocele, anencephaly, spina bifida), fetal nephrosis, cystic hygroma, fetal GI obstruction, omphalocele, intrauterine growth restriction, multiple fetuses, or fetal demise. Underestimated gestational age can also lead to a misinterpreted test because maternal AFP is higher in earlier pregnancy.

Gram-negative bacteria that commonly cause burn wound infections include all of the following except: A. P. aeruginosa B. E. coli C. K. pneumoniae D. H. influenzae

D. H. influenzae

Worldwide, which of the following is the most common type of anemia? A. Pernicious anemia B. Folate-deficiency ameia C. Anemia of chronic disease D. Iron-deficiency anemia

D. Iron-deficiency anemia

167. Which of the following is true concerning colorectal cancer? A. Most colorectal cancers are found during rectal examination. B. Rectal carcinoma is more common than cancers involving the colon. C. Early manifestations include abdominal pain and cramping. D. Later disease presentation often includes iron-deficiency anemia.

D. Later disease presentation often includes iron-deficiency anemia.

76. Which of the following best describes Grade III internal hemorrhoids? A. The hemorrhoids do not prolapse. B. The hemorrhoids prolapse upon defecation but reduce spontaneously. C. The hemorrhoids prolapse upon defecation and must be reduced manually. D. The hemorrhoids are prolapsed and cannot be reduced manually.

D. The hemorrhoids are prolapsed and cannot be reduced manually.

Among the following, who is at greatest risk of developing seborrheic dermatitis? A. a 15-year-old boy residing in a rural setting B. a 34-year-old woman who smokes 2 packs per day(PPD) C. a 48-year-old male truck driver D. a 72-year-old man with Parkinson disease

D. a 72-year-old man with Parkinson disease

138. Which of the following is least likely to be found in a person with pancreatic cancer? A. history of chronic pancreatitis B. lesion identified on abdominal CT C. normocytic, normochromic anemia D. elevation of amylase level

D. elevation of amylase level

79. To avoid rebound gastric hyperacidity following discontinuation of long-term PPI use, all of the following methods can be used except: A. gradually tapering the PPI dose with supplemental antacid.B. switching to every-other-day dosing of PPI with supplemental antacid.C. switching to a low-dose H2RA therapy with supplemental antacid.D. empiric H. pylori therapy.

D. empiric H. pylori therapy.

Analgesia options for a patient with shingles can include all of the following except: A. topical lidocaine gel 5% with oral acetaminophen B. Burow's solution with a high-potency oral NSAID C. Burow's solution with an oral opioid D. fentanyl transdermal patch and a topical medium-potency corticosteroid on the affected area

D. fentanyl transdermal patch and a topical medium-potency corticosteroid on the affected area

173. All of the following are effective methods to kill the hepatitis A virus except: A. heating food to more than 185°F (85°C) for at least 1 minute. B. adequately chlorinating water. C. cleaning surfaces with a 1:100 bleach solution. D. freezing food for at least 1 hour.

D. freezing food for at least 1 hour.

Women at high risk for aneuploidy include all of the following except: A. maternal age 35 years and older at delivery B. hx of prior pregnancy with trisomy C. fetal US findings indicating an increased risk of aneuploidy D. hx of multiparity

D. hx of multiparity

The cornerstone controller therapy for moderate persistent asthma during pregnancy is the use of: A. oral theophylline B. mast cell stabilizer C. leukotriene receptor antagonist D. inhaled corticosteroids

D. inhaled corticosteroids Most inhaled corticosteroids are category C (with budesonide [Pulmicort] being the exception as risk category B).

89. When answering questions about hepatitis A vaccine, you consider that all of the following are true except: A. it does not contain live virus. B. it should be offered to individuals who frequently travel to developing countries. C. it is a recommended immunization for healthcare workers. D. it is given as a single dose.

D. it is given as a single dose.

In treating a pregnant woman with acute bacterial rhinosinustitis, the NP would likely avoid prescribing: A. amoxicillin B. cefuroxime C. cefpodoxime D. levofloxacin

D. levofloxacin Amoxicillin - Category B Cefuroxime - Category B Cefpodoxime - Category B Levofloxacin - Category C

162. Long-term PPI use is associated with all of the following except: A. increased risk of pneumonia in hospitalized patients. B. increased risk of C. difficile colitis in hospitalized patients. C. reduced absorption of calcium and magnesium. D. reduced absorption of dietary carbohydrates.

D. reduced absorption of dietary carbohydrates.

13. According to the National Asthma Education and Prevention Program Expert Panel Report 3 (NAEPP EPR-3) guidelines, which of the following is not a risk for asthma death? A. hospitalization or an emergency department visit for asthma in the past month B. current use of systemic corticosteroids or recent withdrawal from systemic corticosteroids C. difficulty perceiving airflow obstruction or its severity D. rural residence Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

D. rural residence

C. Vitamin E

Examples of phytoestrogens include all of the following except: A. Red clover B. Ginseng C. Vitamin E D. Soy products

B. Tympanic membrane immobility

Expected findings in AOM include: A. Prominent bony landmarks B. Tympanic membrane immobility C. Itchiness and crackling in the affected ear D. Submental lymphadenopathy

C. Elevated CrCl

Expected laboratory findings for the woman with PID include all of the following except: A. Elevated ESR B. Elevated CRP C. Elevated CrCl D. Leukocytosis

(T/F) Access to a firearm by a male perpetrator is associated with increased risk of abuse toward women only in lower socioeconomic income households. (Ch. 14 Fitzgerald)

(T/F) Interpersonal violence is uncommon in same-sex relationships. (Ch. 14 Fitzgerald)

(T/F) The NP is in an ideal position to provide counseling to both members of a couple involved in domestic violence, particularly if both members of the couple are members of the NP's practice panel (Ch. 14 Fitzgerald)

(T/F) Women's violence against male partners is as likely to result in serious injury as men'ts violence toward women. (Ch. 14 Fitzgerald)

T/F Access to a firearm does not increase the rate of fatal episodes of domestic abuse.

T/F Domestic abuse is uncommon in same-sex relationships.

T/F in a normal pregnancy Thyroid decreases in size

With the use of direct thrombin inhibitor, ongoing INR monitoring is not required.

FALSE

True or False: Skin lesions infected by community-acquired MRSA (CA-MRSA) often occur spontaneously on intact skin.

False

True or False: The mechanism of resistance of MRSA is via the production of beta-lactamase.

False

True or False? The body's normative response to anemia is reticulocytopenia

False Thy body's normal response to anemia is to attempt correction via reticulocytosis.

D. A pH greater than 5.0

Findings in estrogen deficiency (atrophic) vaginitis include: A. A malodorous vaginal discharge B. An increased number of lactobacilli C. A reduced number of white blood cells D. A pH greater than 5.0

C. Firm pressure to the area superior to the nasal alar cartilage

First-line intervention for anterior epistaxis includes: A. Nasal packing B. Application of topical thrombin C. Firm pressure to the area superior to the nasal alar cartilage D. Chemical cauterization

A. Penicillin

First-line treatment options for primary syphilis include: A. Penicillin B. Ciprofloxacin C. Erythromycin D. Ceftriaxone

D. Immediate referral to an ophthalmologist

For Mrs. Allen, the most appropriate next course of action is: A. Placement of an eye shield and follow-up in 48 hours B. Initiate treatment with an ophthalmic antimicrobial solution C. Initiate treatment with a corticosteroid ophthalmic solution D. Immediate referral to an ophthalmologist

D. Paroxetine

For the woman with a history of DVT who is having significant vasomotor symptoms, which of the following can be used for symptom management? A. 17-19β-estradiol patch B. Drospirenone C. Estrone D. Paroxetine

D. Help preserve bone density

In advising a perimenopausal woman about HT, you consider that it may: A. Reduce the risk of venous thrombotic events B. Significantly reduce serum triglyceride levels C. Worsen hypertension in most women D. Help preserve bone density

As few as 3 days of malnutrition in the form of inadequate protein-calorie intake can impair normal wound healing mechanisms

TURE

B. Inconvenience of use

The most common reasons for discontinuing oral contraception use is breakthrough bleeding and : A. Nausea/vomiting B. Inconvenience of use C. Cost D. High failure rate

True or False? Approximately 90% of the body's erythropoietin is produced by the kidney

True

True or False? The RBC content is approximately 90% Hgb

True

False

True/False: Nausea with oral contraceptive use can be minimized by taking the pill on an empty stomach.

A. 1 to 5 days

What is the approximate incubation period for Neisseria gonorrhoeae? A. 1 to 5 days B. 7 to 10 days C. 18 days D. 28 days

C. At least 70%

What percentage of anogenital and cervical cancers can be attributed to HPV infection? A. Less than 30% B. At least 50% C. At least 70% D. 95% or greater

C. At least 50%

What percentage of patients with infectious mononucleosis has splenomegaly during the acute phase of the illness? A. At least 10% B. About 25% C. At least 50% D. Nearly 100%

C. 18.9%

What percentage of sexually active adults has serological evidence of human herpes virus 2 (HHV-2 or herpes simplex type 2)? A. 5.8% B. 14.5% C. 18.9% D. 35.6%

B. The rash often peels during recovery

When advising a patient with scarlet fever, the NP considers that: A. There is increased risk for poststreptococcal glomerulonephritis B. The rash often peels during recovery C. An injectable cephalosporin is the preferred treatment option D. Throat culture is usually negative for Group A streptococci

A. Immediately

When can a woman safely conceive after discontinuing COC use? A. Immediately B. After 1 to 2 months C. After 3 to 4 months D. After 5 to 6 months

D. The duration of lower-dose HTR is usually shorter than that of higher-dose regimens

When counseling a 46-year-old woman who is experiencing debilitating hot flashes, you advise all of the following regarding higher and lower dose hormone replacement therapy (HT) except: A. Current clinical guidelines recommend using the lowest effective dose possible B. Higher-dose HT will relieve hot flashes faster than lower-dose regimens C. Lower-dose HT is better tolerated than higher-dose HT D. The duration of lower-dose HT is usually shorter than that of higher-dose regimens

D. Prementrual syndrome symptoms are often improved with use of COC

When counseling a woman about COC use, you advise that: A. Long-term use of COC is discouraged because the body needs a "rest" from birth control pills from time to time B. Fertility is often delayed for many months after discontinuation of COC C. There is an increase in the rate of breast cancer after protracted use of COC D. Prementrual syndrome symptoms are often improved with use of COC

B. Dix-Hallpike test

When elevating a patient with Meniere's disease, the procedure of observing for nystagmus while moving the patient from sitting to supine with the head angled 45 degrees to one side and then the other is called. A. The Romberg test B. Dix-Hallpike test C. The Rinne's test D. The Fukuda test

B. Candidates include women who have difficulty remembering to take a daily pill

When prescribing the contraceptive patch (Ortho Evra) or vaginal ring (NuvaRing), the NP considers that: A. These are progestin-only products B. Candidates include women who have difficulty remembering to take a daily pill C. There is significant drug interactions with both products D. Contraceptive efficacy is less than with COC

A. Few high-quality studies support the use of these products

When reviewing the use of nutritional supplements for the management of menopausal symptoms, the NP considers that: A. Few high-quality studies support the use of these products B. The use of these products is consistently reported to be helpful C. The products can be safely used as long as blood hormone levels are carefully evaluated D. The use of these products is associated with a greater reduction in menopausal symptoms than with prescription HT

B. 6 and 11

Which HPV types are most likely to cause genital condyloma acuminatum? A. 1, 2, and 3 B. 6 and 11 C. 16 and 18 D. 22 and 24

C. 16 and 18

Which HPV types are most often associated with cervical and anogenital cancer? A. 1, 2 and 3 B. 6 and 11 C. 16 and 18 D. 22 and 24

A. Vulva

Which body area has the greatest concentration of estrogen receptors? A. Vulva B. Vascular bed C. Heart D. Brain

A. Ceftriaxone

Which of the following agents is active against N. Gonorrhoeae? A. Ceftriaxone B. Metronidazole C. Ketoconazole D. Amoxicillin

C. Azithromycin

Which of the following agents is most active against C. trachomatis? A. Amoxicillin B. Metronidazole C. Azithromycin D. Ceftriaxone

B. The beta-lactams

Which of the following antimicrobial classes is associated with the highest rate of allergic reaction? A. The macrolides B. The beta-lactams C. The aminoglycosides D. The sulfonamides

A. Upper respiratory tract infection symptoms persisting beyond 7 to 10 days

Which of the following findings is most consistent with the diagnosis of acute bacterial rhinosinusitis (ABRS)? A. Upper respiratory tract infection symptoms persisting beyond 7 to 10 days B. Mild midfacial fullness and tenderness C. Preauricular lymphadenopathy D. Marked eyelid edema

C. Cefixime with doxycycline

Which of the following is a treatment option for a 28-year-old woman with PID who has no history of medication allergy and has undergone a bilateral tubal ligation? A. Ofloxacin with metronidazole B. Gentamicin with cefpodoxime C. Cefixime with doxycycline D. Clindamycin with azithromycin

A. Ofloxacin with metronidazole

Which of the following is a treatment options for a 30-year-old woman with PID and a history of severe hive-form reaction when taking a penicillin or cephalosporin? A. Ofloxacin with metronidazole B. Amoxicillin with gentamicin C. Cefixime with vancomycin D. Clindamycin with azithromycin

C. Fever

Which of the following is absent in otitis media with effusion? A. Fluid in the middle ear B. Otalgia (ear pain) C. Fever D. Itch

A. Weight gain

Which of the following is commonly found after 1 year of using DMPA (Depo-Provera)? A. Weight gain B. Hypermenorrhea C. Acne D. Rapid return of fertility when discontinued

C. Squamous cell carcinoma

Which of the following is the most common form of oral cancer? A. Adenocarcinoma B. Sarcoma-form C. Squamous cell carcinoma D. Basal cell carcinoma

C. This is largely a diagnosis of exclusion

Which of the following is true concerning Meniere's disease? A. Neuroimaging helps locate the offending cochlear lesion B. Associated high-frequency hearing loss is common C. This is largely a diagnosis of exclusion D. Tinnitus is rarely reported.

D. Loratadine

Which of the following medication is most appropriate for allergic rhinitis therapy in an acutely symptomatic 24-year-old machine operator? A. Nasal cromolyn B. Diphenhydramine C. Flunisolide nasal spray D. Loratadine

D. Oral antihistamine

Which of the following medications affords the best relief of acute nasal itch? A. Anticholinergic nasal spray B. Oral decongestant C. Corticosteroid nasal spray D. Oral antihistamine

D. Imipenem - is an intravenous β-lactam antibiotic. First member of the carbapenem class of antibiotics

Which of the following medications is not a penicillin form? A. Amoxicillin B. Ampicillin C. Dicloxacillin D. Imipenem

D. High dose amoxicillin with clavulante

Which of the following represents a therapeutic option for ABRS in an adult patient with no recent antimicrobial care with treatment failure after 72 hours of appropriate doxycycline therapy? A. Clindamycin B. Clarithromycin C. Trimethoprim-sulfamethoxazole D. High-dose amoxicillin with clavulante

D. Ulipristal is taken in two doses 12 hours apart

Which of the following statements is false? A. Progestin-only emergency contraception can be taken as one close dose or two doses B. Ulipristal is available by prescription only C. Progestin-only emergency contraception is available. OTC for women 17 years old and older D. Ulipristal is taken in two doses 12 hours apart

C. After insertion, the cervix should be smoothly covered

Which of the following statements is true concerning vaginal diaphragm use? A. When in place, the woman is aware that the diaphragm fits snugly against the vaginal walls B. This is a suitable form of contraception for women with recurrent urinary tract infection C. After insertion, the cervix should be smoothly covered D. The device should be removed within 2 hours of coitus to minimize the risk of infection

B. Most men have asymptomatic infection

Which of the following statements is true of gonococcal infection? A. The risk of transmission from an infected woman to a male sexual partner is about 80% B. Most men have asymptomatic infection C. The incubation period is about 2 to 3 weeks D. The organism rarely produces beta-lactamase

A. Many over-the-counter progesterone creams contain sterols that the human body is unable to use

Which of the following statements is true? A. Many over-the-counter progesterone creams contain sterols that the human body is unable to use B. All progesterones are easily absorbed via the skin C. Alfalfa is an example of a phytoprogesterone D. Progesterones, whether synthetic or plan-based, should not be used by a woman who has undergone a hysterectomy

A. Menstruation ceases during perimenopause

Which of the following statements regarding perimenopause is false? A. Menstruation ceases during perimenopause B. Hot flashes and flushes are common during the week before menses C. Pregnancy is still possible during perimenopause D. Ovulation becomes more erratic during perimenopause

B. Immune modulator

Which of the following terms describes the mechanism of action of imiquimod (Aldabra)? A.keratolytic B. Immune modulator C. Cryogenic D. Cytolytic

C. A 32-year-old woman with adequately-controlled hypertension

Which of the following women is the best candidate for progestin-only pill (POP) use? A. An 18-year-old woman who frequently forgets to take prescribed medications B. A 28-year-old woman with multiple sexual partners C. A 32-year-old woman with adequately-controlled hypertension D. A 26-year-old woman who wants to use the pill to help "regulate" her menstrual cycle

B. Appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms

With regard to pharyngitis caused by group C streptococci, the NP considers that: A. Potential complications include glomerulonephritis B. Appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms C. Infection with these organisms carries a significant risk of subsequent rheumatic fever D. Acute infectious hepatitis can occur if not treated with an appropriate antimicrobial

D. Reduction in menstrual flow

With the use of a levonorgestrel intrauterine system (Mirena), which one of the following is normally noted? A. Endometrial hyperplasia B. Hypermenorrhea C. Increase in PID rates D. Reduction in menstrual flow

B. Leukopenia

Women with PID typically present with all of the following except: A. Dysuria B. Leukopenia C. Cervical motion tenderness D. Abdominal pain

D. Malodorous discharge

Women with bacterial vaginitis typically present with: A. Vulvitis B. Pruritus C. Dysuria D. Malodorous discharge

"Does this patient have a reactive TST?" 56. a 45-year-old woman with type 2 diabetes mellitus and chest radiograph finding consistent with previous TB and a 7-mm induration Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

Yes

"Does this patient have a reactive TST?" 58. a 31-year-old man with HIV and a 6-mm induration Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

Yes

"Does this patient have a reactive TST?" 59. a 45-year-old woman from a country in which TB is endemic who has an 11-mm induration Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

Yes

"Does this patient have a reactive TST?" 60. a 42-year-old woman with rheumatoid arthritis who is taking etanercept (Enbrel®) who has a 7-mm induration Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

Yes

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a candidate for a copper-containing intrauterine device (IUD)? A 25-year-old woman with hypertension

Yes

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a category 1 or 2 COC candidate? A 22-year-old woman who smokes one pack per day

Yes, in the absence of advanced vascular disease

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a category 1 or 2 COC candidate? A 28-year-old woman with type 1 diabetes mellitus

Yes

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a category 1 or 2 COC candidate? A 29-year-old woman with PID

Yes

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a category 1 or 2 COC candidate? A 32-year-old woman breastfeeding a 6-month-old infant

Meniere's Syndrome

Meniere's disease/Meniere's syndrome: A 17-year-old who received aminoglycoside therapy for an intraabdominal infection.

Meniere's Syndrome

Meniere's disease/Meniere's syndrome: A 24-year-old man who experienced trauma to the head during a car accident.

Meniere's Disease

Meniere's disease/Meniere's syndrome: A 45-year-old woman with no apparent underlying cause for the condition.

B. Elevated intraocular pressure

POAG is primarily caused by: A. Hardening of the lens B. Elevated intraocular pressure C. Degeneration of the optic nerve D. Hypotension in the anterior maxillary artery

Most common indoor allergen

Pet dander

C. Hyphae

Physical examination of a 19-year-old woman with a 3-day history of vaginal itch reveals moderate perineal excoriation, vaginal erythema, and a white, clumping discharge. Expected microscopic examination findings include: A. A pH greater than 6.0 B. An increased number of lactobacilli C. Hyphae D. An abundance of white blood cells

D. Short-term studies demonstrate that oral HT is associated with lower thromboembolic risk than transdermal forms of HT

You see a 45-year-old woman who is considering HT. She has a family history of cervical dysphasia, hyperlipidemia and VTE. You advise her on all of the following except: A. The use of progestin can minimize the risk of endometrial cancer for a woman on HT and who has not had a hysterectomy B. Supplemental estrogen should be avoided in women who are at high risk of breast cancer or uterine cancer C. Supplemental estrogen should be avoided in women who are at high risk of cardiovascular disease D. Short-term studies demonstrate that oral HT is associated with lower thromboembolic risk than transdermal forms of HT.

D. She does not need to have a pap test now or in the future

You see a 48-year-old woman who underwent an abdominal hysterectomy with cervical removal for uterine fibroids 6 months ago. She last had a normal Pap test 1 1/2 years ago. You recommend her next Pap test. A. Immediately B. In 1 1/2 years C. In 3 1/2 years D. She does not need to have a pap test now or in the future

D. STI testing only

You see an 18-year-old with a history of C. trachomatis infection and a total of five lifetime partners. You recommend: A. Pap smear only B. Pap smear and HPV testing C. Pap smear and STI testing D. STI testing only

(T/F) Child abuse is present in about half of all homes where partner mistreatment occurs (Ch. 14 Fitzgerald)

T/F in a normal pregnancy Decrease in diastolic BP most notable during second trimester

One of the potential serious adverse effects of unfractionated heparin is thrombocytopenia.

TRUE

True or False? During the first 6 weeks of the postpartum period, the childbearing woman is at increased risk of VTE.

TRUE

Weight loss medications: True or false? Lorcaserin should not be used with medications that have serotonergic effect.

TRUE

when ordering lab tests to confirm chancroid, the NP considers that: a. concomitant infection with herpes simplex is often found b. a disease-specific serum test is available c. a WBC count with diff is indicated d. dark-field exam is needed

a. concomitant infection with herpes simplex is often found

which of the following is a common finding in a man with varicocele? a. lower sperm count with increased number of abnormal forms b. increased rate of testicular cancer b. recurrent scrotal pain d. BPH

a. lower sperm count with increased number of abnormal forms

indicate whether each finding normally would be present in gonorrheal urethritis in an otherwise well 28 y/o (yes or no) a. milky penile discharge - yes b. milky penile discharge - no

a. milky penile discharge - yes

indicate whether each finding would be present in acute epididymitis (yes or no) a. penile discharge - yes b. penile discharge - no

a. penile discharge - yes

when assessing a 78 y/o man with suspected BPH, the NP considers that: a. prostate size does not correlate well with severity of sxs b. BPH affects less than 50% of men of this age c. he is at increased risk for prostate cancer d. limiting fluids is a helpful method of relieving severe sxs

a. prostate size does not correlate well with severity of sxs

the presentation of acute epididymitis in an otherwise well 22 y/o includes: a. the presence of a + Prehn sign b. low back pain c. absent cremasteric reflex d. diffuse abdominal pain

a. the presence of a + Prehn sign

the best diagnostic text to identify the offending organism in acute bacterial prostatitis is: a. urine culture b. urethral culture c. antibody testing d. urine Gram stain

a. urine culture

in a ring formation

annular

loss of skin markings and full skin thickness

atrophy

the most common causative organism of lymphogranuloma venereum is: a. ureaplasma genitalium b. C. trachomatis types 1 to 3 c. Neisseria gonorrhoease d. H. ducreyi

b. C. trachomatis types 1 to 3

N. gonorrhoeae are best described as: a. gram- positive cocci b. gram-positive rods c. gram-negative diplococci d. gram-negative bacilli

c. gram-negative diplococci

which or the following is the best choice of txment in chronic bacterial prostatitis? a. oral trimethoprim-sulfamethoxazole for 2 weeks b. parenteral ampicillin for 4 weeks c. oral ciprofloxacin for 4 weeks d. injectable gentamicin for 2 weeks

c. oral ciprofloxacin for 4 weeks

to prevent a recurrence of testicular torsion, which of the following is recommended? a. use of a scrotal support b. avoidance of testicular trauma c. orchiopexy d. limiting the number of sexual partners

c. orchiopexy

the causative organism of chancroid is: a. ureaplasma species b. chlamydia trachomatic c. mycoplasma hominis d. haemophilus ducreyi

d. haemophilus ducreyi

when taking a PDE-5 inhibitor, concomitant use of which med must be avoided? a. statins b. sulfonylurea c. aCE inhibitors d. nitrates

d. nitrates

Identify the following organisms as a grampositive, gram-negative, or atypical pathogen. 91. Streptococcus pneumoniae Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 153). F.A. Davis Company. Kindle Edition.

gram-positive

you perform a DRE on a 72 y/o and find a lesion suspicious for prostate cancer. the findings are described as: a. rubbery, enlarged prostatic lobe b. an area of prostatic induration c. an indurated gland d. prostatic tenderness

b. an area of prostatic induration

12. All of the following laboratory findings are expected in a patient with pancreatic cancer except: A. elevated total bilirubin.B. diminished platelet count.C. elevated alkaline phosphatase.D. elevated direct bilirubin.

b. diminished platelet count

indicate whether each finding normally would be present in gonorrheal urethritis in an otherwise well 28 y/o (yes or no) a. fever- yes b. fever- no

b. fever- no

When evaluating a child who has bacterial meningitis, the NP expects to find cerebrospinal fluid (CSF) results of: A. low protein. B. predominance of lymphocytes. C. glucose at about 30% of serum levels. D. low opening pressure.

chronic liver disease signs symptoms

jaundice, asterixis, ascites less obvious: sarcopenia, palmar erythema, vascular spiders/spider angioma, porphyria cutanea tarda--> hep C, alcohol sometimes sun exposure causes swelling, itching, or redness. Hair growth on the face and other sun-exposed areas may increase. Sometimes areas of dark or light patches of skin develop. Liver disease: cirrhosis (23% of people with liver cirrhosis develop palmar erythema), Wilson disease, haemochromatosis Endocrine/nutritional: 18% of people with thyrotoxicosis and 4% of people with diabetes develop palmar erythema Autoimmune diseases: over 60% of people with rheumatoid arthritis develop palmar erythema Drug-induced palmar erythema: drugs include topiramate and salbutamol if the liver is functioning normally, or amiodarone, cholestyramine and gemfibrozil if there is liver impairment

skin thickening usually found over pruritic or friction areas

lichenification

In order for an NP to be reimbursed by a third-party payer (Medicare, Medicaid, private insurance)... (yes or no) Does the service involve procedures the clinician cannot perform?

vesicle-like lesion with purulent content

pustule

In order for an NP to be reimbursed by a third-party payer (Medicare, Medicaid, private insurance)... (yes or no) Does the clinician have legal authority to receive reimbursement for these services?

yes

In order for an NP to be reimbursed by a third-party payer (Medicare, Medicaid, private insurance)... (yes or no) Does the service include a medical evaluation and medical decision making?

yes

At which of the following ages in a young child's life is parental anticipatory guidance about infant sleep position most helpful? A. birth B. 2 weeks C. 2 months D. 4 months

Benzodiazepines taken concomitantly with which of the following can lead to enhanced sedation and increased risk of death? A. alcohol B. acetaminophen C. ibuprofen D. statins (Ch. 14 Fitzgerald)

Changes to the joint during osteoarthritis can typically include all of the following except: A. widening of the joint space B. articular cartilage wears away. C. formation of bone spurs D. synovial membrane thickens. (Ch. 9 Fitzgerald)

Common adverse effects of musculotropic relaxants used in the treatment of urinary incontinence include: A. dry mouth and constipation B. nausea C. headaches D. syncope (Ch. 12 Fitzgerald)

Concomitant health problems found in a patient with panic disorder often include: A. irritable bowel syndrome. B. thought disorders C. hypothyroidism D. inflammatory bowel disease (Ch. 14 Fitzgerald)

Conditions that commonly mimic or can worsen anxiety include all of the following except: A. opioid use. B. thyrotoxicosis C. alcohol withdrawal. D. overuse of caffeine (Ch. 14 Fitzgerald)

Creatinine clearance usually: A. approximates glomerular filtration rate (GFR) B. does not change as part of normative aging C. is greater in women compared with men D. increases with hypotension (Ch. 12 Fitzgerald)

Drug treatment options for a patient with bipolar disorder often include all of the following except: A. atomoxetine (Strattera) B. lithium carbonate. C. risperidone (Risperdal) D. valproic acid (Depakote) (Ch. 14 Fitzgerald)

During a preparticipation sports examination, you hear a grade 2/6 early- to mid- systolic ejection murmur, heard best at the second intercostal space of the left sternal border, in an asymptomatic young adult. The murmur disappears with position change from supine to stand position change. This most ikely represents: A. an innocent flow murmur. B. mitral valve incompetency. C. aortic regurgitation. D. mitral valve prolapse (MVP). (Ch. 9 Fitzgerald)

Factors that contribute to urge incontinence include: A. detrusor overactivity B. pelic floor weakness C. urethral stricture D. urinary tract infection (UTI) (Ch. 12 Fitzgerald)

First-line pharmacological intervention for milder OA should be a trial of: A. acetaminophen B. tramadol. C. celecoxib. D. intraarticular corticosteroid injection. (Ch. 9 Fitzgerald)

First-line therapy for biceps tendonitis usually includes: A. applying ice to the area B. local corticosteroid injection C. orthopedic referral. D. nerve block. (Ch. 9 Fitzgerald)

Intervention for a child with a lead level of 40 to 50 mcg/dL usually includes: A. chelation therapy. B. calcium supplementation. C. exchange transfusion. D. iron depletion therapy.

A 14-year-old male presents with acne consisting of 25 comedones and 20 inflammatory lesions with no nodules. This patient can be classified as having: A. mild acne. B. moderate acne. C. severe acne. D. very severe acne.

B. moderate acne

The daily amount of vitamin D3 recommended for pregnant or lactating women is: A. 300IU B. 600IU C. 1000IU D. 1200IU (Ch. 9 Fitzgerald)

The main risk factor for AOM in infants is: A. undiagnosed dairy allergy B. eustachian tube dysfunction. C. cigarette smoke exposure D. use of soy-based infant formula.

The mechanism of action in fever includes which of the following? A. an increase in systematic vascular resistance B. endogenous pyrogens increase prostaglandin synthesis C. immature neutrophil forms in circulation D. atypical or reactive lymphocytes

The mechanism of action of sulfonylureas is as: A. an antagonist of insulin receptor site activity B. a product that enhances insulin release C. a facilitator of renal glucose excretion D. an agent that can reduce hepatic glucose production

The most appropriate behavioral intervention for a patient with urge incontinence would be A. having an assistant who is aware of voiding cues and helps with toileting activities B. establishing a voiding schedule and gentle bladder stretching C. Kegel exercises and pelvic floor rehabilitation with biofeedback (Ch. 12 Fitzgerald)

The most common causative bacterial pathogen in ABRS is: A. M. pneumoniae. B. S. pneumoniae. C. M. catarrhalis. D. unidentified virus.

The most common cause of acute bursitis is: A. inactivity B. joint overuse C. fibromyalgia D. bacterial infection (Ch. 9 Fitzgerald)

The most common method of preventing DVT in higher risk surgical patients is the use of: A. Vitamin K B. LMWH C. vena cava filter D. warfarin

The most common mode of influenza virus transmission is via: A. contact with a contaminated surface. B. respiratory droplet. C. saliva contact. D. skin-to-skin contact.

The most common reason for precocious puberty in boys is: A. testicular tumor. B. a select number of relatively uncommon health problems. C. exogenous testosterone. D. early onset of normal puberty.

The primary treatment option for sarcoidosis is the use of: A. parenteral methotrexate. B. systemic corticosteroids. C. oral acetaminophen. D. oral hydroxycholoroquine. (Ch. 9 Fitzgerald)

The use of all of the following medications can trigger gout except: A. aspirin B. statins C. diuretics D. niacin (Ch. 9 Fitzgerald)

The use of which of the following medications can precipitate acute renal failure in a patient with bilateral renal artery stenosis? A. corticosteroids B. angiotensin II receptor antagonists C. beta-adrenergic antagonists D. cephalosporins (Ch. 12 Fitzgerald)

To help prevent meniscal tear, you advise: A. limiting participation in sports. B. quadriceps-strengthening exercises. C. using a knee brace D. applying ice to the knee before exercise. (Ch. 9 Fitzgerald)

Use of ST. John's wort is known to impact the effectiveness of all of the following medications except: A. oral contraceptives B. fluoroquinolones. C. cyclosporine D. select antiretrovirals. (Ch. 14 Fitzgerald)

Use of flunitrazepam (Rohypnol) has been associated with: A. agitation. B. amnesia. C. increased appetite D. hallucination. (Ch. 14 Fitzgerald)

VCUG only is indicated: A. after UTI diagnosis is confirmed to determine course of antimicrobial therapy. B. when UTI is recurrent. C. to confirm high-grade reflux. D. as an alternative to RBUS to assure accurate detection of scarring.

Wen assessing a person with acute opioid withdrawal, you expect to find: A. constipation. B. hypertension. C. hypothermia. D. somnolence. (Ch. 14 Fitzgerald)

When answering questions about hepatitis A vaccine, you consider stating that it: A. contains live virus. B. should be given to all children unless contraindicated. C. frequently causes systemic postimmunization reaction. D. is nearly 100% protective after a single injected dose.

When assessing a febrile child, the NP considers that: A. even minor temperature elevation is potentially harmful. B. nuchal rigidity is usually not found in early childhood meningitis. C. fever-related seizures usually occur at the peak of the temperature. D. most children with temperatures of 38.3°C to 40°C (101°F to 104°F) have a potentially serious bacterial infection

Based on the CURB-65 criteria, indicate which patients should be treated as an inpatient (I) or outpatient (O). 78. a 56-year-old woman with no confusion, BUN = 22 mg/dL, respiratory rate = 27/min, blood pressure = 88/56 mm Hg Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

Inpatient

Based on the CURB-65 criteria, indicate which patients should be treated as an inpatient (I) or outpatient (O). 79. a 72-year-old man with confusion, BUN = 18 mg/dL, respiratory rate = 35/min, blood pressure = 102/66 mm Hg Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

Inpatient

A. Intraocular pressure greater than 25 mmHg

Key diagnostic findings in POAG include which of the following? A. Intraocular pressure greater than 25 mmHg B. Papilledema C. Cup-to-disk ratio greater than 0.4 D. Sluggish pupillary

In a patient with suspected superficial VTE in the calf, the abnormalities in the lower extremity are potentially enhanced by having the patient stand for 2 minutes.

TRUE

Prescribing a direct thrombin inhibitor is an acceptable therapeutic option to reduce the risk of recurrent DVT.

TRUE

T/F? In general, weight lost post gastric bypass is significantly more when compared with postoperative course of a restrictive procedure such as adjustable gastric band.

TRUE

T/F? Phentermine/topiramate carries a warning about potential teratogenic effects

TRUE

True or False? In treatment of venous stasis ulcer that is not responsive to standard therapy, other options include hyperbaric oxygen therapy?

TRUE

C. C. trachomatis

The most likely causative pathogen in a 23-year-old woman with PID is: A. Escherichia coli B. Enterobacteriaceae C. C. trachomatis D. Pseudomonas

A. 2 days

The rash associated with scarlet fever typically occurs how long after the start of the symptomatic infection? A. 2 days B. 4 days C. 7 to 10 days D. 2 to 3 weeks

B. Acne vulgaris

The reduction in free androgens noted in a woman using COC can yield an improvement in: A. Cycle control B. Acne vulgaris C. Breast tenderness D. Rheumatoid arthritis

D. Corticosteroid ophthalmic drops

Treatment options in acute and recurrent allergic conjunctivitis include all of the following except: A. Cromolyn ophthalmic drops B. Oral antihistamines C. Ophthalmological antihistamines D. Corticosteroid ophthalmic drops

True or False: In an adult with BMI greater than 40 kg/m2 who is being treated with TMP-SMX for CA-MRSA,the recommended dose is two tablets bid

True

D. Mast cell stabilizers

Treatment options for POAG include all of the following topical ocular agents except: A. Beta-adrenergic antagonists B. Alpha2-agonists C. Prostaglandin analogues D. Mast cell stabilizers

D. Oral azithromycin

Treatment options for bacterial vaginosis include all of the following except: A. Oral metronidazole B. Clindamycin cream C. Oral Clindamycin D. Oral azithromycin

A. Topical acyclovir

Treatment options for patients with condyloma acuminatum include all of the following except: A. Topical acyclovir B. Cryotherapy C. Podofilox D. Trichloroacetic acid

B. Trimethoprim-sulfamethoxazole

Treatment options for streptococcal pharyngitis for a patient with penicillin allergy include all of the following except: A. Azithromycin B. Trimethoprim- sulfamethoxazole C. Clarithromycin D. Clindamycin

True or False? Anemia in children is potentially associated with poorer school performance

True

True or False? During pregnancy, folic acid requirements increased 2-fold to 4-fold

True

Patients whose CTS fails to respond to conservative treatment measures should be considered for: A. systemic corticosteroid use. B. low-dose opioids. C. surgery D. vitamin B6 injections in the carpal tunnel (Ch. 9 Fitzgerald)

Patients with subscapular bursitis typically present with A. limited shoulder ROM B. heat over affected area. C. localized tenderness under the superomedial angle of the scapula D. cervical nerve root irritation. (Ch. 9 Fitzgerald)

Patients with urge incontinence often report urine loss: A. with exercise B. at night C. associated with a strong sensation of needing to void D. as dribbling after voiding (Ch. 12 Fitzgerald)

Periodic routine screening for hypothyroidism is indicated in the presence of which condition? A. digoxin use B. male gender C. Downs syndrome D. alcoholism

Physical examination findings in patients with Graves disease includes: muscle tenderness coarse, dry skin eyelid retraction delayed relaxation phase of patellar reflex

Preferred therapy for nonmuscle-invasive bladder cancer without evidence of metastases is: A. cystectomy. B. intravesical chemotherapy only C. transurethral resection with intravesical chemotherapy D. systemic chemotherapy (Ch. 12 Fitzgerald)

Priapism is a potential adverse effect of which of the following psychotropic medications? A. bupropion B. sertraline C. trazodone D. amitriptyline (Ch. 14 Fitzgerald)

Primary prevention of CTS includes: A. screening for thyroid dysfunction. B. treatment of concomitant arthritis forms. C. stretching and toning exercises. D. wrist splinting. (Ch. 9 Fitzgerald)

Recommended A1C goals in a 79 yo woman with a 20 year history of T2DM who has difficulty ambulating, uses a walker, and has a EF of 35% with a history of heart failure should be equal to or less than: A. 7% B. 7.5% C. 8% D. 8.5%

Sally is a 34 year old married woman who is diagnosed with major depressive disorder. She feels that it is likely associated with stress resulting from her troubled marriage. She is initiated on and SSRI and reports initial improvement in symptoms. However, over the following months, the medication loses its effectiveness despite her insistence that she is being adherent with the dosing regimen. This is likely a result of: A. an inadequate dose of the medication B. development of tolerance to the SSRI C. continued or escalated stress from the troubled marriage D. missed doses despite her insistence on compliance. (Ch. 14 Fitzgerald)

Sam is a 4-year-old boy who presents with a 1-week history of intermittent fever, rash, and "watery, red eyes." Clinical presentation is of an alert child who is cooperative with examination but irritable, with a temperature of 38°C(100.4°F), pulse rate of 132 bpm, and respiratory rate of 38/min. Physical examination findings include nasal crusting; dry, erythematous, cracked lips; red, enlarged tonsils without exudate; and elevated tongue papillae. The diagnosis of Kawasaki disease is being considered. Additional findings are likely to include: A. vesicular-form rash. B. purulent conjunctivitis. C. peeling hands. D. occipital lymphadenopathy.

Spider varicosities are: A. usually symptomatic. B. a potential site for thrombophlebitis. C. responsive to laser obliteration. D. caused by sun exposure.

The American Academy of Orthopaedic Surgeons (AAOS) favors all of the following in the management of symptomatic OA of the knee except: A. low-impact aerobic exercises. B. weight loss for those with BMI >/= 25 kg/m2 C. acupuncture D. strengthening exercises. (Ch. 9 Fitzgerald)

The Vitamin D needs for a 36 year old person who is taking phenytoin are best described as: A. easily met by a well-balanced diet. B. equivalent to what is required by other adults in this age group C. markedly increased by twofold to fivefold from the age norm. D. reduced from baseline because of the drug's vitamin D-preserving qualities. (Ch. 9 Fitzgerald)

The average required caloric intake in an infant from age 0 to 3 months is usually: A. 40 to 60 kcal/kg/d. B. 60 to 80 kcal/kg/d. C. 80 to 100 kcal/kg/d. D. 100 to 120 kcal/kg/d.

The mechanism of action of metformin (Glucophage) is as: A. an insulin production enhancer B. a product virtually identical in action to sulfonylureas C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production D. a facilitator of renal glucose excretion

The mechanism of action of pioglitazone is as: A. an insulin production enhancer B. a reduce or pancreatic glucose output C. an insulin sensitizer D. a facilitator of renal glucose excretion

The most common causative organism of bronchiolitis is: A. Haemophilus influenzae. B. parainfluenza virus. C. respiratory syncytial virus. D. coxsackievirus.

The most common site of sprain is the: A. wrist. B. shoulder. C. ankle. D. knee. (Ch. 9 Fitzgerald)

The most common sites for lumbar disk herniation are: A. L1 to L2 and L2 to L3. B. L2 to L3 and L4 to L5. C. L4 to L5 and L5 to S1. D. L4 to S1 and S1 to S2. (Ch. 9 Fitzgerald)

The most helpful diagnostic test to perform during acute gouty arthritis is: A. measurement of erythrocyte sedimentation rate (ESR) B. measure of serum uric acid C. analysis of aspirate from the affected joint. D. joint radiography (Ch. 9 Fitzgerald)

The onset of anticoagulation effect of warfarin usually occurs how soon after the initiation of therapy? A. immediately B. 1 to 2 days C. 3 to 5 days D. 5 to 7 days

The onset of symptoms in food poisoning caused by Salmonella species is typically how many hours after the ingestion of the offending substance? A. 2 to 8 B. 8 to 12 C. 12 to 24 D. 24 to 36

The use of calcitonin to treat osteoporosis has been associated with an increased risk of: A. type 2 diabetes B. rheumatoid arthritis. C. malignancy D. systemic lupus erythematosus. (Ch. 9 Fitzgerald)

Risk factors for acute glomerulonephritis include all of the following except: A. bacterial endocarditis B. Goodpasture's syndrome C. Crohn's disease D. polyarteritis (Ch. 12 Fitzgerald)

Risk of benzodiazepine misuse can be minimized by use of: A. agents with a shorter half-life B. the drug as an "as-needed" rescue medication for acute anxiety. C. more lipophilic products D. products with longer duration of action. (Ch. 14 Fitzgerald)

Risk of benzodiazepine misuse is minimized by use of: A. agents with a shorter T1/2. B. the drug as an as-needed rescue medication for acute anxiety. C. more lipophilic products. D. products with long duration of action (Ch. 14 Fitzgerald)

Secondary causes of hyperglycemia potentially include the use of all of the following medications except: A. high dose niacin B. systemic corticosteroids C. high dose thiazide diuretics D. low dose angiotensin receptor blockers

Sturvite stones are typically found in people: A. with type 2 diabetes B. who live in colder climates C. who abuse alcohol D. with a history of kidney infections (Ch. 12 Fitzgerald)

Successful treatment of a patient with reactive depression associated with a loss (e.g. death of a loved one) would expect all of the following results except: A. elevated mood. B. restored function. C. improved decision-making ability. D. elimination of sadness (Ch. 14 Fitzgerald)

TSH is released by: thyroid follicles adrenal cortex hypothalamus anterior lobe of the pituitary

The 5-HT1C and 5HT2C receptor sites are associated with the following activity when stimulated A. agitation, anxiety, panic B. antimigraine effect C. antidepressant D. cerebral spinal fluid production E. nausea, diarrhea (Ch. 14 Fitzgerald)

The action of which of the following is believed to be most responsible for the sensation of satiety? norepinephrine epinephrine dopamine serotonin

The anticipated average daily weight gain during the first 3 months of life is approximately: A. 15 g or 0.53 oz. B. 20 g or 0.7 oz. C. 25 g or 0.88 oz. D. 30 g or 1 oz.

The anticipated effect on the lipid profile with high-dose omega-3 fatty acid use includes: A. increase in HDL. B. decrease in LDL. C. decrease in total cholesterol. D. decrease in triglycerides.

The anticipated result of debridement as part of the treatment of venous stasis ulcers includes all of the following except: A. enhanced tissue granulation B. encouragement of reepitheliaziation C. reduction of bacterial burden D. prevention of peripheral arterial disease

The commonly recommended physical activity level of 10,000 steps per day is roughly the equivalent of walking _____ miles. 1-2 2-3 3-4 4-5

The following symptom indicates possible acute human immunodeficiency virus (HIV) infection: A. pustular lesions in a scattered pattern. B. red wheals that begins on the face and spreads to the truck and extremities. C. vesicular-form skin lesion. D. maculopapular rash.

The rate of bronchiolitis is highest in which age group: A. toddlers. B. school-aged children. C. preschool children. D. infants younger than age 2 years.

The urinary tract abnormality most often associated with UTI in younger children is: A. bladder neck stricture. B. ureteral stenosis. C. urethral stricture. D. vesicoureteral reflux.

These results increase the likelihood that the cause of the above-mentioned child's infection is: A. viral. B. parasitic. C. fungal. D. bacterial.

Tophi are best described as: A. ulcerations originating on swollen joints B. swollen lymph nodes. C. abscesses with one or more openings draining pus onto the skin. D. nontender, firm nodules located in soft tissue (Ch. 9 Fitzgerald)

Treatment options for venous stasis ulcers in the lower extremities include: A. cleansing with hydrogen peroxide B. applying Burrow solution C. prescribing a systemic corticosteroid D. applying a moisture retaining dressing

Treatment with venlafaxine (Effexor) can lead to dose-dependent increases in: A. heart rate. B. serum glucose C. AST/ALT D. blood pressure (Ch. 14 Fitzgerald)

Universal infant vaccination against HBV was recommended in what year? A. 1972 B. 1978 C. 1982 D. 1991

Up to what percent of patients with medial epicondylitis recover without surgery? A. 35% B. 50% C. 70% D. 95% (Ch. 9 Fitzgerald)

When couseling a patient taking a bisphosphonate such as alendronate (Fosamax), you advise that the medication should be taken with: A. a bedtime snack B. a meal C. other medications D. a large glass of water (Ch. 9 Fitzgerald)

When evaluating the urinalysis of a 10-month-old infant with UTI, the NP considers that: A. leukocytes would be consistently noted. B. proteinuria is usually absent. C. the presence of urobilinogen is commonly noted. D. 20% of urinalyses can be normal.

Which medication can induce thyroid dysfunction? A. sertraline B. venlafaxine C. bupropion D. lithium

Which of the following SSRIs is associated with the greatest anticholinergic effect? A. fluvoxamine B. sertraline C. fluxoetine D. paroxetine (Ch. 14 Fitzgerald)

Which of the following antimicrobials provides effective activity against atypical pathogens? A. amoxicillin B. cefprozil C. ceftriaxone D. clarithromycin

Which of the following classes of medication is commonly recommended as part of first line therapy in the newly diagnosed T2DM patient? A. alpha glucosidase inhibitor B. meglitinide C. thiazolnidione D. biguanide

Which of the following contains the greatest amount of alcohol? A. 12 oz (360 ml) beer (9 proof) B. 4 oz (120 mL) wine (22 proof) C. 3.5 oz (105mL) mixed drink (30 proof) D. 3 oz (90mL) liquor (80 proof) (Ch. 14 Fitzgerald)

Which of the following does not directly contribute to the development of varicose veins? A. leg crossing B. pregnancy C. heredity D. Raynaud disease

Which of the following does not represent a risk factor for recurrent AOM in younger children? A. pacifier use after age 10 months B. history of first episode of AOM before age 3 months C. exposure to second-hand smoke D. beta-lactam allergy

Which of the following is an over-the-counter herbal preparation used to relieve symptoms of depression? A. valerian root B. melatonin C. kava kava D. St. John's wort (Ch. 14 Fitzgerald)

Which of the following is appropriate advice to give to a mother who is breastfeeding her 10-day-old infant? A. "Your milk will come in today." B. "To minimize breast tenderness, the baby should not be kept on either breast for more than 5 to 10 minutes." C. "A clicking sound made by the baby during feedings signifies a good latch and suck." D. "The baby's urine should be light or colorless."

Which of the following is least likely to be found in patients with pulmonary embolus (PE)? A. pleuritic chest pain B. tachypnea C. DVT signs and symptoms D. hemoptysis

Which of the following is most likely to be noted in a 3 year old with CAP? A. complaint of pleuritic chest pain B. sputum production C. report of dyspnea D. tachypnea

160. Which of the following medications is a PPI? A. loperamide B. metoclopramide C. nizatidine D. lansoprazole

D. lansoprazole

13. Peptic ulcer disease can occur in any of the following locations except: A. duodenum.B. stomach.C. esophagus.D. large intestine.

D. large intestine

83. Which of the following does not increase a patient's risk of developing colorectal cancer? A. family history of colorectal cancer B. familial polyposis C. personal history of neoplasm D. long-term aspirin therapy

D. long-term aspirin therapy

A. Vasoconstriction

Decongestants work primarily through: A. Vasoconstriction B. Action on the H1 receptor sites C. Inflammatory mediation D. Peripheral vasodilation

The 5-HT3 receptor site is associated with the following activity when stimulated A. agitation, anxiety, panic B. antimigraine effect C. antidepressant D. cerebral spinal fluid production E. nausea, diarrhea (Ch. 14 Fitzgerald)

177. Is the following statement most consistent with IBD, with IBS, or with both conditions? This is a potentially life-threatening condition.

IBD is apparently.

Yes

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a candidate for a copper-containing intrauterine device (IUD)? A 33-year-old woman with low-grade squamous intraepithelial lesions noted on Pap test

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a candidate for a copper-containing intrauterine device (IUD)? A 45-year-old woman with fibroids with uterine cavity distortion

Yes

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a category 1 or 2 COC candidate? A 45-year-old woman with tension-type headaches

B. Treatment failure rates approach 20%

You are seeing a 25-year-old man with S. Pyogenes pharyngitis. He asks if he can get a "shot of penicillin" for therapy. He has not history of drug allergy. You consider the following when counseling about the use of intramuscular penicillin: A. There is nearly 100% cure rate in streptococcal pharyngitis when it is used B. Treatment failure rates approach 20% C. This is the preferred agent in treating group G streptococcal infection D. Injectable penicillin has a superior spectrum of antimicrobial coverage compared with the oral version of the drug

how does PDE-5 inhibitors (sildenafil, vardenafil, avanafil, and tadalafil) work?

by enhancing the effects of nitric oxide, a chemical that relaxes the smooth muscles int he penis during sexual stimulation and allows increased blood flow

What is this? TSH=<0.15, Free T4=79

Hyperthyroid

you examine a 32 y/o man with chancroid and anticipate finding: a. a verruciform lesion b. a painful ulcer c. a painless, crater-like lesion d. a plaquelike lesion

b. a painful ulcer

which HPV types are most likely to cause anorectal carcinoma? a. 1 and 3 b. 6 and 11 c. 16 and 18 d. 72 and 81

c. 16 and 18

circumscribed area of skin edema

wheal

T/F in a normal pregnancy Physiologic glucosuria and proteinuria common

T/F in a normal pregnancy Physiologic systolic ejection murmur usually evident

T/F in a normal pregnancy S1 heart sound becomes louder

At which age would a child likely start to imitate housework? A. 18 months B. 24 months C. 30 months D. 36 months

Casler week 3 liver/GI

"powerpoint" michael scott voice

Of the following: 1. thinking it would be fine to just die 2. having suicidal thoughts 3. making a plan to commit suicide Which one is the most common when considering depression and thoughts about death (Ch. 14 Fitzgerald)

D. 85 years and older

1. In the elderly population, the current fastest growing group is the age range: A. 71 to 75 years B. 76 to 80 years C. 81 to 84 years D. 85 years and older

With an 8 am dose of the Regular insulin followed by inadequate dietary intake or excessive energy use, at approximately what time would hypoglycemia occur?

10 - 11 am

D. an essential gene is destroyed and causes the cell to stop dividing

10. Match Somatic mutation theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

B. relatively fragile blood vessels.

100. Older adults are at greater risk of subdural hematoma, even with minor head trauma due to: A. lower bone density in the skull B. relatively fragile blood vessels. C. decreased adipose tissue reserves. D. age-related reduction in circulating clotting factors

B. treatment with a cholinesterase inhibitor will likely improve his mental status to a point similar to his pre-dementia baseline.

104. An 81 year old man who was recently diagnosed with Alzheimer's type dementia is accompanied by his granddaughter for an office visit. The granddaughter reports that her grandfather often acts erratic with angry outbursts that can soon be followed by a more "normal" demeanor. She reports that the grandfather recently moved in with her, and she would like for this to continue as long as possible. In counselling the granddaughter, you consider all of the following except: A. behavioral difficulties often arise in patients with AD if their usual routine is disrupted. B. treatment with a cholinesterase inhibitor will likely improve his mental status to a point similar to his pre-dementia baseline. C. a home safety evaluation should be conducted and appropriate modification performed. D. any sudden change in mental status should be reported to the healthcare provider as soon as possible.

B. vitamin E

105. Which of the following supplements is used to potentially slow cognitive decline in AD? A. Vitamin B-12 B. vitamin E C. ginkgo biloba D. St. John's wort

B. creating an environment that allows for storage and retrieval of information

106. The NMDA receptor antagonist memantine works via: A. slowing the death of neurons in the brain. B. creating an environment that allows for storage and retrieval of information C. promoting more rapid transduction of nerve signals. D. a largely unknown mehanism

A. ADHD

107. Potential noncognitive reasons for behavioral issues observed in older adults include all of the following except: A. ADHD B. pain C. infection D. depression

B. language disturbance

108. Define Aphasia A. failure to recognize objects despite intact sensory function B. language disturbance C. impairment of motor activities despite intact motor function.

C. impairment of motor activities despite intact motor function.

109. Define Apraxia A. failure to recognize objects despite intact sensory function B. language disturbance C. impairment of motor activities despite intact motor function.

B. Presbycusis

11. Difficulty with appreciating the content of the conversation in a noisy environment is an age-related change in the senses reported by the older adult. It is known as: A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

A. failure to recognize objects despite intact sensory function

110. Define Agnosia A. failure to recognize objects despite intact sensory function B. language disturbance C. impairment of motor activities despite intact motor function.

A. stroke and cardiovascular events

111. The use of antipsychotic medications in older adults is associated with an increased risk for: A. stroke and cardiovascular events B. hypoglycemia C. delirium D. hypertension

B. pseudodementia

112. Dementia syndrome or cognitive impairment that is associated with severe depression is called: A. delirium B. pseudodementia C. Alzheimer's disease D. bipolar disorder

A. start at the highest dose possible of antidepressant and then titrate down once symptoms resolve

113. When managing depression in older adults, all of the following should be considered except: A. start at the highest dose possible of antidepressant and then titrate down once symptoms resolve B. encourage psychotherapy in addition to pharmacotherapy. C. utilize electroconvulsive therapy for severe depression D. conduct a medication review to minimize potential drug-drug interactions.

C. Healthcare providers have the ability to determine whether a patient can provide informed consent.

114. Which of the following statements is true with regard to decision making for the impaired patient? A. Only a court or close family member can declare a person incompetent. B. Impaired judgment can be used to declare a person incompetent C. Healthcare providers have the ability to determine whether a patient can provide informed consent. D. Informed consent does not necessarily require disclosing the diagnosis to the patient.

B. when needed to meet a healthcare need.

115. The use of physical restraints in older adults is appropriate: A. as a form of discipline B. when needed to meet a healthcare need. C. to prevent wandering outside an institution D. under no circumstances.

D. Age-related maculopathy

13. Painless vision change that includes central vision distortion is an age-related change in the senses reported by the older adult. It is known as: A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

C. Presbyopia

14. This age related change that results in near vision blurriness is a change in the senses sometimes reported by the older adult. A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

E. Chronic glaucoma

15.This age related change can result in peripheral vision loss. It is a change in the senses sometimes reported by the older adult. A. Hyposmia B. Presbycusis C. Presbyopia D. Age-related maculopathy E. Chronic glaucoma

B. alcohol abuse

16. A 76 year old woman is being treated for senile cataracts. The granddaughter who is accompanying the patient expresses concern that one day she may also develop cataracts. You explain that she can reduce the risk of senile cataracts by avoiding all of the following except: A. tobacco use. B. alcohol abuse C. ocular corticosteroid therapy D. sunlight exposure

D. reading road signs while driving

17. An 81 year old woman has early bilateral senile cataracts. Which of the following situations would likely pose the greatest difficulty for her? A. reading the newspaper B. distinguishing between primary colors C. following extraocular movements D. reading road signs while driving

D. gradual loss of peripheral vision

18. All of the following are consistent with normal age related vision changes except: A. need for increased illumination. B. increasing sensitivity to glare. C. washing out of colors D. gradual loss of peripheral vision

B. age more than 40 years

19. A risk factor for primary open-angle glaucoma is: A. postural hypotension B. age more than 40 years C. history of fungal conjunctivitis D. white race

Of the following: 1. thinking it would be fine to just die 2. having suicidal thoughts 3. making a plan to commit suicide Which one is the in the middle when considering depression and thoughts about death (Ch. 14 Fitzgerald)

With an 8 am dose of the NPH insulin, followed by inadequate dietary intake or excessive energy use, at approximately what time would hypoglycemia occur?

2 - 10pm

C. 65 to 74 years

2. The age range referred to as "young old" is A. 60 to 65 years B. 66 to 70 years C. 65 to 74 years D. 70 to 80 years

C. tobacco use.

21. Besides aging, a risk factor for age-related macular degeneration is: A. hypertension B. hyperlipidemia C. tobacco use. D. alcohol abuse.

B. use of ear protection when exposed to loud noises.

22. An effective method to prevent presbycusis is: A. avoid using cotton swabs in the ear canal. B. use of ear protection when exposed to loud noises. C. avoid using hearing aids for a prolonged period of time. D. regular cerumen removal

B. diminution of high-frequency hearing

23. A common complaint for a person with presbycusis is: A. general diminution of hearing B. diminution of high-frequency hearing C. worsening hearing at night D. unable to hear low-pitched sounds

A. a general diminution of hearing

24. A person with cerumen impaction experiences: A. a general diminution of hearing B. unhampered ability in hearing low-pitched sounds C. pain when exposed to high-pitched sounds D. an ability to hear but cannot understand a conversation in a noisy environment

C. increase in serum albumin

25. Age related changes in an elderly adult include all of the following except: A. total body water decreases by 10% to 15% between ages 20 and 80 years. B. body weight as fat increases from 18% to 36% in men and from 33% to 45% in women C. increase in serum albumin D. increase in gastric pH

B. rate of absorption is changed

26. A general principle of drug absorption in an elderly adult is best described as: A. amount of absorption is decreased B. rate of absorption is changed C. drug absorption is altered but predictable. D. bioavailability is altered

A. this value is influenced by glomerular filtration rate

27. When evaluating serum creatinine in an elderly adult, the clinician considers that: A. this value is influenced by glomerular filtration rate B. age-related physiological changes do not influence this laboratory value C. male and female norms are equivalent D. an increase is an expected age-related change.

A. loss of beta-2 receptor sites

28. Anticipated age-related changes that can result in less drug effect include: A. loss of beta-2 receptor sites B. lower gastrointestinal (GI) pH. C. increased renin-angiotensin production D. increased GI motility.

A. has diminished ability to conserve sodium

29. When prescribing a diuretic, the NP considers that the older adult: A. has diminished ability to conserve sodium B. has increased ability to excrete potassium C. has continued response to a thiazide despite increasing creatinine D. often develops allergic reaction to these products

Of the following: 1. thinking it would be fine to just die 2. having suicidal thoughts 3. making a plan to commit suicide Which one is the least common when considering depression and thoughts about death (Ch. 14 Fitzgerald)

D. increased absorption of iron and copper

31. Long-term proton pump inhibitor (PPI) is associated with all of the following except: A. increased risk of pneumonia in hospitalized patients B. increased risk of C. difficile colitis in hospitalized patients C. reduced absorption of calcium and magnesium D. increased absorption of iron and copper

D. increased renal mass to compensate for decreased function

33. Age-related renal changes in older adults potentially include all of the following except: A. decreased glomerular filtration rate (GFR) B. diminished renal blood flow C. loss of functional nephrons D. increased renal mass to compensate for decreased function

B. decreased serum creatinine

34. An expected age-related change in the older adult with intact renal function is decreased muscle mass and an associated: A. increase in serum creatinine B. decreased serum creatinine C. minimal impact on serum creatinine D. increase in creatinine clearance

A. ceftriaxone

35. In an older adult with advanced impaired renal function, the clinician anticipates that there is usually no need to adjust the antimicrobial dose with the use of: A. ceftriaxone B. tobramycin C. levofloxacin D. vancomycin

A. a lower dose is needed due to lower serum albumin

36. When dosing warfarin in older adults it is important to consider: A. a lower dose is needed due to lower serum albumin B. a lower dose is needed due to higher serum albumin C. a higher dose is needed due to lower serum albumin D. a higher dose is needed due to lower serum albumin

D. loratadine

37. Which of the following medications has little anticholinergic effect? A. diphenhydramine B. amitriptyline C. chlorpheniramine D. loratadine

39. (Y/N) Hypertension is associated with the use of anticholinergic agents in older adults

At 3 weeks of age, the average-weight, formula-fed infant should be expected to take: mL A. 2 to 3 oz, or 60 to 90 mL, every 2 to 3 hours. B. 2 to 3 oz, or 60 to 90 mL, every 3 to 4 hours. C. 3 to 4 oz, or 90 to 118 mL, every 2 to 3 hours. D. 3 to 4 oz, or 90 to 118 mL, every 3 to 4 hours.

B. highest among the old old

4. The poverty rate among elderly people residing in the United States can best be described as: A. at approximately the same level across ethnic and age groups B. highest among the old old C. greatest among married couples D. highest among older adults depending on investment income as a substantial part of their finances.

40. (Y/N) Urinary retention is associated with the use of anticholinergic agents in older adults

41. (Y/N) Constipation is associated with the use of anticholinergic agents in the older adults

C. pharmacokinetics

42. The process of absorption, distribution, metabolism, and elimination of a drug is known as: A. pharmacodynamics B. drug interactions study. C. pharmacokinetics D. therapeutic trasformation

A. phamacodynamics

43. The study of biochemical and physiological effects of drugs on the body or disease is called: A. phamacodynamics B. pharmacokinetics C. biotrasformation D. bioavailability

C. pharmacodynamics

44. When considering the properties of a drug in the body, which of the following does not change as a person ages? A. excretion B. biotransformation C. pharmacodynamics D. absorption

B. 50%

45. When prescribing a medication, the clinician considers that half-life is the amount of time needed to decrease the serum concentration of a drug by: A. 25% B. 50% C. 75% D. 100%

C. 3 to 5

46. Under ordinary circumstances, the presence of a medication in the body is needed for how many half-lives to reach steady state? A. 0.5 to 1 B. 1 to 3 C. 3 to 5 D. 5 to 7

C. 30

47. Compared with a healthy 40 year old, CYP 450 isoenzyme levels can decrease by _____% in elderly adults after age 70. A. 10 B. 20 C. 30 D. 40

B. amitriptyline

48.when considering pharmacological options to treat neuropathic pain in a 72 year old man, which of the following is the least appropriate option due to its anticholinergic effect? A. nortriptyline B. amitriptyline C. duloxetine D. venlafaxine

C. report the situation to the appropriate state agency

49. When making a home visit to a bedridden 89 year old man, you note that he is cachectic and dehydrated but cognitively intact. He states he is not receiving his medications regularly and that his granddaughter is supposed to take care of him but mentions, "She seems more interested in my Social Security check." The patient is unhappy but asks that you not "tell anybody" because he wants to remain in his home. The most appropriate action would be to: A. talk with he patient's granddaughter and evaluate her ability to care for the patient B. visit the patient more frequently to ensure that his condition dies not deteriorate C. report the situation to the appropriate state agency D. honor the patient's wishes because a competent patient has the right to determine care.

B. history of a stroke C. current diagnosis of osteoporosis D. osteoarthritis of the hips

61. Which of the following are identifiable risk factors for fall in the older adult? Choose all that apply A. negative prior history of fall B. history of a stroke C. current diagnosis of osteoporosis D. osteoarthritis of the hips

C. Routine screening is indicated as part of the care of an older adult

50. Which of the following statements is true concerning elder maltreatment? A. This problem is found mainly in families of lower socioeconomic status. B. An elderly adult who is being mistreated usually seeks help C. Routine screening is indicated as part of the care of an older adult D. In most instances of elder maltreatment, a predictable cycle of physical violence directed at the older adult followed by a period of remorse on the part of the perpetrator is the norm.

C. assumption of caregiving responsibilities at a later stage of life

51. Risk factors for becoming a perpetrator of elder maltreatment include all of the following except: A. a high level of hostility about the caregiver role B. poor coping skills C. assumption of caregiving responsibilities at a later stage of life D. maltreatment as a child.

C. five

52. Elder maltreatment is considered to be underreported, with an estimated _____ cases going unreported to each one that is reported. A. three B. four C. five D. six

D. neglect

53. The most commonly reported form of elder maltreatment is: A. physical abuse B. sexual exploitation C. financial exploitation D. neglect

B. self-neglect

54. The daughter of a 76 year old woman expresses concern regarding her mother's refusal for assistance in everyday living activities. The mother lives by herself and is often found with poor hygiene and reports eating one small meal a day. She also has poor adherence to her current medication regimen. This represents an example of: A. abandonment B. self-neglect C. early-onset dementia D. psychological abuse

C. 20, 10

55. Orthostatic (postural) hypotension is defined as an excessive decrease in blood presure with position, usually greater than ____ m Hg systolic and _____ mm Hg diastolic A. 10, 5 B. 15, 7 C. 20, 10 D. 30, 15

B. 20

56. Orthostatic hypotension is present in about ____% of older adults A. 10 B. 20 C. 30 D. 40

D. lisinopiril

57. The use of which of the following medications is associated with the least risk of postural hypotension in the older adult? A. nifedipine B. furosemide C. clonidine D. lisinopiril

C. flexing the feet multiple times before changes position

58. Lifestyle interventions for an older adult with orthostatic hypotension should include counseling about: A. avoiding the use of compression stockings B. minimizing salt intake C. flexing the feet multiple times before changes position D. restricting fluids

A. 1, 3

59. In assessing a person with or at risk for orthostatic hypotension, the BP should be measured after 5 minutes in the supine position and then ___ and ___ minutes after standing. A. 1, 3 B. 2, 4 C. 3, 5 D. 5, 10

D. a syncopal episode requiring a cardiovascular and neurological evaluation.

62. The NP is asked to evaluate a 77 year old woman who recently had an unexpected fall. The patient is normally healthy and has no mobility limitations or other obvious risk factors. During the history, the NP learns that the patient did not attempt to break the fall, "I just suddenly found myself on the floor." This statement suggests: A. a previously undiagnosed cognitive impairment that requires further evaluation. B. that the underlying sensory deficits (visual, hearing) are the most likely cause of the fall and require physical assessment. C. that a history of alcohol use or abuse should be explored D. a syncopal episode requiring a cardiovascular and neurological evaluation.

D. hip

63. In an older adult, the greatest risk of long-term complication is associated with fracture of the : A. forearm. B. spine. C. ankle. D. hip

D. semi-rigid sole shoe

64. Fall risk in an older adult is decreased with the use of which of the following footwear? A. sandal B. jogging shoe C. slipper D. semi-rigid sole shoe

B. at the peak of action

65. With the use of insulin, fall risk in an older adult is most likely to occur _____ of the medication. A. at the onset of action B. at the peak of action C. at the middle point of duration of action D. toward the end of anticipated duration of action

A. amitriptyline

66. A 68 year old man is taking multiple medications for various chronic conditions. Discontinuing or finding an alternative for which of the following medications will have the greatest impact in decreasing the potential for fall risk? A. amitriptyline B. sitagliptin C. atorvastatin D. aspirin

B. 2 to 3

67. An older adult who has recently fallen as a(n)_____ times increased risk of falling again within the next year. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5

B. walking 10 feet without the use of a walking aid

68. Which of the following is not part of the "Get Up and Go" criteria when evaluating gait and balance for a 72 year old woman who normally uses a walker? A. rising from a straight-backed chair B. walking 10 feet without the use of a walking aid C. turning around after walking 10 feet D. returning to the chair and sitting down

B. at the peak of action

69. With the use of a benzodiazepine in an older adult, the risk of fall is most likely to occur ____ of the medication. A. at the onset of action B. at the peak of action C. at the middle point of duration of action D. toward the end of anticipated duration of action.

E. proteins produced in the cell accumulate more errors during aging.

7. Match Error theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

B. pelvic floor weakness

70. Factors that contribute to stress incontinence include: A. detrusor overactivity B. pelvic floor weakness C. urethral stricture D. urinary tract infection (UTI)

B. urine culture with susceptibility testing

72. An 82 year old man presents with his caretaker who reports new-onset urinary incontinence occurring in the past 3 days. Diagnostic evaluation should include: A. PSA testing B. urine culture with susceptibility testing C. ultrasound of the bladder D. urine stream flow assessment

B. sedation and dry mouth

76. Medications used to treat urge incontinence and overactive bladder usually have anticholinergic and antimuscarinic effects that can lead to problems in older adults including: A. tachycardia and hypertension B. sedation and dry mouth C. agitation and excessive saliva production D. loose stools and loss of appetite

A. increased urinary volume

77. Poorly controlled diabetes mellitus is a potential cause of reversible urinary incontinence primarily caused by which of the following mechanisms? A. increased urinary volume B. increased UTI risk C. irritating effect of increased glucose in the urine D. decreased ability to perceive need to void

C. functional

78. A 78 year old woman who has osteoarthritis affecting both knees but no current problems with urinary incontinence is placed on a loop diuretic. She is now at increased risk for _______ urinary incontinence. A. overflow B. urge C. functional D. idiopathic

D. delirium

79. The diagnosis of _______ should be considered in an older adult with new-onset urinary incontinence coupled with an acute change in mental status. A. dementia B. spinal cord compression C. bladder stone D. delirium

B. a senescence factor accumulates in the cell

8. Match Programmed theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

D. tailgating

82. Common driving errors observed with older drivers include all of the following except: A. difficulty backing up and making turns B. delayed glare recovery when driving at night C. bumping into curbs and objects D. tailgating

B. that having the radio on to an enjoyable talk show enhances driving skills

83. When counseling an older driver, you recommend all of the following except: A. reviewing current medications for potential adverse effects. B. that having the radio on to an enjoyable talk show enhances driving skills C. predetermining the route before driving D. driving during the day and in good weather.

D. Diseases usually present at earlier stages due to impaired compensatory systems

84. Which of the following is a true statement with regard to disease presentation in older adults? A. Normal age-related changes do not alter the way an illness presents. B. Diseases in the elderly are usually more difficult to treat because they present at later stages C. A mild decline in memory an information processing is not a normal age-related change. D. Diseases usually present at earlier stages due to impaired compensatory systems

C. normal age-related decline

85. When evaluating illness symptoms in the older patients, the disease often presents in a manner different from younger adults due to: A. polypharmacy. B. increased physiological responses to illness C. normal age-related decline D. increased compensatory mechanisms.

A. mild hypothyroidism

86. In older adults, heart failure can be precipitated by: A. mild hypothyroidism B. hyperparathyroidism C. mild hyperkalemia D. mild hyponatremia

D. weight gain.

87. Risk factors for pressure ulcers include all of the following except: A. malnutrition B. dehydration C. smoking D. weight gain.

B. osteoporosis

88. Complications of pressure ulcers include all of the following except: A. squamous cell carcinoma B. osteoporosis C. bone and joint infections. D. cellulitis.

C. stage 3

89. A pressure ulcer that exhibits full-thickness skin loss with a crater-like appearance can be categorized as: A. stage 1 B. stage 2 C. stage 3 D. stage 4

With an 8 am dose of Lispro, followed by inadequate dietary intake or excessive energy use, at approximately what time would hypoglycemia occur?

8:30-9:30 am

A. collagen molecules bind to each other to produce stiffness and rigidity

9. Match Cross-link theory with it's key aspect A. collagen molecules bind to each other to produce stiffness and rigidity B. a senescence factor accumulates in the cell C. one or more latent harmful genes become activated D. an essential gene is destroyed and causes the cell to stop dividing E. proteins produced in the cell accumulate more errors during aging.

C. debridement of non-vital skin

90. Appropriate treatment of stage 1 pressure ulcer can include all of the following except: A. ensuring proper nutrition and hydration of the patient. B. regular repositioning of the patient C. debridement of non-vital skin D. special padding for vulnerable skin areas.

delirium

93. Is delirium or dementia most likely associated with the use of medications with anticholinergic effects

delirium

94. Is it more likely that mental status will potentially return to pre-illness baseline with delirium or dementia?

dementia

95. In a person with no perceptual disturbances (i.e. hallucinations) until later disease most likely experiencing delirium or dementia?

D. acute infection

96. The most common trigger for delirium is: A. alcohol withdrawal B. fecal empaction C. head trauma D. acute infection

B. Alzheimer's disease

97. The most common etiology of dementia is: A. vascular disease B. Alzheimer's disease C. traumatic head injury. D. drug-drug interaction induced.

B. cardioselective beta-adrenergic antagonists.

98. Medications that commonly contribute to delirium include all of the following except: A. first-generation antihistamines B. cardioselective beta-adrenergic antagonists. C. opiods D. benzodiazepines.

A. hyponatremia

99. Which of the following electrolyte disorders is commonly associated with delirium A. hyponatremia B. hypernatremia C. hyperkalemia D. hypophosphatemia

A 10-day-old child presents with multiple raised lesions resembling flea bites over the trunk and nape of the neck. The infant is nursing well and has no fever or exposure to animals. These lesions likely represent: A. erythema toxicum neonatorum. B. milia. C. acne neonatorum. D. staphylococcal skin infection.

A 15-year-old male is found to be at Tanner stage 1 on exam. The least likely cause of this finding is: A. A variation of normal based on ethnicity or familial factors. B. human growth hormone abnormality. C. Klinefelter syndrome. D. nutritional factors.

A 19 year old man presents with Stage I hypertension. Which of the following statements is correct concerning sports participation? A. Full activity should be encouraged. B. Weight lifting is contraindicated. C. An exercise tolerance test is advisable. D. A beta-adrenergic antagonist should be prescribed. (Ch. 9 Fitzgerald)

A 2-year-old girl presents with pustular, ulcerating lesions on the hands and feet and oral ulcers. The child is cranky, well hydrated, and afebrile. The most likely diagnosis is: A. hand-foot-and-mouth disease. B. aphthous stomatitis. C. herpetic gingivostomatitis. D. Vincent angina.

A 23 year old woman presents with mild mitral stenosis and is without symptoms. Which of the following is correct concerning sports participation? A. Full activity is likely acceptable. B. Prolonged aerobic exercise is discouraged. C. An ACE inhibitor should be prescribed prior to participation. D. Sports participation should be limited to noncontact sports. (Ch. 9 Fitzgerald)

A 25 year old woman presents with sinus arrhythmia. Which of the following statements is correct concerning sports participation? A. Full activity should be encouraged. B. Weight lifting is contraindicated. C. An exercise tolerance test is advisable. D. A calcium channel antagonist should be prescribed. (Ch. 9 Fitzgerald)

A 4-year-old child presents with fever; exudative pharyngitis; anterior cervical lymphadenopathy; and a fine, raised, pink rash. The most likely diagnosis is: A. scarlet fever. B. roseola. C. rubella. D. rubeola.

A 6-year-old boy presents with a 1-day history of a fiery red, maculopapular facial rash concentrated on the cheeks. He has had mild headache and myalgia for the past week. The most likely diagnosis is: A. erythema infectiosum. B. roseola. C. rubella. D. scarlet fever.

A 68 year old woman with heart failure presents with tachycardia, S3 heard sound and basilar crackles bilaterally. Blood pressure is 90/68 mm Hg; BUN is 58 mg/dL (20.7 mmol/L); creatinine is 2.4 mg/dL (212.1 umol/L). This clinical presentation is most consistent with A. prerenal azotemia B. acute glomerulonephritis C. acute tubular necrosis D. postrenal azotemia (Ch. 12 Fitzgerald)

A first-line approach to treat Cushing's syndrome in a 56-year-old woman who has been taking oral corticosteroids to treat rheumatoid arthritis for the past 2 years is: A. gradually tapering corticosteroid use. B. referral for surgery. C. consider radiation therapy. D. prescribe mifepristone.

A healthy 2 yo is able to: A. speak in phrases of 2 words or more B. throw a ball at a target C. scribble spontaneously D. ride a tricycle

A healthy 3 yo child is expected to: A. give his or her first and last name B. use pronouns C. kick a ball D. name a best friend

A healthy 6 to 7 month old is able to: A. roll from back to stomach B. confidently feed self a cracker C. reach for an object D. crawl on abdomen

After use, the onset of action of lispro (Humalog) occurs in: A. less than 30 minutes B. approx. 1 hour C. 1-2 hours D. 3-4 hours

Anxiety in response to a challenging life event ins a natural response by the body to: A. help a person focus on the issue at hand. B. diminish the fight-or-flight response. C. impair decision-making under duress. D. provide transient improvement in physical capabilities. (Ch. 14 Fitzgerald)

At which age is a child at greatest risk of death from pertussis? A. <1 year B. 2-4 years C. 5-10 years D. >10 years

Jason is a healthy 18 year old who presents for primary care. According to his immunization record, he received two doses of HBV vaccine 1 month apart at age 14 years. Which of the following best describes his HBV vaccination needs? A. He should receive a single dose of HBV vaccine now. B. A three-dose HBV vaccine series should be started during today's visit. C. He has completed the recommended HBV vaccine series. D. He should be tested for HBsAb and further immunization recommendations should be made according to the test results.

John is a 47 year old man who reports constant sadness following the death of his wife in a motor vehicle accident 2 weeks ago. He has not been able to function at work and avoids socializing with friends and family. You recommend: A. giving him time and support during this period of acute grief B. weekly phsychotherapy sessions C. prescribing an anxiolytic to help with grief symptoms D. psychotherapy plus a prescription for an antidepressant. (Ch. 14 Fitzgerald)

Klinefelter syndrome is most commonly marked by: A. language impairment in males. B. fine motor delay in males. C. hip and breast enlargement in women. D. attention deficit disorder in males.

Laboratory findings in heatstroke usually include: Elevated total CK Anemia Metabolic alkalosis Hypokalemia

Lifestyle modification for patients with Raynaud phenomenon includes: A. discontinuing cigarette smoking B. increasing fluid intake C. avoiding placing hands in warm water D. discontinuing ASA use

Long-term bisphosphonate treatment (i.e >5 years) has been associated with: A. atypical fractures. B. hyperprolactinemia. C. ostoarthritis D. bone marrow suppression. (Ch. 9 Fitzgerald)

Long-term use of which medication has been possibly associated with increased risk for bladder cancer? A. pioglitazone B. saxagliptin C. rosuvastatin D. clopidogrel (Ch. 12 Fitzgerald)

Most AOM is caused by: A. certain gram-positive and gram-negative bacteria and respiratory viruses. B. atypical bacteria and pathogenic fungi. C. rhinovirus and methicillin-resistant Staphylococcus aureus. D. predominately beta-lactamase-producing organisms.

Nursing infants generally maximally receive about which percentage of the maternal dose of a drug? A. 1% B. 3% C. 5% D. 10%

One week into sertraline (Zoloft) therapy, a patient complains of new onset recurrent dull frontal headache that is relieved promptly with acetaminophen. Which of the following is true in this situation? A. This is a common, transient side effect of selective serotonin reuptake inhibitor (SSRI) therapy B. She should discontinue the medication. C. Fluoxetine should be substituted. D. Desipramine should be added. (Ch. 14 Fitzgerald)

Patient with guluteus medius or deep trocharteric bursitis typically present with: A. increased pain from resisted hip abduction. B. limited hip ROM C. sciatic nerve pain D. heat over the affected area. (Ch. 9 Fitzgerald)

Patients with fibromyalgia should be encouraged to do all of the following except: A. consider adopting a high-intensity aerobic activity such as jogging B. limit caffeine use. C. utilize stress management techniques D. participate in a program of exercise focused on maintaining flexibility. (Ch. 9 Fitzgerald)

Patients with olecranon bursitis typically present with: A. swelling and redness over the affected area B. limited elbow range of motion (ROM) C. nerve impingement D. destruction of the joint space (Ch. 9 Fitzgerald)

Patients with stress incontinence often report urine loss: A. with lifting B. at night C. associated with a strong sensation of needing to void D. as dribbling after voiding (Ch. 12 Fitzgerald)

Pertaining to the use of sliding scale insulin in response to elevate blood glucose, which of the following best describes current practice? A. Discouraged because it treats hyperglycemia after it has already occurred. B. Safe and helpful method of treating hyperglycemia. C. Acceptable only in the acute care hospital setting. D. Appropriate only for patients with T1DM.

Poorly controlled asthma in children can lead to: A. attenuated lung development. B. chronic tracheitis. C. sleep apnea. D. alveolar destruction.

Possible adverse outcomes from heatstroke include: Rhabdomyloysis Anemia Hypernatremia Leukopenia

QT prolongation is a concern with higher doses of: A. citalpram B. sertraline C. venlafaxine D. fluoxetine (Ch. 14 Fitzgerald)

RA disease progression is typically evaluated using all of the following approaches except: A. x-ray B. MRI C. echosonography. D. ultrasound (Ch. 9 Fitzgerald)

Recommended exercises for patients with OA of the knee include all of the following except: A. squatting with light weights B. straight-leg raises without weights C. quadripceps sets. D. limited weight-bearing aerobic exercises. (Ch. 9 Fitzgerald)

Risk factors for acute gouty arthritis include: A. obesity B. female gender C. rheumatoid arthritis D. joint trauma (Ch. 9 Fitzgerald)

SSRI withdrawal syndrome is best characterized as: A. bothersome but not life-threatening. B. potentially life-threatening. C. most often seen with discontinuation of agents with a long half-life D. associated with seizure risk (Ch. 14 Fitzgerald)

Screening children with a known risk factor for type 2 diabetes mellitus is recommended at age 10 or at onset of puberty, and should be repeated how often? A. every other year. B. every year. C. every six months. D. If child presents with a body mass index in the 85th percentile or higher.

Secondary adrenal insufficiency can occur with the presence of a diseased or malfunctioning: A. pituitary gland. B. thyroid. C. pancreatic beta cells. D. hypothalamus.

Sepsis is defined as the: A. clinical manifestation of systemic infection. B. presence of bacteria in the blood. C. circulation of pathogens. D. allergenic response to infection.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for substance use tolerance includes: A. diminished effect with the same amount of substance used. B. desiring to get an amplified effect with higher doses. C. ability to decrease the frequency of substance use. D. absence of withdrawal symptoms when substance is not used for a prolonged period. (Ch. 14 Fitzgerald)

The Phalen test is described as: A. reproduction of symptoms with forced flexion of the wrists. B. abnormal tingling when the median nerve is tapped. C. pain on internal rotation. D. palmar atrophy (Ch. 9 Fitzgerald)

The drug buspirone (BuSpar) has: A. low abuse potential B. significant antidepressant action. C. a withdrawal syndrome when discontinued, similar to benzodiazepines D. rapid onset of action. (Ch. 14 Fitzgerald)

The findings of a painless thyroid mass and TSH level of less than 0.1 in a 35 yo woman is most consistent with: A. autonomously functioning adenoma B. Graves disease C. Hashimotos D. thyroid malignancy

The mechanism of action in DPP-4 inhibitors is as: A. a drug that increases levels of incretin, increasing synthesis and release of insulin from pancreatic beta cells B. a product of virtually identical action to sulfonylureas C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production D. a facilitator of renal glucose excretion

The mechanism of action of exenatide (Byetta) is: A. a drug that stimulates insulin production in response to increase in plasma glucose B. a product virtually identical to sulfonylureas C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production D. a facilitator of renal glucose excretion

The mechanism of action of radioactive iodine in the treatment of Graves disease is to: destroy overactive thyroid tissue reduce production of TSH alter thyroid metabolic rate relieve distress caused by increased thyroid size

The most appropriate behavioral intervention for a patient with functional incontinence would be A. having an assistant who is aware of voiding cues and helps with toileting activities B. establishing a voiding schedule and gentle ladder stretching C. Kegel exercises and pelvic floor rehabilitation with biofeedback (Ch. 12 Fitzgerald)

The most common renal stones are composed of A. Calcium B. Uric acid C. sodium D. iron (Ch. 12 Fitzgerald)

The most common type of injury causing a sport-related meniscal tear involves: A. twisting of the knee B. hyperextension of the knee C. repetitive hard impact on the knee (i.e. running on hard surface). D. an unknown origin in most cases. (Ch. 9 Fitzgerald)

The use of which of the following medications is often associated with weight gain? risperidone topiramate metformin sitagliptin

To confirm the results of a MCMurray test, you ask the patient to: A. squat. B. walk C. flex the knee D. rotate the ankle (Ch. 9 Fitzgerald)

To obtain the most accurate hydration status in a child with acute gastroenteritis, the NP should ask about: A. the time of last urination. B. thirst. C. quantity of liquids taken. D. number of episodes of vomiting and diarrhea.

Treatment of otitis media with effusion usually includes: A. symptomatic therapy. B. antimicrobial therapy. C. an antihistamine. D. a mucolytic.

When advising a person who will be using orlistat as part of a weight loss program, the NP provides the following information about when to take the medication: within an hour of each mean that contains fat before any food with high carbohydrate content only in the morning to avoid sleep disturbance up to 3 hours after any meal, regardless of types of food eaten

When considering a person's risk for measles, mumps, and rubella, the NP considers the following: A. Children should have two doses of the measles, mumps, and rubella (MMR) vaccine before their sixth birthday. B. Considerable mortality and morbidity occur with all three diseases. C. Most cases in the United States occur in infants. D. The use of the vaccine is often associated with protracted arthralgia.

When giving influenza vaccine to a 7-year-old who has not received this immunization in the past, the NP considers that: A. two doses 4 weeks or more apart should be given. B. a single dose is adequate. C. children in this age group have the highest rate of influenza-related hospitalization. D. the vaccine should not be given to a child with shellfish allergy.

When taken with warfarin, which causes a possible increased anticoagulant effect? A. clarithromycin B. carbamazepine C. pravastatin D. sucralfate

Which do you expect to find in a 2 week old infant? A. visual preference for human face B. preference for low pitched noises C. indifference to the cry of other neonates D. poorly developed sense of smell

Which is not a reason for the delayed onset of puberty in a 13-year-old boy? A. report of a high level of physical activity B. Kallmann syndrome C. familial trait D. history of radiation exposure

Which of the following agents has the longest T1/2? A. fluoxetine B. paroxetine C. citalopram D. sertraline (Ch. 14 Fitzgerald)

Which of the following agents should be avoided in heavy alcohol users due to a potential risk for hepatotoxicity? A. duloxetine B. desvenlafaxine C. escitalopram D. bupropion (Ch. 14 Fitzgerald)

Which of the following best describes the presentation of a patient with OA? A. worst symptoms in weight-bearing joints later in the day B. symmetrical early morning stiffness C. sausage-shaped digits with associated skin lesions D. back pain with rest and anterior uveitis (Ch. 9 Fitzgerald)

Which of the following characteristics about atrial septic defect is false? A. It is more common in boys than girls. B. Child presentation can range from entirely well to heart failure. C. Full sports participation is typically acceptable with correction. D. Easy fatigability is a sign of atrial septic defect. (Ch. 9 Fitzgerald)

Which of the following characteristics applies to T1DM? A. Significant hyperglycemia and ketoacidosis result from lack of insulin B. This condition is commonly diagnosed on routine exam for other health problems. C. Initial response to oral sulfonylureas is usually favorable D. Insulin resistance is a significant part of the disease.

Which of the following characteristics applies to T2DM? A. Major risk factors are hereditary and obesity. B. Pear shaped body type is commonly found. C. Exogenous insulin is needed for control disease. D. Physical activity enhances IR.

Which of the following findings is most consistent with the diagnosis of acute bacterial rhinosinusitis (ABRS) in children? A. upper respiratory tract infection symptoms persisting beyond 10 days B. nasal discharge progresses from clear to purulent to clear without antibiotics C. headaches and myalgias that resolve in 24 to 48 hours as the respiratory symptoms worsen D. persistent cough

Which of the following is an unlikely consequence of untreated metabolic syndrome and IR in a woman of reproductive age? A. hyperovulation B. Irregular menses. C. Acne. D. Hirsutism.

Which of the following is considered the ideal method for obtaining a urine sample for culture and sensitivity in an 18-month-old-old girl with suspected UTI? A. suprapubic aspiration B. transurethral bladder catheterization C. bag collection D. diaper sample

Which of the following is found early in the development of chronic renal railure? A. persistent proteinuria B. elevated creatinine level C. acute uremia D. hyperkalemia (Ch. 12 Fitzgerald)

Which of the following is most likely to be apart of the clinical presentation of an otherwise healthy 27 year old woman with uncomplicated lower urinary tract infection (UTI)? A. urinary frequency B. fever C. suprapubic tenderness D. lower gastrointestinal (GI)upset (Ch. 12 Fitzgerald)

Which of the following is noted in a child with premature thelarche? A. breast enlargement. B. accelerated linear growth. C. pubic hair. D. body odor.

Which of the following is the most likely to be found in deep vein thrombophlebitis (DVT)? A. unilateral leg edema B. leg pain C. warmth over the affected area D. positive obturator sign

Which of the following is the preferred medication to reverse the anticoagulant effects of warfarin? A. vitamin K B. protamine sulfate C. platelet transfusion D. plasma components

Which of the following is the route of transmission of the poliovirus? A. fecal-oral B. droplet C. blood and body fluids D. skin-to-skin contact

Which of the following is true about the MMR vaccine? A. This vaccine contains live virus. B. Its use is contraindicated in persons with a history of egg allergy. C. Revaccination of an immune person is associated with risk of allergic reaction. D. One dose is recommended for young adults who have not been previously immunized.

Which of the following laboratory tests can identify the causative organism of bronchiolitis? : A. nasal washing antigen test B. antibody test via blood sample. C. urine culture D. a laboratory test is not available.

Which of the following patients with acute gouty arthritis is the best candidate for local corticosteroid injection? A. a 66 year old patient with a gastric ulcer B. a 44 year old patient taking a thiazide diuretic C. a 68 year old patient with type 2 diabetes mellitus D. a 32 year old patient who is a binge drinker (Ch. 9 Fitzgerald)

Which of the following should be the goal measurement in treating a person with DM and HTN? A. BP less than 140/90 B. HA1C of 7 or greater C. TG 200-300 D. HDL 35-40

Which of the following special examinations should be periodically obtained during hydroxychloroquine sulfate use? A. dilated eye retinal examination B. bone marrow biopsy C. pulmonary function tests D. exercise tolerance test (Ch. 9 Fitzgerald)

Which of the following statements best describes the Somogyi effect? A. Insulin induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia. B. Early morning elevated blood glucose levels result in part from growth hormone and cortisol triggering hepatic glucose release C. Late evening hyperglycemia is induced by inadequate insulin dose. D. Episodes of postprandial hypoglycemia occur as a result of inadequate food intake.

Which of the following statements is most accurate concerning RA? A. Joint erosions are often evident on radiographs or MRI. B. RA s seldom associated with other autoimmune diseases. C. a butterfly-shaped facial rash is common D. Parovirus B19 infection can contribute to its developement. (Ch. 9 Fitzgerald)

Which of the following tests is most specific to the diagnosis of RA? A. elevated levels of rheumatoid factor B. abnormally high ESR C. leukopenia D. positive ANA titer (Ch. 9 Fitzgerald)

Which test is demonstrated when the examiner applies pressure to the top of the head with the neck bending forward, producing pain or numbness in the upper extremities? A. Spurling B. McMurry C. Lachman D. Newman (Ch. 9 Fitzgerald)

Which wound presents the greatest risk for tetanus infection? A. a puncture wound obtained while playing in a garden B. a laceration obtained from a knife used to trim raw beef C. a human bite D. an abrasion obtained by falling on a sidewalk

With initial presentation, the diagnosis of tendonitis is usually made from : A. clinical presentation. B. plain radiographic films C. CT scan of the area. D. laboratory diagnosis. (Ch. 9 Fitzgerald)

D. None of the above

A 24-year-old woman who requests emergency contraception pills wants to know the effects if pregnancy does occur. You respond that there is the risk of increased rate of: A. Spontaneous abortion B. Birth defects C. Placental abruption D. None of the above

With regard to seasonal influenza prevention in well children, the NP considers that: A. compared with school-aged children, younger children (≤24 months old) have an increased risk of seasonal influenza-related hospitalization. B. a full adult dose of seasonal influenza vaccine should be given starting at age 4 years. C. the use of the seasonal influenza vaccine in well children is discouraged. D. widespread use of the vaccine is likely to increase the risk of eczema and antibiotic allergies.

X-rays will fail to show changes in affected joints in approximately what percent of patients with RA at disease onset? A. 30% B. 50% C. 75% D. 95% (Ch. 9 Fitzgerald)

You are devising a program to screen preschoolers for lead poisoning. The most sensitive component of this campaign is: A. environmental history. B. physical examination. C. hematocrit level. D. hemoglobin electrophoresis.

You consider prescribing insulin glargine (Lantus) because of its: A. extended duration of action B. rapid onset of action C. ability to prevent diabetic end organ damage D. ability to preserve pancreatic function

You examine a newborn with a capillary hemangioma on her thigh. You advise her parents that this lesion: A. is likely to increase in size over the first year of life. B. should be treated to avoid malignancy. C. usually resolves within the first months of life. D. is likely to develop a superimposed lichenification.

You see a 28 year old man who has been diagnosed with moderate depression and has not responded well to SSRI therapy over the past 3 months. He was involved in a motor vehicle accident 2 years ago that resulted in head trauma and now occasionally experiences occasional clonic seizures. When considering alternative antidepressant therapy, which of the following should be avoided? A. bupropion B. trazodone C. citalopram D. duloxetine (Ch. 14 Fitzgerald)

You see a 48 year old woman who reports low back pain. During the evaluation, she meantions new-onset loss of bowel and bladder control. This most likely indicates: A. cauda equina syndrome B. muscular spasm. C. vertebral fracture. D. sciatic nerve entrapment. (Ch. 9 Fitzgerald)

A. Suppurative conjunctivitis

A 19-year-old man presents with a chief complaint of a red, irritated right eye for the past 48hrs with eyelids that were "stuck together" this morning when he awoke. Examination reveals injected palpebral and bulbar conjunctiva and reactive pupils; vision screen with the Snellen chart evaluation reveals 20/30 in the right eye (OD), left eye (OS), and both eyes (OU); and purulent eye discharge on the right. This presentation is most consistent with: A. Suppurative conjunctivitis B. Viral conjunctivitis C. Allergic conjunctivitis D. Mechanical injury

C. Allergen

A 19-year-old woman presents with a complaint of bilateral itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope-like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by a(n): A. Bacterium B. Virus C. Allergen D. Injury

A. Initiating systemic prothrombotic therapy

A 22-year-old man with recurrent epistaxis episodes fails to respond to simple pressure. Alternative approaches include all of the following except: A. Initiating systemic prothrombotic therapy B. Nasal packing C. Chemical cautery D. Topical antifibrinolytic agents

A. A chalazion

A 22-year-old woman presents with a "bump" on her right eyelid. Examination reveals a 2 mm, hard, non-tender swelling on the lateral border of the right eyelid margin. This is most consistent with: A. A chalazion B. A hordeolum C. Blepharitis D. Cellulitis

B. A hordeolum

A 22-year-old woman presents with a "pimple" on her right eyelid. Examination reveals a 2mm pustule on the lateral border of the right eyelid margin. This is most consistent with: A. A chalazion B. A hordeolum C. Blepharitis D. Cellulitis

A. Take the last pill missed immediately, even if this means taking 2 pills today

A 22-year-old woman taking a 35-mcg ethinyl estradiol COC calls after forgetting to take her pills for 2 consecutive days. She is 2 weeks into the pack. You advise her to: A. Take the last pill missed immediately, even if this means taking 2 pills today B. Discard two pills and take two pills today C. Discard the rest of the pack and start a new pack with the first day of her next menses D. Continue taking one pill daily for the rest of the cycle

C. Antimicrobial therapy minimizes the risk of glomerulonephritis

A 23-year-old man is diagnosed with pharyngitis caused by S. Pyogenes serotype 4. Which of the following statements is false regarding this patient? A. Antimicrobial therapy will reduce the risk of developing rheumatic fever B. Onset of glomerulonephritis symptoms can occur 1 to 3 weeks after pharyngeal infection C. Antimicrobial therapy minimizes the risk of glomerulonephritis D. Post streptococcal glomerulonephritis is usually a self-limiting condition.

B. Trichomoniasis

A 24-year-old woman presents with a 1-week history of thin, green-yellow vaginal discharge with perivaginal irritation. Physical examination findings include vaginal erythema with petechial hemorrhages on the cervix, numerous white blood cells, and motile organisms on microscopic examination. These findings most likely represent: A. Motile sperm with irritative vaginitis B. Trichomoniasis C. Bacterial vaginosis D. Condyloma acuminatum

B. Levofloxacin

A 25-year-old woman has a 3-day history of left ear pain that began after 1 week of URI symptoms. On physical examination, you find that she has AOM. She is allergic to penicillin (use results in a rapidly developing hive-form reaction accompanied by difficulty breathing). She took an oral antimicrobial for the treatment of a urinary tract infection 2 weeks ago. The most appropriate oral antimicrobial option for this patient is: A. Clarithromycin B. Levofloxacin C. Amoxicillin D. Cefadroxil

C. "After a rain shower"

A 25-year-old woman who has seasonal allergic rhinitis likes to spend time outdoors. She asks you when the pollen count is likely to be the lowest. You respond: A. "Early in the morning." B. "During breezy times of the day." C. "After a rain shower." D. "When the sky is overcast."

C. Peritonsilar abscess

A 26-year-old man presents with a progressively worsening sore throat with dysphasia, trismus, and unilateral otalgia. His voice is muffled, and examination reveals an erythematous, swollen tonsil with contralateral uvular deviation. The most likely diagnosis is: A. Infectious mononucleosis B. Viral pharyngitis C. Peritonsilar abscess D. Early-stage scarlet fever

B. POP is a more effective contraceptive than COC

A 26-year-old mother who breastfeeds her 10-month-old child queries about contraceptives. In counseling her on the use of the progestin-only pill (POP), you mention all of the following except: A. The pill is taken every day B. POP is a more effective contraceptive than COC C. POP does not alter the quality or quantity of breast milk D. POP is associated with bleeding irregularity, ranging from prolonged flow to amenorrhea

S. Pyogenes

A 26-year-old woman with sore throat and fever, swollen tonsils covered with exudate, palatial petechial, and anterior cervical lymphadenopathy.

C. Moxifloxacin

A 27-year-old woman presents with acute bacterial rhinosinusitis that has failed to respond to 5 days of treatment with amoxicillin. She reports that she experienced an allergic reaction to levofloxacin a few years ago that caused a rash as well as swelling of the lips and tongue. In deciding on a new antimicrobial, you consider avoiding the use of: A. Amoxicillin-clavulanate B. Azithromycin C. Moxifloxacin D. Cefpodoxime

A. Chlamydia trachomatis

A 30-year-old woman presents without symptoms but states that her male partner has dysuria without penile discharge. Examination reveals a friable cervix covered with thick yellow discharge. This description is most consistent with an infection caused by: A. Chlamydia trachomatis B. Neisseria gonorrhoeae C. Human papillomavirus (HPV) D. Trichomonas vaginalis

B. Moxifloxacin

A 34-year-old man with penicillin allergy presents with ABRS. Three weeks ago, he was treated with doxycycline for "bronchitis." You now prescribe: A. Clarithromycin B. Moxifloxacin C. Cephalexin D. Amoxicillin

Respiratory virus

A 34-year-old with cough, nasal discharge, hoarseness, conjunctival inflammation and diarrhea

B. Refer to allergy and immunology for evaluation

A 36-year-old man presents for his initial visit to become a patient in a primary care practice. He is generally in good health with a history of hyperlipidemia and is currently taking an HMG-CoA reductase inhibitor. He reports that he is "allergic to just about every antibiotic," and reports a variety of reactions including diffuse urticaria, gastrointestinal upset, and fatigue but without respiratory involvement. He is unclear as to which antibiotics have caused these reactions and states that much of what he knows is from his mother who "told me I always got sicker instead of better when I took an antibiotic." His last use of an antimicrobial was more than 10 years ago and was without reaction. He does not recall the name of this medication, but he remembers that he was being treated for a "sinus infection." The next most appropriate step in his care is to: A. Advise the patient to obtain a more detailed history of what antibiotics he was given during his childhood B. Refer to allergy and immunology for evaluation C. Inform the patient to start an antihistamine whenever he is given an antibiotic D. Provide a prescription for a systemic corticosteroid to take if he develops a reaction to his next antimicrobial course

B. Immediately removing any protruding foreign body from the eye

A 45-year-old man presents with eye pain. He reports that he was cutting a tree with a chainsaw when some wood fragments hit his eye. You consider all of the following except: A. Educating the patient on the use of appropriate eye protection for primary prevention of eye trauma B. Immediately removing any protruding foreign body from the eye C. Using fluorescein in staining to detect small objects in the eye D. Prompt referral to an eye care specialist

D. M. Catarrhalis

A 45-year-old man presents with otitis externa. Likely causative pathogens include all of the following except: A. Enterobacteriaceae B. P. Aeruginosa C. Proteus spp D. M. Catarrhalis

C. Prompt referral for sinus imaging with a CT scan

A 45-year-old person with severe ABRS has shown no clinical improvement after a total of 10 days of antimicrobial therapy. Initially treated with doxycycline for 5 days, he was then switched to levofloxacin for the past 5 days. This is his third episode of ABRS in the past 12 months. You consider: A. Initiating a course of oral corticosteroid B. Switching treatment to moxifloxacin C. Prompt referral for sinus imaging with a CT scan D. Discontinuing antimicrobial therapy, performing a nasal swab for culture and sensitivity, and treatment dependent on these results

C. 5 years

A 45-year-old woman just had a normal Pap test result and has an absence of high-risk HPV. You recommend her next Pap test in: A. 1 year B. 3 years C. 5 years D. 7 years

B. Elevated levels of testosterone

A 48-year-old woman complains of increased frequency and severity of hot flashes. Her last menses occurred 6 months ago. You would expect all of the following laboratory findings expect: A. Increased levels of LH B. Elevated levels of testosterone C. Reduced levels of estradiol D. Reduced levels of progesterone

B. The addition of a topical estrogen can be helpful

A 53-year-old woman who is taking hormone therapy (HT) with conjugated equine estrogen, 0.45 mg/d, with MPA, 1.5 mg, has bothersome atrophic vaginitis symptoms. You advise that: A. Her oral estrogen dose should be increased B. The addition of a topical estrogen can be helpful C. The MPA component should be discontinued D. Baking soda douche should be tried

D. Epstein-Barr virus

A cutaneous reaction nearly always occurs with the use of amoxicillin in the presence of infection with: A. Human herpes virus type 1 B. Human papillomavirus type 11 C. Adenovirus type 20 D. Epstein-Barr virus

D. Oral Cancer

A firm, painless, relatively fixed submandibular node would most likely be seen in the diagnosis of: A. Herpes simplex B. Acute otitis media (AOM) C. Bacterial pharyngitis D. Oral cancer

6. Is the following statement most consistent with IBD, with IBS, or with both conditions? Potential complications include increased risk for colonic malignancy. A. IBDB. IBSC. Both IBD and IBS

A. IBD

Present in Meniere's Disease

A positive Fukuda marching step test.

B. Cellulitis of the eyelid

A potential complication of hordeolum is: A. Conjunctivitis B. Cellulitis of the eyelid C. Corneal ulceration D. Sinusitis

A. Oral Metronidazole

A preferred treatment option for trichomoniasis is: A. Oral metronidazole B. Clindamycin vaginal cream C. Topical acyclovir D. Oral azithromycin

A. Cefpodoxime

A reasonable treatment option for AOM in an adult who is develops GI upset while taking amoxicillin is: A. Cefpodoxime B. Erythromycin C. Cephalexin D. Trimethoprim-sulfamethoxazole

D. Ceftriaxone injection

A recommended treatment for rectal gonorrhea is: A. Oral amoxicillin B. Oral azithromycin C. Oral ciprofloxacin D. Ceftriaxone injection

A. The presence of an immunocompromised condition

A risk factor for malignant otitis externa includes: A. The presence of an immunocompromised condition B. Age younger than 21 years C. A history of a recent upper respiratory tract infection (URI) D. A complicated course of otitis media with effusion

C. 3 to 4

A woman who has used emergency contraception pills should be advised that if she does not have a normal menstrual period within ________ weeks, a pregnancy test should be obtained. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5

Intervention in microalbuminuria for a person with DM include: (More than one may apply) A. improved glycemic control B. strict dyslipidemia control C. use of an optimized dose of ACEI or ARB D. use of an ACEI or ARB

A, B, C

Clinical conditions with presentation similar to acute bursitis include: (More than one option can apply.) A. rheumatoid arthritis B. septic arthritis C. joint trauma D. pseudogout (Ch. 9 Fitzgerald)

A, B, C, D

Which of the following best describes the physical activity recommendations such as brisk walking for a 55 yo woman with newly diagnosed T2DM? More than one can apply: A. Goal should be total increased activity of 150 min or more per week B. Increase physical activity is recommended for at least 30 minutes per day, at least 3 times a week, with no more than 48 hours without exercise C. Some form of resistance exercise such as lifting dumbells or using an exercise band should be included 3 time per week D. vigorous exercise is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy due to the risk of vitreous hemorrhage or retinal detachment

A, B, C, D

Hydration status can be determined by evaluating: A. BP B. HR C. skin turgor D. HR E. presence of dry lips and oral mucosa

A, B, C, D, E

The following are risk factors for T2DM in children and teens: A. hyperinsulinemia B. abnormal height to weight ratio C. onset of nonorganic failure to thrive in toddler years D. Native American ancestry

A, B, D

You are counseling a patient who is considering gastric bypass surgery for weight loss. You advise the following. (More than one may apply) Calcium absorption will be reduced. Rapid weight loss after obesity surgery can contribute to the development of gallstones. Chronic constipation is a common postoperative adverse effect. Lifelong vitamin B12 supplementation is recommended.

A, B, D

A 64 year old woman presents with urge incontinence and has not been able to tolerate treatment with anticholinergic agents. You recommend the use of which of the following? More than one can apply. A. botulinum toxin injections B. fesoterodine fumarate (Toviaz) C. mirabegron (Myrbetriq) D. finasteride (Proscar) (Ch. 12 Fitzgerald)

A, C

The following are risk factors for HTN in children and teens: A. being obese B. drinking whole milk C. being exposed to second hand smoke D. watching 2 or more hours of television per day

A, C

The following criteria should be met for a child to be treated for AOM with observation and analgesia but no antimicrobial therapy? A, age greater than 6 months B. bilateral infection C. moderate illness D. presumptively caused by bacterial infection

A, C

Which of the following must be present for the diagnosis of AOM? A. bulging TM B. TM retraction C. otalgia D. anterior cervical lymphadenopathy

A, C

100. Lung cancer ranks number as a cause of cancer-related death in men and women. A. 1 B. 2 C. 3 D. 4 Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 157). F.A. Davis Company. Kindle Edition.

A. 1

A burn that is about twice as large as an adult's palmar surface of the hand including the fingers encompasses aBSA of approximately ____%. A. 1 B. 2 C. 3 D. 4

A. 1

You see a 33-year-old male with a minor dog bite on his hand. The examination reveals a superficial wound on the left palm. The dog is up-to-date on immunizations. In deciding whether to initiate antimicrobial therapy, you consider that ______ of dog bites become bacterially infected. A. 5% B. 20% C. 50% D. 75%

A. 5%

A drug with demonstrated safety for use in all trimesters of pregnancy is categorized a USFDA risk category: A. A B. B C. C D. D

A. A

One of the earliest lab markers in evolving macrocytic or microcytic anemia is: A. An increase in RBC distribution width (RDW) B. A reduction in measurable hemoglobin C. A low MCH level D. An increased PLT count

A. An increase in RBC distribution width (RDW)

Match the at-risk ethnic groups for the following genetically based conditions. Tay-Sachs disease A. Ashkenazi Jewish ancestry B. Norther European ancestry C. African ancestry

A. Ashkenazi Jewish ancestry

Lyme disease is caused by the bacterium: A. Borrelia burgdorferi. B. Bacillus anthracis. C. Corynebacterium striatum. D. Treponema pallidum

A. Borrelia burgdorferi

Match the stage of pregnancy with the appropriate term. Up to 8 to 10 weeks A. Embryo B. Fetus C. Blastocyst D. Zygote

A. Embryo

180. You see a 27-year-old man who says he ate at a restaurant last week that was later reported to have a worker identified with hepatitis A. He is healthy and shows no sign of infection but is concerned about contracting HAV infection. You recommend: A. HAV vaccine. B. HAV immune globulin. C. HAV vaccine plus immune globulin. D. no intervention at this time and wait until symptoms manifest.

A. HAV vaccine.

86. You are caring for a 52-year-old man who is currently smoking 1.5 packs per day (PPD), has a 40 pack-year cigarette smoking history, and has CAP. It is the third day of his antimicrobial therapy, and he is without fever, is well hydrated, and is feeling less short of breath. His initial chest x-ray revealed a right lower lobe infiltrate. Physical examination today reveals peak inspiratory crackles with increased tactile fremitus in the right posterior thorax. Which of the following represents the most appropriate next step in this patient's care? A. His current plan of care should continue because he is improving by clinical assessment. B. A chest radiograph should be taken today to confirm resolution of pneumonia. C. Given the persistence of abnormal thoracic findings, his antimicrobial therapy should be changed. D. A computed tomography (CT) scan of the thorax is needed today to image better any potential thoracic abnormalities. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

A. His current plan of care should continue because he is improving by clinical assessment.

137. Is the following statement most consistent with IBD, with IBS, or with both conditions? Extraintestinal manifestations occasionally include nondestructive arthritis and renal calculi. A. IBD B. IBS C. Both IBD and IBS

A. IBD

80. Is the following statement most consistent with IBD, with IBS, or with both conditions? Involvement can be limited to intestinal mucosa only, or the full thickness of the intestinal wall can be involved. A. IBD B. IBS C. Both IBD and IBS

A. IBD

The time to highest blood concentration (Cmax) of epinephrine is shorter when the medication is given: A. IM in the vastus lateralis B. SQ in the abdominal wall C. IM in the deltoid D. IM into the gluteus

A. IM in the vastus lateralis

172. Which of the following is most consistent with the presentation of a patient with acute colonic diverticulitis? A. cramping, diarrhea, and leukocytosis B. constipation and fever C. right-sided abdominal pain . frank blood in the stool with reduced stool caliber

A. cramping, diarrhea, and leukocytosis

Which of the following statements is most accurate regarding cellulitis? A. Insect bites, abrasion, or other skin trauma can be the origin of cellulitis. B. Cellulitis most often occurs on the chest and abdomen. C. Necrosis is a common complication of cellulitis. D. Cellulitis often occurs spontaneously without any identifiable skin wound

A. Insect bites, abrasion, or other skin trauma can be the origin of cellulitis

26. Which of the following statements is false regarding the use of omalizumab (Xolair®)? A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares. B. The medication selectively binds to immunoglobulin E (IgE) to reduce exacerbations. C. Labeled indication is for patients with poorly controlled asthma with frequent exacerbations. D. Special evaluation is required prior to its use and ongoing monitoring is needed during use. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares.

90. Which pneumococcal vaccine offers protection against the greatest number of serotypes? A. Pneumovax® B. Prevnar® C. PCV7 D. LAIV Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 153). F.A. Davis Company. Kindle Edition.

A. Pneumovax®

54. A 33-year-old woman works in a small office with a man recently diagnosed with active pulmonary TB. Which of the following would be the best plan of care for this woman? A. She should receive TB chemoprophylaxis if her TST result is 5 mm or more in induration. B. Because of her age, TB chemoprophylaxis is contraindicated even in the presence of a positive TST result. C. If the TST result is positive but the chest radiograph is normal, no further evaluation or treatment is needed. D. Further evaluation is needed only if the TST result is 15 mm or more in induration. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

A. She should receive TB chemoprophylaxis if her TST result is 5 mm or more in induration.

Match uterine size with stage of pregnancy. 10 weeks A. Size of a baseball B. Size of a softball or grapefruit C. Size of a large lemon D. Size of a tennis ball or orange E. Uterine fundus at umbilicus F. Uterine fundus halfway between symphysis pubis and umbilicus

A. Size of a baseball First fetal heart tone via abdominal Doppler at 10 to 12 weeks

In a 13-year-old female patient with mild acne and who experiences an inadequate response to benzoyl peroxide treatment, an appropriate treatment option would be to: A. add a topical retinoid. B. add an oral antibiotic. C. consider isotretinoin. D. consider hormonal therapy.

A. add a topical retinoid

18. Which of the following is consistent with the NAEPP comment on the use of inhaled corticosteroids (ICS) for a child with asthma? A. The potential but small risk of delayed growth with ICS is well balanced by their effectiveness. B. ICS should be used only if a leukotriene receptor antagonist fails to control asthma. C. Permanent growth stunting is consistently noted in children using ICS. D. A leukotriene receptor antagonist are equal in therapeutic effect to the use of a long-acting beta2-agonist. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

A. The potential but small risk of delayed growth with ICS is well balanced by their effectiveness.

43. A 56-year-old man with a 60 pack-year cigarette smoking history, recent 5-lb unintended weight loss, and a 3-month history of new-onset symptoms of peptic disease presents for care. He is taking no medications on a regular basis and reports drinking approximately six 12-oz beers per week with no more than three beers per day. Physical examination is unremarkable except for mild pharyngeal erythema and moderate epigastric tenderness without rebound. The most helpful diagnostic test at this point in his evaluation is: A. an upper endoscopy.B. a barium swallow.C. an evaluation of H. pylori status.D. an esophageal pH monitoring.

A. Upper endoscopy.

Match the clinical presentation of the following. Inevitable abortion A. Uterine contents include a nonviable pregnancy that is in the process of being expelled B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable C. The products of conception have been completely expelled D. US evaluation shows a viable pregnancy, although vaginal bleeding is present

A. Uterine contents include a nonviable pregnancy that is in the process of being expelled

104. When compared with screening for breast cancer, screening for lung cancer results in: A. a lower number needed to screen to prevent one death. B. approximately the same number needed to screen to prevent one death. C. a higher number needed to screen to prevent one death. D. a higher percentage of patients identified where cancer can be prevented. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 158). F.A. Davis Company. Kindle Edition.

A. a lower number needed to screen to prevent one death.

145. Lower GI hemorrhage associated with diverticular disease usually manifests as: A. a painless event. B. a condition noted to be found with a marked febrile response. C. a condition accompanied by severe cramp-like abdominal pain. D. a common chronic condition.

A. a painless event.

Which of the following examples represents a potential malpractice scenario? A. a patient with type 2 diabetes mellitus is prescribed an inappropriate dose of insulin and experiences a severe hypoglycemic episode B. a patient with a known self allergy is prescribed trimethoprim-sulfamethoxazole (TMP-SMX) but no reaction occurs C. a patient with acute bacterial sinusitis does not see any improvement in signs and symptoms 3 days after being given a dose-appropriate prescription for augmentin D. prior to taking a medication, a patient realizes that the wrong drug was dispensed at the pharmacy

A. a patient with type 2 diabetes mellitus is prescribed an inappropriate dose of insulin and experiences a severe hypoglycemic episode

Skin lesions associated with actinic keratoses can be described as: A. a slightly rough, pink or flesh-colored lesion in a sun-exposed area. B. a well-defined, slightly raised, red, scaly plaque in a skinfold. C. a blistering lesion along a dermatome. D. a crusting lesion along flexor aspects of the fingers

A. a slightly rough, pink or flesh-colored lesion in a sun-exposed area

65. Clinical findings most consistent with appendiceal rupture include all of the following except: A. abdominal discomfort less than 48 hours in duration. B. fever greater than 102°F (>38°C). C. palpable abdominal mass. D. marked leukocytosis with total WBC greater than 20,000/mm3.

A. abdominal discomfort less than 48 hours in duration.

2. Clinical findings in patients with acute hepatitis B likely include all of the following except: A. abdominal rebound tenderness.B. scleral icterus.C. a smooth, tender, palpable hepatic border.D. report of myalgia.

A. abdominal rebound tenderness

72. Which of the following is a quality of respiratory fluoroquinolones? A. activity against drug-resistant S. pneumoniae (DRSP) B. poor activity against atypical pathogens C. predominantly hepatic route of elimination D. poor activity against beta-lactamase-producing organisms. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

A. activity against drug-resistant S. pneumoniae (DRSP)

Criteria for an "incident to" office visit include all of the following except that: A. all prescriptions must be written by the physician B. the physician must conduct the initial visit and any visit in which there is a new episode of illness or a change in the plan of care C. the physician, in most instances, must be in the suite of offices, though not in the same room while the NP performs the service

A. all prescriptions must be written by the physician

Medicare Part C: A. allows beneficiaries to enroll in private plan as an alternative to the traditional fee-for-service plan B. covers inpatients and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, NP, outpatient, home health, and preventive services

A. allows beneficiaries to enroll in private plan as an alternative to the traditional fee-for-service plan

An oral antimicrobial option for the treatment of methicillin-sensitive S. aureus includes all of the following except: A. amoxicillin. B. dicloxacillin. C. cephalexin. D. cefadroxil

A. amoxicillin

99. A 34-year-old woman presents with a 7-day history of cough with no fever or difficulty breathing. She is otherwise healthy. She is producing small amounts of yellow-tinged sputum. As part of her treatment, you recommend: A. an antitussive. B. an antihistamine. C. a macrolide antimicrobial. D. a beta-lactam antimicrobial. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 157). F.A. Davis Company. Kindle Edition.

A. an antitussive.

Anthralin (Drithocreme) is helpful in treating psoriasis because it has what kind of activity? A. antimitotic B. exfoliative C. vasoconstrictor D. humectant

A. antimitotic

Testing for STI should be initially obtained: A. as early as possible in pregnancy B. during the second trimester C. during the third trimester D. as close to the anticipated date of birth as possible

A. as early as possible in pregnancy

184. A 35-year-old woman complains of a 6-month history of periodic "heartburn" primarily after eating tomato-based sauces. Her weight is unchanged and examination reveals a single altered finding of epigastric tenderness without rebound. As first-line therapy, you advise: A. avoiding trigger foods. B. the use of a prokinetic agent. C. addition of sucralfate with meals. D. increased fluid intake with food intake.

A. avoiding trigger foods.

63. Choose the therapy for: a 42-year-old man with no comorbidity, no reported drug allergy, and no recent antimicrobial use? A. azithromycin B. cefpodoxime C. trimethoprim-sulfamethoxazole D. ciprofloxacin Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

A. azithromycin

74. The primary mechanism of antimicrobial resistance of H. influenzae is through the organism's: A. beta-lactamase production. B. hypertrophy of cell membrane. C. alteration in protein-binding sites. D. failure of DNA gyrase reversal. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

A. beta-lactamase production.

Match sign with correct characteristic. Chadwick sign A. blue-violet vaginal color B. softening of uterus isthmus C. softening of vaginal portion of the cervix

A. blue-violet vaginal color

SSRI with withdrawal syndrome is best characterized as: A. bothersome but not life-threatening B. potentially life-threatening C. most often seen with medications with a longer half-life D. associated with seizure risk

A. bothersome but not life-threatening

139. Which of the following best describes colonic diverticulosis? A. bulging pockets in the intestinal wall B. poorly contracting intestinal walls C. strictures of the intestinal lumen D. flaccidity of the small intestine

A. bulging pockets in the intestinal wall

Which of the following medications is likely to cause the most sedation? A. chlorpheniramine B. cetirizine C. fexofenadine D. loratadine

A. chlorpheniramine

33. The H2RA most likely to cause drug interactions with phenytoin and theophylline is: A. cimetidine.B. famotidine.C. nizatidine.D. ranitidine.

A. cimetidine

67. Choose the therapy for: a 28-year-old woman with a severe beta-lactam allergy who has a dry cough, headache, malaise, no recent antimicrobial use, and no comorbidity who takes no medication? A. clarithromycin B. amoxicillin C. levofloxacin D. ceftriaxone Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

A. clarithromycin

When compared with children with private insurance, those with Medicaid and CHIP are: A. comparable in access to healthcare and meeting several core measures in preventive care B. more deficient in several core measures of preventive care C. less likely to see primary care providers D. more likely to receive mandatory immunizations

A. comparable in access to healthcare and meeting several core measures in preventive care

82. Commonly encountered diagnoses other than acute appendicitis can include which of the following in a 28-year-old with a 2-day history of lower abdominal pain and with right-sided pain slightly worse than left? (Select all that apply.) A. constipation B. pelvic inflammatory disease C. ectopic pregnancy D. splenic infarct

A. constipation B. pelvic inflammatory disease C. ectopic pregnancy

You have initiated therapy for an 18-year-old man with acne vulgaris and have prescribed doxycycline. He returns in 3 weeks, complaining that his skin is "no better." Your next action is to: A. counsel him that 6 to 8 weeks of treatment is often needed before significant improvement is achieved. B. discontinue the doxycycline and initiate minocycline therapy. C. advise him that antibiotics are likely not an effective treatment for him and should not be continued. D. add a second antimicrobial agent such trimethoprim-sulfamethoxazole.

A. counsel him that 6 to 8 weeks of treatment is often needed before significant improvement is achieved

69. When considering an IBS diagnosis, the NP should be aware that: A. diagnosis is largely based on clinical presentation and application of the Rome III Criteria.B. a colonoscopy should be done routinely when the diagnosis is suspected.C. complete blood count (CBC), erythrocyte sedimentation rate (ESR), CRP, and serum albumin should be the initial labs for an IBS workup.D. once an IBS diagnosis has been confirmed, you can assure the patient that treatment is generally curative.

A. diagnosis is largely based on clinical presentation and application of the Rome III Criteria. INSTRUCTIONS Recurrent abdominal pain or discomfort, 3 days per month in the last 3 months (12 weeks), associated with ≥2 of the criteria below. The criteria are fulfilled with symptoms onset 6 months prior to diagnosis. 2+ required for positive diagnosis Improvement with defecation Onset associated with a change in stool frequency Onset associated with a change in stool form (appearance)

Which of the following is the best treatment option for cellulitis when risk of infection with a methicillin-resistant pathogen is considered low? A. dicloxacillin B. amoxicillin C. metronidazole D. trimethoprim-sulfamethoxazole

A. dicloxacillin

71. Rectal bleeding associated with anal fissure is usually described by the patient as: A. drops of blood noticed when wiping.B. dark brown to black in color and mixed in with normal-appearing stool.C. a large amount of brisk red bleeding.D. significant blood clots and mucus mixed with stool.

A. drops of blood noticed when wiping.

Results from the establishment of a provider-patient relationship: A. duty of care B. breach of the standard of care C. injury D. proximal cause

A. duty of care

174. Which of the following is usually not seen in the diagnosis of acute cholecystitis? A. elevated serum creatinine B. increased alkaline phosphatase level C. leukocytosis D. elevated aspartate aminotransferase (AST) level

A. elevated serum creatinine

Which of the following do you expect to find in the assessment of the person with urticaria? A. eosinophilia B. low erythrocyte sedimentation rate C. elevated thyroid-stimulating hormone level D. leukopenia

A. eosinophilia

68. Diagnostic testing in inflammatory bowel disease (IBD) often reveals: A. evidence of underlying inflammation. B. notation of intestinal parasites. C. normal results on most testing. D. a characteristic intra-abdominal mass on radiological imaging.

A. evidence of underlying inflammation.

A 78-year-old resident of a long-term care facility complains of generalized itchiness at night that disturbs her sleep. Her examination is consistent with scabies. Which of the following do you expect to find on examination? A. excoriated papules on the interdigital area B. annular lesions over the buttocks C .vesicular lesions in a linear pattern D. honey-colored crusted lesions that began as vesicles

A. excoriated papules on the interdigital area

An 88-year-old, community-dwelling man who lives alone has limited mobility because of osteoarthritis.Since his last office visit 2 months ago, he has lost 5%of his body weight and has developed angular cheilitis. You expect to find the following on examination: A. fissuring and cracking at the corners of the mouth B. marked erythema of the hard and soft palates C. white plaques on the lateral borders of the buccal mucosa D. raised, painless lesions on the gingival

A. fissuring and cracking at the corners of the mouth

Concerning individuals who are disabled, Medicaid funding can assist in all of the following except: A. fund education opportunities (I.e., tuition) B. provide a fuller range of healthcare services C. maximize independent living opportunities D. support participation in the workforce, if possible

A. fund education opportunities (I.e., tuition)

Symptoms of postpartum depression include all of the following except: A. hallucination B. overwhelming fatigue C. insomnia D. severe mood swings

A. hallucination

84. Elevated lipase levels can be a result of all of the following conditions except: A. hepatic failure. B. renal failure. C. perforated duodenal ulcer. D. bowel obstruction or infarction.

A. hepatic failure

Match each hypertensive disorder with its characteristic. Gestational HTN A. high BP diagnosed after 20th week of pregnancy B. presence of tonic-clonic seizures or other alteration in mental status C. high BP diagnosed before pregnancy D. preeclampsia accompanied by elevated hepatic enzymes and low platelets E. high BP diagnosed after the 20th week of pregnancy and accompanied by significant proteinura

A. high BP diagnosed after 20th week of pregnancy

A significant rabies risk is associated with a bite from all of the following except: A. humans B. foxes C. bats D. skunks

A. humans

7. Which of the following is most likely to appear on a chest radiograph of a person during an acute severe asthma attack? A. hyperinflation B. atelectasis C. consolidation D. Kerley B signs Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition.

A. hyperinflation

The mechanism of action of imiquimod is as a/an: A. immunomodulator. B. antimitotic. C. keratolytic. D. irritant

A. immunomodulator

The mechanism of action of pimecrolimus (Elidel) in the treatment of atopic dermatitis is as a/an: A. immunomodulator B. antimitotic C. mast cell activator D. exfoliant

A. immunomodulator

86. Esophageal squamous cell cancer is usually located: A. in the upper esophagus. B. near the upper esophageal sphincter.C. at the junction of the esophagus and stomach.D. in the lower esophagus.

A. in the upper esophagus.

You see a 36-year-old man with no chronic health problems who presents with two furuncles, each around 4 cm in diameter, on the right anterior thigh. These lesions have been present for 3 days, slightly increasing in size during this time. He has no fever or other systemic symptoms. You advise the following: A. incision and drainage of the lesion B. a systemic antibiotic empirically C. a topical antibiotic D. aspiration of the lesion contents and prescription of a systemic antibiotic based on culture results

A. incision and drainage of the lesion

The most common form of acquired anemia during pregnancy is: A. iron deficiency B. folate deficiency C. vitamin B12 deficiency D. primary hypoproliferative

A. iron deficiency IDA is the most common form of anemia during pregnancy with most cases occurring because the woman enters pregnancy with iron deficiency rather than develops this problem because of increased iron requirements. In terms of elemental iron, requirements are as follows: in absence of iron deficiency, 30 mg/d; with iron deficiency or in a multiple gestation pregnancy, 60 to 100 mg/day. A 325 mg ferrous sulfate tablet contains 65 mg of elemental iron, whereas most prescription prenatal vitamins contain 30 to 65 mg.

50. All of the following characterize celiac disease except that: A. it is a temporary immunological gluten disorder. B. it affects more often people of northern European ancestry. C. it causes diffuse damage to the proximal small intestinal mucosa with malabsorption of nutrients. D. it is often misdiagnosed as irritable bowel disease.

A. it is a temporary immunological gluten disorder.

52. All of the following are consistent with the GOLD COPD recommendation for pulmonary rehabilitation except: A. it is reserved for very severe COPD. B. its goals include improvement in overall well-being. C. it is an underused therapeutic option. D. its components are aimed at reducing the deconditioning common in COPD. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

A. it is reserved for very severe COPD.

Risk factors for preeclampsia include all of the following except: A. low maternal weight B. age younger than 16 years or older than 40 years C. collagen vascular disease D. first pregnancy with a new partner

A. low maternal weight

182. Major risk factors for diverticulosis include all of the following except: A. low-fiber diet. B. family history of the condition. C. older age. D. select connective tissue disorders (e.g., Marfan syndrome).

A. low-fiber diet.

46. You see a 22-year-old male who is an injection drug user who has recently been diagnosed with chronic HBV infection. You recommend additional testing for all of the following except: A. Lyme disease.B. HIV.C. HAV.D. HCV.

A. lyme disease.

44. According to the GOLD COPD guidelines, the goal of inhaled corticosteroid use in severe COPD is to: A. minimize the risk of repeated exacerbations. B. improve cough function. C. reverse alveolar hypertrophy. D. help mobilize secretions. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

A. minimize the risk of repeated exacerbations.

77. First-line therapy for Crohn's disease or ulcerative colitis is: A. oral aminosalicylates. B. parenteral corticosteroids. C. antibiotics. D. immune modulators.

A. oral aminosalicylates

Second-line drug intervention in the presence of anaphylaxis should be: A. oral diphenhydramine B. nebulized albuterol C. nebulized epinephrine D. oral prednisone

A. oral diphenhydramine

58. The clinical presentation of pancreatic cancer involving the head of the pancreas usually includes: A. painless jaundice. B. polycythemia. C. hematuria. D. hyperkalemia.

A. painless jaundice.

98. The most common anal fissure location is: A. posterior midline of the anus. B. anterior anal midline. C. anterior and posterior anal midline. D. transversely across the anal mucosa.

A. posterior midline of the anus.

165. Which of the following is most likely to be found in a 40-year-old woman with new-onset reflux esophagitis? A. recent initiation of estrogen-progestin hormonal therapy B. recent weight loss C. report of melena D. evidence of H. pylori infection

A. recent initiation of estrogen-progestin hormonal therapy

67. A 56-year-old man with a history of colon cancer undergoes a follow-up abdominal MRI scan. A small mass is identified on the pancreas that is later diagnosed as a benign pseudocyst. The pseudocyst is not causing any symptoms and measures 8 mm in diameter. You consider: A. repeating the scan in 1 year to check for any changes. B. draining the pseudocyst. C. surgical removal of the pseudocyst. D. initiating a regimen of anti-inflammatory medication to decrease the size of the pseudocyst.

A. repeating the scan in 1 year to check for any changes.

43. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD guidelines, which of the following medications is indicated for use in all COPD stages? A. short-acting inhaled beta2-agonist B. inhaled corticosteroid C. phosphodiesterase 4 (PDE-4) inhibitor D. mucolytic Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

A. short-acting inhaled beta2-agonist

88. Rectal bleeding associated with hemorrhoids is usually described as: A. streaks of bright red blood on the stool. B. dark brown to black in color and mixed in with normal-appearing stool. C. a large amount of brisk red bleeding. D. significant blood clots and mucus mixed with stool.

A. streaks of bright red blood on the stool.

When prescribing itraconazole (Sporanox), the NPconsiders that: A. the drug is a cytochrome P-450 3A4 inhibitor. B. one pulse cycle is recommended for fingernail treatment, and two cycles are needed for toenail therapy. C. continuous therapy is preferred in the presence of hepatic disease. D. taking the drug on an empty stomach enhances the efficacy of the product

A. the drug is a cytochrome P-450 3A4 inhibitor

14. Cyclooxygenase-2 (COX-2) contributes to: A. the inflammatory response.B. pain transmission inhibition.C. maintenance of gastric protective mucosal layer.D. renal arteriole dilation.

A. the inflammatory response.

155. You see a 72-year-old woman who reports vomiting and abdominal cramping occurring over the past 24 hours. In evaluating a patient with suspected appendicitis, the clinician considers that: A. the presentation can differ according to the anatomical location of the appendix. B. this is a common reason for acute abdominal pain in elderly patients. C. vomiting before onset of abdominal pain is often seen. D. the presentation is markedly different from the presentation of pelvic inflammatory disease.

A. the presentation can differ according to the anatomical location of the appendix.

A possible adverse effect with the use of a first-generation antihistamine such as diphenhydramine in an 80-year-old man is: A. urinary retention. B. hypertension. C. tachycardia. D. urticaria

A. urinary retention.

In counseling a patient with seborrheic dermatitis on the scalp about efforts to clear lesions, you advise her to: A. use ketoconazole shampoo. B. apply petroleum jelly nightly to the affected area. C. coat the area with high-potency corticosteroid cream three times a week. D. expose the lesions periodically to heat by carefully using a hair dryer.

A. use ketoconazole shampoo

All of the following organisms have been implicated in the development of rosacea except: A. viruses B. bacteria C. yeast D. mites

A. viruses

42. Irritable bowel syndrome is characterized by all of the following except: A. weight loss and malnutrition.B. abdominal pain or discomfort (hypersensitivity) at least three times per month for a 6-month period.C. altered bowel pattern in the absence of detected structural abnormalities.D. occurs two to three times more often in women than men.

A. weight loss and malnutrition.

An urticarial lesion is usually described as a: A. wheal B. plaque C. patch D. papule

A. wheal

One of the most common trigger agents for contact dermatitis is: A. exposure to nickel B. use of fabric softener C. bathing with liquid body wash D. eating spicy foods

A.exposure to nickel

A. Streptococcus pyogenes pharyngitis

An 18-year-old woman has chief complaint of a "sore throat and swollen glands" for the past 3 days. Her physical examination includes a temperature of 101 degrees F (38.3 degrees C), exudative pharyngitis, and tender anterior cervical lymphadenopathy. Right and left upper quadrant abdominal tenderness is absent. The most likely diagnosis is: A. Streptococcus pyogenes pharyngitis B. Infectious mononucleosis C. Viral pharyngitis D. Vincent angina

Is Lanugo associated with anorexia nervosa, bulimia nervosa, or both disorders (Ch. 14 Fitzgerald)

Anorexia nervosa

C. Localized nasal mucosa trauma

Anterior epistaxis is usually caused by: A. Hypertension B. Bleeding disorders C. Localized nasal mucosa trauma D. A foreign body

D. Cromolyn nasal spray

According to ARIA treatment guidelines, which of the following medications affords the least control of rhinorrhea associated with allergic rhinitis? A. Anticholinergic nasal spray B. Antihistamine nasal spray C. Corticosteroid nasal spray D. Cromolyn nasal spray

B. Decongestant nasal spray

According to the Allergic Rhinitis and Its Effects on Asthma (ARIA) treatment guidelines, which of the following medications affords the best relief of acute nasal congestion? A. Anticholinergic nasal spray B. Decongestant nasal spray C. Corticosteroid nasal spray D. Oral antihistamine

A. Topical mast cell stabilizer with a topical antihistamine

According to the Global Resources in Allergy (GLORIA) guidelines, which of the following is recommended for intervention in persistent allergic conjunctivitis? A. Topical mast cell stabilizer with a topical antihistamine B. Ocular decongestant C. Topical nonsteroidal antiinflammatory drug D. Topical corticosteroid

B. AIDS-defining illness

According to the U.S. Medical Eligibility Criteria for Contraception Use, which of the following is a clinical condition in which use of a copper-containing IUD should be approached with caution? A. Uncomplicated valvular heart disease B. AIDS-defining illness C. Hypertension D. Dysmenorrhea

B. Purulent eye discharge

All of the following are components of the classic ophthalmological emergency except: A. Eye pain B. Purulent eye discharge C. Red eye D. New onset change in visual acuity

D. Pustular lesions

All of the following are likely reported in a woman with an initial episode of genital HSV-2 (HHV-2) infection except: A. Painful ulcer B. Inguinal lymphadenopathy C. Thin vaginal discharge D. Pustular lesions

A. When allergy symptoms are controlled with environmental management

Allergen subcutaneous immunotherapy should be considered in all of the following except: A. When allergy symptoms are controlled with environmental management B. When allergy symptoms persist despite optimal use of appropriate medications C. When there is a desire to reduce the use of allergy medications D. To prevent progression or development of asthma

D. Insertion of a copper-containing IUD offers an effective form of emergency and ongoing contraception

An 18-year-old woman requests emergency contraception after having unprotected vaginal intercourse approximately 18 hours ago. Today is day 12 of her normally 27- to 29- day menstrual cycle and she has no contraindications to the use of any currently available forms of emergency contraception. You advise her that: A. Emergency hormonal contraception use reduces the risk of pregnancy by approximately 33% B. All forms of emergency contraception must be used within 12 hours after unprotected intercourse C. The likelihood of conception is minimal D. Insertion of a copper-containing IUD offers an effective form of emergency and ongoing contraception

C. Fluoroquinolone

Appropriate oral antimicrobial therapy for otitis externa with an accompanying facial cellulitis suitable for outpatient therapy includes a course of an oral: A. Macrolide B. Cephalosporin C. Fluoroquinolone D. Penicillin

44. The average incubation time for HAV is approximately: A. 10 days.B. 28 days.C. 60 days.D. 6 months.

B. 28 days

A 46-year-old woman complains of fatigue, weakness, lethargy, decreased concentration and memory, and increased facial hair over the past 12 months. She also reports gaining over 30 pounds (13. 6 kg) in the past 2 months. She has a history of asthma with repeated flares during the past 6 months requiring multiple courses of prednisone therapy. A likely diagnosis for this patient is: A. type 2 diabetes. B. Cushing's syndrome. C. Cushing's disease. D. Central obesity.

A Still murmur: A. is heard in the presence of cardiac pathology. B. has a humming or vibratory quality. C. is a reason for denying sports participation clearance. D. can become louder when the patient is standing.

A child needs to demonstrate more than one developmental red flag to warrant further evaluation. A. true B. false

A common site for eczema in infants is the: A. dorsum of the hand. B. face. C. neck. D. flexor surfaces.

A complication of glomerulonephritis is: A. type 2 diabetes B. nephrotic syndrome C. pyelonephritis D. bladder cancer (Ch. 12 Fitzgerald)

A healthy full term infant at 3 to 5 months should be able to: A. gesture to an object B. brings hands together C. reach for an object with one hand D. feed self a biscuit

A laboratory finding commonly observed in patients with sarcoidosis is: A. hyponatremia. B. hypercalcemia. C. hypokalemia. D. hyperkalemia. (Ch. 9 Fitzgerald)

A middle-aged woman who has taken therapeutic dose of lorazepam for the past 6 years wishes to stop taking the medication. You advise her that: A. she can discontinue the drug immediately is she believes it no longer helps with her symptoms. B. rapid withdrawal in this situation can lead to tremors and hallucinations. C. she should taper down the dose of the medication over the next week. D. gastrointestinal upset is typically reported during the first week of benzodiazepine withdrawal. (Ch. 14 Fitzgerald)

A still murmur: A. is an indication to restrict sports participation selectively. B. has a buzzing quality. C. is usually heard in patients who experience dizziness when exercising. D. is a sign of cardiac structural abnormality. (Ch. 9 Fitzgerald)

An 18-year-old woman has a chief complaint of "a sore throat and swollen glands" for the past 3 days. Her physical examination reveals exudative pharyngitis, minimally tender anterior and posterior cervical lymphadenopathy, and maculopapular rash. Abdominal examination reveals right and left upper quadrant abdominal tenderness. The most likely diagnosis is: A. group A beta-hemolytic streptococcal pharyngitis. B. infectious mononucleosis. C. rubella. D. scarlet fever.

An example of an appropriate question to pose to a person with obesity who is in the contemplation change stage is: How do you feel about your weight? What are barriers you see to losing weight? What is your personal goal for weight loss? How do you envision my helping you meet your weight loss goal?

An infant is born with port wine stains and Sturge-Weber syndrome. These are unlikely related. A. true B. false

An inrease in creatinine from 1 to 2 mg/dL is typically seen with a _ loss in renal function A. 25% B. 50% C. 75% D. 100% (Ch. 12 Fitzgerald)

Angiotensin-converting enzyme inhibitors can limit the progression of some forms of renal disease by: A. increasing intraglomerular pressure B. reducing efferent arteriolar resistance C. enhancing afferent arteriolar tone D. increasing urinary protein excretion (Ch. 12 Fitzgerald)

Approximately what percent of patients with radiological findings of osteoarthritis of the knee will report having symptoms? A. 25% B. 50% C. 70% D. 95% (Ch. 9 Fitzgerald)

As part of an evaluation of a 3 cm round, mobile thyroid mass, you obtain a thyroid US revealing a fluid filled structure. The most likely diagnosis is: A. adenoma B. thyroid cyst C. multinodular goiter D. vascular lesion

At which of the following ages in a young child's life is parental anticipatory guidance about temper tantrums most helpful? A. 8 to 10 months B. 10 to 12 months C. 12 to 14 months D. 14 to 16 months

At which of the following ages in a young child's life is parental anticipatory guidance about using "time out" as a discipline method most helpful? A. 12 to 18 months B. 18 to 24 months C. 24 to 30 months D. 30 to 36 months

At which of the following ages should screening begin for a child who has significant risk of lead poisoning? A. 3 months B. 6 months C. 1 year D. 2 years

Bronchiolitis commonly occurs in the US during warm weather months. A. true B. false

Celeste is a 9-year-old girl with moderate persistent asthma. She is not taking a prescribed inhaled corticosteroid but is using albuterol PRN to relieve her cough and wheeze. According to her mother, she currently uses about six albuterol doses per day, in particular for cough and wheeze after active play. You consider that: A. albuterol use can continue at this level. B. excessive albuterol use is a risk factor for asthma death. C. she should also use salmeterol (Serevent) to reduce her albuterol use. D. active play should be limited to avoid triggering cough and wheeze.

Characteristics of S. pneumoniae include: A. beta-lactamase production common. B. antimicrobial resistance because of altered protein binding sites. C. causative organism of skin infection associated with acute otitis media. D. gram-negative organism.

Cilostazol should be used with great caution in the presence of: A. DM B. HF C. HTN D. dylipidemia

Compared with albuterol, levalbuterol (Xopenex): A. has a different mechanism of action. B. has the ability to provide greater bronchodilation with a lower dose. C. has an anti-inflammatory effect similar to an inhaled corticosteroid. D. is contraindicated for use in children.

Compared with the use of infant formula, advantages for the baby of breastfeeding include all of the following except: A. lower incidence of diarrheal illness. B. greater weight gain in the first few weeks of life. C. reduced risk of allergic disorders. D. lower occurrence of constipation.

Creatinine is best described as A. a substance produced by the kidney. B. a product related to skeletal muscle metabolism C. produced by the liver and filtered by the kidney D. a by-product of protein metabolism (Ch. 12 Fitzgerald)

DSM-5 criteria for a substance use disorder include all of the following except: A. substance use in larger amounts or over longer period than intended. B. substance overuse resulting in hospitalization. C. craving or strong desire to use. D. substance use in potentially hazardous positions. (Ch. 14 Fitzgerald)

Deformity of the proximal interphalangeal joints found in an elderly patient with OA is known as: A. Heberden nodes. B. Bouchard nodes. C. hallus valgus D. Dupuytren contracture. (Ch. 9 Fitzgerald)

Demographic data indicate which of the following persons is most likely to misuse prescription medications? A. a 14 year old male B. a 24 year old female C. a 33 year old male D. a 38 year old male (Ch. 14 Fitzgerald)

Dietary recommendations for a person with gouty arthritis include avoiding foods high in: A. artificial flavors and colors B. purine C. vitamin C D. protein (Ch. 9 Fitzgerald)

During an office visit, a 38 year old woman states, "I drink way too much but do not know what to do to stop." According to Prochaska's change framework, her statement is most consistent with a person at the stage of: A. precontemplation B. contemplation C. preparation D. action (Ch. 14 Fitzgerald)

Evidence demonstrates that the MMR virus acquired via vaccine can be shed during lactation. A. True B. False

Factors that contribute to stress incontinence include: A. detrusor overactivity B. pelic floor weakness C. urethral stricture D. urinary tract infection (UTI) (Ch. 12 Fitzgerald)

Fibromyalgia is more common in patients with: A. type 2 diabetes B. rheumatoid arthritis and systemic lupus erythematosus. C. migrain headaches D. COPD (Ch. 9 Fitzgerald)

First-line therapy for treating patients with acute gouty arthritis usually includes: A. aspirin B. naproxen sodium C. allopurinol D. Probenecid (Ch. 9 Fitzgerald)

First-line treatment of SLE in a patient with mild symptoms is: A. systemic corticosteroids. B. hydroxychloroquine plus NSAIDs C. anakinra D. methotrexate. (Ch. 9 Fitzgerald)

How many doses of the MMR vaccine should a child 6 to 11 months of age receive before traveling outside of the United States? A. none B. one dose C. two doses D. depends on where the child is traveling

Hyperthermia and a racing heart rate is a potentially life-threatening presentation for a person using: A. cannabis. B. MDMA (e.g., Molly) C. LSD D. barbiturates. (Ch. 14 Fitzgerald)

In a person with obesity, weight loss of ____ % or more yields an immediate reduction in death rates from cardiovascular and cerebrovascular disease. 5 10 15 20

In most children with bronchiolitis, intervention includes: A. aerosolized ribavirin therapy. B. supportive care. C. oral theophylline therapy. D. oral corticoid steroid therapy.

In ordering imaging studies in a patient with peripheral vascular disease, the use of contrast medium can potentially result in: A. hepatic failure B. renal failure C. bone marrow suppression D. thrombocytopenia

Inital therapy for patients with CTS includes: A. intra-articular injection. B. joint splinting. C. systemic corticosteroids. D. referral for surgery. (Ch. 9 Fitzgerald)

Initial treatment of lateral epicondylitis includes all of the following except: A. rest and activity modifications B. corticosteroid injections C. topical or oral NSAIDs D. counterforce bracing. (Ch. 9 Fitzgerald)

Intervention for patients with heatstroke includes: Total body ice packing Rehydration Fluid restriction Potassium supplementation

Long-term consequences of Kawasaki disease include: A. renal insufficiency. B. coronary artery obstruction. C. hepatic failure. D. hypothyroidism.

Maria is a 28 year-old well woman who is 6 weeks pregnant and voices her intent to breastfeed her infant for at least 6 months. Her routine prenatal laboratory testing reveals she is not immune to varicella. Which of the following represents the best advice for Maria? A. She should receive VZV vaccine once she is in her second pregnancy trimester. B. Maria should be advised to receive two appropriately timed doses of VZV vaccine after giving birth. C. Once Maria is no longer breastfeeding, she should receive one dose of VZV vaccine. D. A dose of VZIG should be administered now.

Medications that are often helpful in relieving symptoms associated with Raynaud phenomenon include: A. NSAIDs B. ACEI C. BB D. diuretics

Milia is typically caused by: A. low levels of androgen. B. enlarged sebaceous glands. C. excessive oil production in the skin follicles. D. an unknown etiology.

Mr. Samuels is a 58 yo man with T2DM who is using a single 10 unit daily dose of the long acting insulin glargine. His FPG has been between 141-180. Which of the following best describes the next step in his therapy? A. Continue current glargine dose B. Increase glargine dose by 4U per day C. Increase glargine dose by 1U per day D. Increase glargine dose by 6U per day

Obesity is defined as having a body mass index equal to or greater than____ 25 30 35 40

One physical sign of fragile X syndrome in males includes: A. large eyes. B. large forehead. C. small head. D. recessive jaw

Osteoporosis is more common in individuals: A. with type 2 diabetes mellitus. B. on long-term systemic corticosteroid therapy. C. who are obese. D. of African ancestry. (Ch. 9 Fitzgerald)

Patient presentation possibly common to anxiety and depression includes: A. feeling of worthlessness B. psychomotor agitation. C. dry mouth D. appetite disturbance (Ch. 14 Fitzgerald)

Peak symptoms of alcohol withdrawal are usually observed how long after alcohol intake is discontinued? A. less than 12 hours B. 12 to 24 hours C. 24 to 36 hours D. more than 36 hours (Ch. 14 Fitzgerald)

Persistent microscopic hematuria would be the primary finding in about ___% of individuals with bladder cancer. A. 10 B. 20 C. 30 D. 40 (Ch. 12 Fitzgerald)

Pharmacological intervention for patients with urge incontinence includes: A. doxazosin (Cardura) B. tolterodine (Detrol) C. finasteride (Proscar) D. pseudoephedrine (Ch. 12 Fitzgerald)

Pharmacological intervention in an anxiety disorder should be: A. generally given for about 4 to 6 months. B. continued for at least 6 months after remission is achieved. C. continued indefinitely with a first diagnosis of the condition. D. titrated to a highest dose recommended after symptom relief is achieved. (Ch. 14 Fitzgerald)

Post-polio syndrome is commonly marked by: A. muscular hypertrophy. B. muscle atrophy C. flulike symptoms D. increased mortality

Poststreptococcal glomerulonephritis typically occurs how long following a bacterial pharyngitis infection? A. 4 to 6 days B. 1 to 2 weeks C. 3 to 4 weeks D. 2 month (Ch. 12 Fitzgerald)

Potential adverse events of acetaminophen in a child with fever and mild dehydration include: A. seizure. B. hepatotoxicity. C. petechial rash. D. gastric ulcer.

Rates of urinary tract infection (UTI) among uncircumcised infant boys are how much higher than those in circumcised boys? A. as much as 10% B. as much as 20% C. as much as 30% D. less than 10%

Risk factors for UTI in women include: A. post-void wiping back to front B. low peri-vaginal loactobacilli colonization C. hot tub use D. wearing snug-fitting pantyhose (Ch. 12 Fitzgerald)

Risk factors for ankle sprain include all of the following except: A. poor conditioning B. running on paved surfaces. C. inappropriate footwear. D. lack of a warm-up period prior to exercising. (Ch. 9 Fitzgerald)

Risk factors for lumbar radiculopathy include all of the following except: A. male gender B. Age < 50 years. C. overweight. D. cigarette smoking. (Ch. 9 Fitzgerald)

Risk factors for medial epicondylitis include playing: A. tennis B. golf C. baseball D. volleyball (Ch. 9 Fitzgerald)

Risk factors for mitral regurgitation include a prior diagnosis of all of the following except: A. rheumatic heart disease. B. scarlet fever. C. endocarditis. D. calcific annulus. (Ch. 9 Fitzgerald)

Risk factors for renal stones include all of the follwoing except: A. male gender B. vegetarian diet C. family history of renal stones D. obesity (Ch. 12 Fitzgerald)

Risk factors for the development of low back pain include all of the following except: A. older age B. carpal tunnel syndrome C. scoliosis D. spinal stenosis (Ch. 9 Fitzgerald)

Screening cholesterol levels in children with one or more risk factors begins at what age? A. birth B. 2 years C. 5 years D. 10 years

Symptoms commonly associated with reactive arthritis include all of the following except: A. dactylitis B. bursitis C. enthesitis D. cervicitis (Ch. 9 Fitzgerald)

The 5-HT1D receptor site is associated with the following activity when stimulated A. agitation, anxiety, panic B. antimigraine effect C. antidepressant D. cerebral spinal fluid production E. nausea, diarrhea (Ch. 14 Fitzgerald)

The NP can consider presenting treatment options and support for change after the patient has moved into which of Prochaska's stages? A. precontemplation B. contemplation C. preparation D. action (Ch. 14 Fitzgerald)

The Tinel test is best described as: A. reproduction of symptoms with forced flexion of the wrists. B. abnormal tingling when the median nerve is tapped. C. pain on internal rotation D. palmar atrophy. (Ch. 9 Fitzgerald)

The anticipated effect on the lipid profile with plant stanol and sterol use includes: A. increase in HDL. B. decrease in LDL. C. decrease in select lipoprotein subfractions. D. decrease in triglycerides.

The bisphosphonate therapy given as an annual infusion is: A. risedronate. B. zoledronic acid. C. ibandronate. D. denosumab. (Ch. 9 Fitzgerald)

The clinical presentation of acute gouty arthritis affecting the base of the great toe includes: A. slow onset of discomfort over many days B. greatest swelling and pain along the median aspect of the joint C. improvement of symptoms with joint rest D. fever. (Ch. 9 Fitzgerald)

The clinician anticipates that a child with Mongolian spots will cry out because of discomfort when the area is gently pressed or palpated. A. true B. false

When choosing an antimicrobial agent for the treatment of UTI in a febrile female child who is 16 months old, the NP considers that: A. gram-positive organisms are the most likely cause of infection. B. a parenteral aminoglycoside is the preferred treatment choice. C. the use of an oral third-generation cephalosporin is acceptable if gastrointestinal function is intact. D. nitrofurantoin use is considered first-line therapy.

When considering characteristics of the domestic violence perpetrator, one of the best predictors of a subsequent homicide of victims of domestic violence is which of the following? A. history of perpetrator striking victim in the face with open hand B. history of perpetrator attempting to strangle the victim C. perpetrator's access to kitchen knives. D. alcohol abuse history in the victim. (Ch. 14 Fitzgerald)

When counseling about malabsorptive bariatric surgery, the NP provides the following information: Most people achieve ideal BMI postoperatively. The most dramatic weight losses are seen in the first few postoperative months. The death rate directly attributable to surgery is about 10%. Weight loss will continue for years postoperatively in most patients.

When examining a patient with biromyalgia, tender points: A. are located only above the waist B. can be identified by applying enough pressure to blanch the nail bed of the examiner. C. are easily identified through radiography D. can wax and wane throughout the day. (Ch. 9 Fitzgerald)

When prescribing a benzodiazepine, the NP considers that: A. the drugs are virtually interchangeable, with similar durations of action and therapeutic effect. B. the onset of therapeutic effect is usually rapid. C. these drugs have low abuse potential in substance abusers. D. elderly adults will likely require doses similar to those needed by younger adults. (Ch. 14 Fitzgerald)

When prescribing a fibrate, the NP expects to see what change in the lipids? A. marked decrease in LDL B. increase in HDL C. no effect on TG D. increase in VLDL

When providing care for a febrile patient, the NP bears in mind that all of the following are true except that: A. the use of antipyretics is potentially associated with prolonged illness. B. consistent use of an antipyretic provides a helpful way to shorten the course of infectious illnesses. C. fever increases metabolic demand. D. in a pregnant woman, increased body temperature is a potential first-trimester teratogen.

When treating a 3-year-old well child with community-acquired pneumonia (CAP), the NP realizes that the most likely causative pathogen is: A. Mycoplasma pneumoniae. B. a respiratory virus. C. H. influenzae. D. S. pneumoniae.

Which of the following agents offers an intervention for the control of tremor and tachycardia associated with alcohol withdrawal? A. phenobarbital B. clonidine C. verapamil D. naltrexone (Ch. 14 Fitzgerald)

Which of the following best describes ethnicity and insulin sensitivity? A. Little variation exists among ethnic groups. B. African Americans are typically less sensitive compared to Europeans. C. Mexican Americans are likely the most sensitive in the US D. Degree of insulin sensitivity has little influence on insulin production.

Which of the following est describes the presentation of a person with RA? A. worst symptoms in weight-bearing joints later in the day B. symmetrical early-morning stiffness C. sausage-shaped digits with characteristic skin lesions D. back pain with rest and anterior uveitis (Ch. 9 Fitzgerald)

Which of the following is a mineralocorticoid? A. cortisol B. aldosterone C. insulin D. hydrocortisone

Which of the following is an example of moderate-intensity statin therapy? A. fluvastatin 10 mg B. atorvastatin 10 mg C. simvastatin 10 mg D. pravastatin 20 mg

Which of the following is appropriate advice to give to a mother who is breastfeeding her 12-hour-old infant? A. "You will likely have enough milk to feed the baby within a few hours of birth." B. "The baby might need to be awakened to be fed." C. "Supplemental feeding is needed unless the baby has at least four wet diapers in the first day of life." D. "The baby will likely have a seedy yellow bowel movement today."

Which of the following is inconsistent with the clinical presentation of fibromyalgia? A. widespread body aches B. joint swelling C. fatigue D. cognitive changes (Ch. 9 Fitzgerald)

Which of the following is most consistent with the diagnosis of bulimia nervosa? A. Patients with bulimia nervosa usually present asking for treatment. B. Periods of anorexia often occur. C. Hyperkalemia often results from laxative abuse. D. Most patients with bulimia nervosa are significantly obese. (Ch. 14 Fitzgerald)

Which of the following is most consistent with the diagnosis of generalize anxiety disorder? A. gastrointestinal upset B. difficulty initiating sleep C. diminished cognitive ability D. consistent early morning wakening (Ch. 14 Fitzgerald)

Which of the following is most consistent with the presentation of a patient with bipolar I disorder? A. increased need for sleep B. impulsive behavior C. fatigue D. anhedonia (Ch. 14 Fitzgerald)

Which of the following is most likely to be found in the laboratory data of a child who has infectious mononucleosis? A. neutrophilia B. lymphocytosis C. positive antinuclear antibody D. macrocytic anemia

Which of the following is the most common UTI organism in children? A. Pseudomonas aeruginosa B. Escherichia coli C. Klebsiella pneumonia D. Proteus mirabilis

Which of the following is the most helpful approach in the care of a patient with alcoholism? A. Advise the patient to stop drinking in a straightforward manner. B. Counsel the patient that alcohol abuse is a treatable disease. C. Inform the patient of the long-term health consequences of alcohol abuse. D. Refer the patient to Alcoholics Anonymous. (Ch. 14 Fitzgerald)

The use of a systemic corticosteroid in the treatment of anaphylaxis is primarily helpful for: A. treatment of the most acute symptoms B. minimization of a protracted allergic response C. prevention of future episodes D. reducing the risk of fatality associated with the event

B. minimization of a protracted allergic response

Which of the following is the most likely candidate to initiate dialysis due to chronic kidney disease (CKD)? A. a 46 year old man with hypertension and GFR=42 mL/min B. A 64 year old woman with type 2 diabetes and GFR=28mL/min C. A 76 year old man with anemia and GFR=55mL/min D. A 58 year old woman with heart disease and GFR=46 mL/min (Ch. 12 Fitzgerald)

Which of the following is the preferred medication to reverse the anticoagulant effects of unfractionated heparin? A. vitamin K B. protamine sulfate C. platelet transfusion D. plasma components

Which of the following medications is most likely to cause sexual dysfunction? A. vilazodone (Viibryd) B. fluoxetine (Prozac) C. nortriptyline (Pamelor) D. bupropion (Wellbutrin) (Ch. 14 Fitzgerald)

Which of the following medications is representative of high-intensity statin therapy? A. pravastatin 40 mg B. rosuvastatin 20 mg C. simvastatin 40 mg D. lovastatin 20 mg

Which of the following patients would be an appropriate candidate for treatment with teriparatide (Forteo)? A. a 54 year old woman with osteopenia B. a 64 year old woman with BMD T-score of -2.5 and prior hip fracture C. a 67 year old man with a BMD T-score of -1 D. a 72 year old woman who has a stable BMD T-score of -1.5 with bisphosphonate treatment for the past 3 years. (Ch. 9 Fitzgerald)

Which of the following represents the best choice of clinical agents for a child who has had a history of penicillin allergy who requires antimicrobial therapy? A. ciprofloxacin B. cefdinir C. amoxicillin D. trimethoprim-sulfamethoxazole (TMP-SMX)

Which of the following statements about tendonitis is false? A. Tendonitis is typically the result of overuse. B. Tendonitis is the result of a macroscopic or partial tear of the tendon. C. Acute pain results when firm pressure is applied to the tendon. D. Signs of tendonitis include reduced ROM caused by stiffness and discomfort. (Ch. 9 Fitzgerald)

Which of the following statements is false regarding patients with depression and hypochondriasis? A. About 30% of patients with depression also have hypochondriasis. B. These patients are less likely to see a healthcare provider compared to those with depression alone. C. These patients are unable to process objective information that they have no particular health problem D. They perceive that an existing health problem is far more serious than it is in reality. (Ch. 14 Fitzgerald)

Which of the following statements is false regarding sunlight exposure and vitamin D production? A. In the continental United States, summertime exposure to sunlight can produce the majority of the body's requirement for vitamin D B. One glass of fortified milk has an equivalent amount of vitamin D as what is produced after 10 minutes of exposure to summer sunlight in a healthy young individual. C. Use of sunscreen can block the majority of solar induced vitamin D production D. A person with a darker skin tone produces less vitamin D with sun exposure compared with a person with lighter sin tone. (Ch. 9 Fitzgerald)

Which of the following statements is true about inactivated poliovirus vaccine (IPV)? A. It contains live virus. B. It is the preferred method of immunization in North America. C. Two doses should be administered by a child's fourth birthday. D. After administration of IPV, live poliovirus is usually shed from the stool.

While counseling an adolescent about the risks of marijuana use, the NP considers that: A. symptoms of physical and psychological dependency are rarely reported by regular users. B. the development of chronic obstructive airway disease is often associated with regular use. C. use on a daily basis among teens is significantly less common than that of alcohol. D. driving ability is minimally impaired with its use. (Ch. 14 Fitzgerald)

You are advising a 58 yo woman with hypothyroidism about the correct use of levothyroxine. She also takes a calcium supplement. All of the following should be shared with her except: A. Take the medication on an empty stomach B. To help with adherence, take your calcium supplement at the same time as your thyroid medication C. You should take the medication at approximately the same time every day D. Do not take your medication with soy milk.

You are examining a 18 month old boy who is not speaking any discernible words. Mom tells you he has not said mama or dada yet or babbled or smiled responsively. You: A. encourage mother to enroll him in daycare to increase socialization B. conduct further evaluation of milestone attainment C. reassure the parent that delayed speech is common in boys D. order audiogram and tympanometry

You hear a fixed split second heart sound (S2) in a 28 year old woman who wants to start an exercise program and consider that it is: A. a normal finding in a younger adult. B. occasionally found in uncorrected atrial septal defect. C. the result of valvular sclerosis. D. often found in patients with right bundle branch block (Ch. 9 Fitzgerald)

You see a 33 year old man diagnosed with reactive arthritis and urethritis. You recommend antimicrobial treatment with: A. amoxicillin B. doxycycline. C. TMP-SMX. D. nitrofurantoin. (Ch. 9 Fitzgerald)

You see a 42 year old woman recently diagnosed with sarcoidosis. She is reluctant to use any first-line medications for the condition because of severe adverse effects experienced previously. You consider prescribing all of the following alternatives except: A. hydroxychloroquine B. tofacitinib. C. infliximab. D. azathioprine (Ch. 9 Fitzgerald)

You see a 54 year old man complaining of low back pain and is diagnosed with acute lumbosacral strain. Which of the following is the best advice to give about exercising? A. You should not exercise until you are free of pain. B. Back-strengthening exercises can cause mild muscle soreness. C. Electric-like pain in response to exercise is to be expected. D. Conditioning exercises should be started immediately. (Ch. 9 Fitzgerald)

170. Which of the following medications is a prostaglandin analogue? A. sucralfate B. misoprostol C. esomeprazole D. metoclopramide

B. misoprostol

Services that are an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness can be classified as: A. capitated services B. "incident to" services C. mandatory services D. shared services

B. "incident to" services

93. The nurse practitioner (NP) is advising a 58-year-old woman about the benefits of a high-fiber diet. Which of the following foods provides the highest fiber content? A. a small banana B. 1 cup of cooked oatmeal C. a 1/2-cup serving of brown rice D. a medium-sized blueberry muffin

B. 1 cup of cooked oatmeal

For a woman who was normotensive before 20 weeks of gestation, an indication of preeclampsia is blood pressue of more than ____ mm hg systolic and more than _____ mm Hg diastolic. A. 130, 80 B. 140, 90 C. 150, 95 D. 160, 100

B. 140, 90

How many grams of a topical cream or ointment are needed for a single application to the hands? A. 1 B. 2 C. 3 D. 4

B. 2

The recommended frequency of prenatal visits in weeks 28 to 32 of pregnancy is every: A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks

B. 2 weeks Up to 28 weeks --- Every 4 weeks 28-36 weeks ------ Every 2 weeks >/= 36 weeks ------ Every week

102. According to American College of Chest Physicians (ACCP) guidelines, annual screening with low-dose CT (LDCT) for lung cancer should occur in 55- to 74-year-old smokers with a smoking history of at least pack-years. A. 15 B. 30 C. 50 D. 70 Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 158). F.A. Davis Company. Kindle Edition.

B. 30

How many grams of a topical cream or ointment are needed for a single application to the entire body? A. 10 to 30 B. 30 to 60 C. 60 to 90 D. 90 to 120

B. 30 to 60

During pregnancy, the most intense organogenesis occurs how many days following the LMP? A. 12 to 30 days B. 31 to 81 days C. 92 to 120 days D. 121 to 150 days

B. 31 to 81 days

In the first weeks of a viable intrauterine pregnancy, serum quantitative hCG levels usually doubles every ___ hours until approximately 10,000-20,000 mIU/mL. A. 24 B. 48 C. 72 D. 96

B. 48

What is the molecular weight requirement for a drug to easily pass through the placental barrier? A. < 250 daltons B. < 500 daltons C. < 1000 daltons D. < 5000 daltons

B. < 500 daltons

15. You see a 34-year-old man with moderate persistent asthma who has an asthma flare and a regimen of oral prednisone is being considered. Which of the following is true? A. A taper is needed for prednisone therapy lasting longer than 4 days. B. A taper is not needed if the prednisone regimen is for 7 days or less. C. A taper is not needed regardless of duration of prednisone therapy. D. A taper is needed if the patient is taking concomitant inhaled corticosteroids. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

B. A taper is not needed if the prednisone regimen is for 7 days or less.

A 64-year-old man with seborrhea mentions that his skin condition is "better in the summer when I get outside more and much worse in the winter." You respond: A. Sun exposure is a recommended therapy for the treatment of this condition. B. Although sun exposure is noted to improve the skin lesions associated with seborrhea, its use as a therapy is potentially associated with an increased rate of skin cancer. C. The lower humidity in the summer months noted in many areas of North America contributes to the improvement in seborrheic lesions. D. Use high-potency topical corticosteroids during the winter months, tapering these off for the summer months

B. Although sun exposure is noted to improve the skin lesions associated with seborrhea, its use as a therapy is potentially associated with an increased rate of skin cancer

Risk factors for folate-deficiency anemia include: A. Menorrhagia B. Chronic ingestion of overcooked foods C. Use of NSAIDs D. Gastric atrophy

B. Chronic ingestion of overcooked foods The most common causes of folic acid-deficiency anemia are inadequate dietary intake, seen in elderly, alcohol abusers, and impoverished persons and in persons with decreased ability to absorb folic acid which occurs in malabsoprtion syndromes such as sprue and celiac disease. Folic acid deficiency can be avoided with a healthy diet with folate-rich fruits and vegetables. Most flours are fortified with folate.

Which of the following is the most common UTI organism in pregnant women? A. Pseudomonas aeruginosa B. E. coli C. K. pneumoniae D. Proteus mirabilis

B. E. coli

Match the stage of pregnancy with the appropriate term. 10 weeks to term A. Embryo B. Fetus C. Blastocyst D. Zygote

B. Fetus

157. Is the following statement most consistent with IBD, with IBS, or with both conditions? The etiology is considered to be an alteration in small and large bowel motility. A. IBD B. IBS C. Both IBD and IBS

B. IBS

When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that: A. These usually resolve within days with appropriate therapy B. If present for longer than 6 months, these changes are occasionally permanent C. The use of parenteral vitamin B12 therapy is needed to ensure symptom resolution D. Cognitive changes associated with vitamin B12 deficiency are seldom reversible even with appropriate therapy

B. If present for longer than 6 months, these changes are occasionally permanent

51. The most accurate serological markers to diagnose celiac sprue are: A. ESR and CRP.B. IgA endomysial and IgA tTG antibodies.C. mucosal biopsies of the terminal ileum.D. H. pylori IgG antibodies.

B. IgA endomysial and IgA tTG antibodies.

According to Hale's Lactation Risk Category, a medication in which there is no controlled study on its use during lactation, or controlled study shows minimal, non-life-threatening risk, is listed as category: A. L2 B. L3 C. L4 D. L5

B. L3 L1 (Safest) - Drug which has been taken by a large number of breastfeeding mothers w/o any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk tot he infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant. L2 (Safer) - Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; &/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote. L3 (Moderately Safe) - There is no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only int he potential benefit justifies the potential risk to the infant. L4 (Possibly Hazardous) - There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective). L5 (Contraindicated) - Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Pernicious anemia is usually caused by: A. Dietary deficiency of vitamin B12 B. Lack of production of IF by the gastric mucosa C. RBC enzyme deficiency D. A combo of micronutrient deficiencies caused by malabsorption

B. Lack of production of IF by the gastric mucosa

Which of the following is most consistent with iron-deficiency anemia? A. Low MCV, normal MCH B. Low MCV, low MCH C. Low MCV, elevated MCH D. Normal MCV, normal MCH

B. Low MCV, low MCH IDA is a microcytic hypochromic

In Edwards syndrome, which of the following statements is true? A. Edwards syndrome is more common than Down syndrome B. Most affected infants with Edwards syndrome die during the first year of life C. Edwards syndrome is unlikely to cause developmental disability D. Edwards syndrome is associated with elevated AFP

B. Most affected infants with Edwards syndrome die during the first year of life Edwards syndrome is less common than Downs syndrome occurring in 1 in every 6000 births. Edwards syndrome is associated with low birth weight; developmental disability; and cranial, cardiac, and renal malformations. Most affected infants die within the first year of life; stillbirth or death int he first week of life is common.

101. Which of the following is true concerning hepatitis B vaccine? A. The vaccine contains live hepatitis B virus. B. Most individuals born after 1986 in the United States who have been fully immunized have received vaccine against HBV. C. The vaccine is contraindicated in the presence of HIV infection. D. Postvaccination arthralgias are often reported.

B. Most individuals born after 1986 in the United States who have been fully immunized have received vaccine against HBV.

Match the at-risk ethnic groups for the following genetically based conditions. Cystic fibrosis A. Ashkenazi Jewish ancestry B. Northern European ancestry C. African ancestry

B. Northern European ancestry

A 68-year-old man who is usually healthy presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical exam reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows: Hgb=7.6 g (12-14 g) Hct=20.5% (36-43%) RBC=2.1 million mm3 (4.2-5.4 million) MCV=76 fL (80-96 fL) MCHC=28 g/dL (31-37 g/dL) RDW=18.4% Reticulocytes: 1.8% The most likely cause of these findings is: A. Poor nutirition B. Occult blood loss C. Malabsorption D. Chronic inflammation

B. Occult blood loss Normochromic (MCV 80-96): - Acute blood loss - Anemia of chronic disease

Which of the following conditions in unlikely to result in anemia of chronic disease? A. Rheumatoid arthritis B. PVD C. Chronic renal insufficiency D. Osteomyelitis

B. PVD Anemia is often noted in persons with select chronic health problems such as acute and chronic inflammatory conditions (infection, arthritis), renal insufficiency, and hypothyroidism.

A common infective agent in domestic pet cat bites is: A. viridans streptococcus species. B. Pasteurella multocida C. Bacteroides species. D. Haemophilus influenzae

B. Pasteurella multocida

Most of the body's iron is obtained from: A. Animal-based food sources B. Recycled iron content from aged RBCs C. Endoplasmic reticulum production D. Vegetable-based food ousrces

B. Recycled iron content from aged RBCs

A 26 yo woman has been taking an SSRI for depression during the entire course of her pregnancy. She gives birth to a full-term healthy girl. Five days after the birth, she reports that the baby is irritable with protracted periods of crying. This is likely a result of: A. increased ICP from en utero SSRI exposure B. SSRI withdrawal C. colic D. impending sepsis

B. SSRI withdrawal

Match uterine size with stage of pregnancy. 12 weeks A. Size of a baseball B. Size of a softball or grapefruit C. Size of a large lemon D. Size of a tennis ball or orange E. Uterine fundus at umbilicus F. Uterine fundus halfway between symphysis pubis and umbilicus

B. Size of a softball or grapefruit Rising above symphysis pubis, uterine fundus palpable through abdominal wall

Intervention in ACD most often includes: A. Oral vitamin B12 B. Treatment of the underlying cause C. Transfusion D. Parenteral iron

B. Treatment of the underlying cause

Who is the best candidate for isotretinoin (Accutane) therapy? A. a 17-year-old patient with pustular lesions and poor response to benzoyl peroxide B. a 20-year-old patient with cystic lesions who has tried various therapies with minimal effect C. a 14-year-old patient with open and closed comedones and a family history of "ice pick" scars D. an 18-year-old patient with inflammatory lesions and improvement with tretinoin (Retin-A)

B. a 20-year-old patient with cystic lesions who has tried various therapies with minimal effect

103. Which of the following is at greatest risk of esophageal cancer? A. a 34-year-old male who eats a high-fat diet B. a 76-year-old male who stopped smoking 15 years ago C. a 45-year-old woman with a history of 6 full-term pregnancies D. a 58-year-old female vegetarian

B. a 76-year-old male who stopped smoking 15 years ago

A 72-year-old woman presents with a newly formed,painless, pearly, ulcerated nodule with an overlying telangiectasis on the upper lip. This most likely represents: A. an actinic keratosis B. a basal cell carcinoma C. a squamous cell carcinoma D. molluscum contagiosum

B. a basal cell carcinoma

Medicare is best defined as: A. an entitlement program to provide healthcare coveage for low income elderly persons. B. a publicly supported health insurance program for elderly persons and younger persons with permanent disabilities. C. a health insurance program for persons ineligible for private insurance. D. the nation's insurance program for long-term care coverage in elderly persons.

B. a publicly supported health insurance program for elderly persons and younger persons with permanent disabilities.

66. Antiprostaglandin drugs cause stomach mucosal injury primarily by: A. a direct irritative effect. B. altering the thickness of the protective mucosal layer. C. decreasing peristalsis. D. modifying stomach pH level.

B. altering the thickness of the protective mucosal layer.

In a malpractice case involving the NP care of a 4 y.o previously well boy with acute otitis media who is seen in a family practice primary care setting, the most appropriate expert the plaintiff may use to establish standard of care would be: A. a pediatrician B. an FNP C. an infectious disease physician specialist D. an NP specializing in ethical and legal dilemmas

B. an FNP

To enhance the potency of a topical corticosteroid, the prescriber recommends that the patient apply the preparation: A. to dry skin by gentle rubbing B. and cover with an occlusive dressing C. before bathing D. with an emollient

B. and cover with an occlusive dressing

In counseling a patient with atopic dermatitis, you suggest all of the following can be used to alleviate symptoms of a flare except: A. the use of oral antihistamines B. applying a heating pad on the affected region for 30 minutes C. the use of topical corticosteroids D. applying cool, wet dressings made from a clean cloth and water to the affected area

B. applying a heating pad on the affected region for 30 minutes

All of the following criteria can be used to help determine whether a level 4 office visit occurred for an established patient except: A. at least 4 elements of physical exam B. at least 4 elements of HPI C. medical decision making of moderate complexity D. positive or negative responses to at least 2 ROS questions and at least one notation about past history

B. at least 4 elements of HPI

Which of the following findings is often found in a person with stage 2 Lyme disease? A. peripheral neuropathic symptoms B. atrioventricular heart block C. conductive hearing loss D. macrocytic anemia

B. atrioventricular heart block

183. The HBV vaccine should not be offered to individuals who have a history of anaphylactic reaction to: A. eggs. B. baker's yeast. C. peanuts. D. shellfish.

B. baker's yeast.

Failure of a provider to adhere to current practice standards: A. duty of care B. breach of the standard of care C. injury D. proximal cause

B. breach of the standard of care

Which of the following statements is false regarding a capitated system of reimbursement? A. the institution or practice gets a set amount per month for all services needed by the patient and covered under a contract between the payer and practice B. capitated rates are not negotiable C. capitated rates are based on profit projections and actuarial data D. when payment is capitated, clinics prefer to take care of patients as much as possible through phone calls and mailings rather than seeing an NP or MD.

B. capitated rates are not negotiable

When treating a woman with a UTI who is 28 weeks pregnant, the NP considers prescribing: A. TMP-SMX B. cephalexin C. ciprofloxacin D. doxycylcine

B. cephalexin

99. Which of the following is likely to be reported in a patient with persistent GERD? A. hematemesis B. chronic sore throat C. diarrhea D. melena

B. chronic sore throat

When advising the patient about scabies contagion, you inform her that: A. mites can live for many weeks away from the host B. close personal contact with an infected person is usually needed to contract this disease C. casual contact with an infected person is likely to result in infestation D. bedding used by an infected person must be destroyed

B. close personal contact with an infected person is usually needed to contract this disease

56. Which of the following characteristics is predictive of severity of chronic liver disease in a patient with chronic hepatitis C? A. female gender, age younger than 30 years B. coinfection with hepatitis B, daily alcohol use C. acquisition of virus through intravenous drug use, history of hepatitis A infectionD. frequent use of aspirin, nutritional status

B. coinfection with hepatitis B, daily alcohol use

Which of the following best illustrates the leadership role of nurse practitioners? A. discussing with a pharmacist the selection of the most appropriate HTN medication for a 72 y.o man B. collaborating with public health officials to develop a community initiative to improve childhood vaccination rates C. volunteering to teach a group of high school students about substance abuse D. teaching an expectant mother on proper nutrition during her pregnancy

B. collaborating with public health officials to develop a community initiative to improve childhood vaccination rates

12. In the treatment of asthma, leukotriene receptor antagonists should be used as: A. controllers to prevent bronchospasm. B. controllers to inhibit inflammatory responses. C. relievers to treat acute bronchospasm. D. relievers to treat bronchospasm and inflammation. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

B. controllers to inhibit inflammatory responses.

When caring for an adult with an outbreak of shingles, you advise that: A. there is no known treatment for this condition B. during outbreaks, the chickenpox (varicella) virus is shed C. although they are acutely painful, the lesions heal well without scarring or lingering discomfort D. this condition commonly strikes young and old alike

B. during outbreaks, the chickenpox (varicella) virus is shed

11. Sharon is a 29-year-old woman with moderate persistent asthma. She is not using prescribed inhaled corticosteroids, but is using albuterol PRN to relieve her cough and wheeze with reported satisfactory clinical effect. Currently she uses about two albuterol metered-dose inhalers per month and is requesting a prescription refill. You consider that: A. her asthma is well controlled and albuterol use can continue. B. excessive albuterol use is a risk factor for asthma death. C. her asthma is not well controlled and salmeterol (Serevent®) should be added to relieve bronchospasm and reduce her albuterol use. D. her asthma has better control with albuterol than inhaled corticosteroids. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

B. excessive albuterol use is a risk factor for asthma death.

179. According to the American Cancer Society recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51-year-old man? A. digital rectal examination B. fecal occult blood test C. colonoscopy D. barium enema study

B. fecal occult blood test - annually colonoscopy only every 10 years if low risk

Tina is a 26 yo woman who is pregnant and has an abnormal "quad screen." When sharing this information with Tina, you consider that: A. this testing is diagnostic of specific conditions B. further testing is recommended C. the testing should be repeated D. no further testing is required

B. further testing is recommended

8. A 24-year-old man presents with a 3-month history of upper abdominal pain. He describes it as an intermittent, centrally located "burning" feeling in his upper abdomen, most often occurring 2 to 3 hours after meals. His presentation is most consistent with the clinical presentation of: A. acute gastritis.B. gastric ulcer.C. duodenal ulcer.D. cholecystitis.

B. gastric ulcer

60. A 64-year-old woman presents with a 3-month history of upper abdominal pain. She describes the discomfort as an intermittent, centrally located "burning" feeling in the upper abdomen, most often with meals and often accompanied by mild nausea. Use of an over-the-counter H2RA affords partial symptom relief. She also uses diclofenac on a regular basis for the control of osteoarthritis pain. Her clinical presentation is most consistent with: A. acute gastroenteritis. B. gastric ulcer. C. duodenal ulcer. D. chronic cholecystitis.

B. gastric ulcer.

146. Which of the following hepatitis forms is most effectively transmitted from man to woman via heterosexual vaginal intercourse? A. hepatitis A B. hepatitis B C. hepatitis C D. hepatitis D

B. hepatitis B

Risk factors for malignant melanoma include: A. Asian ancestry B. history of blistering sunburn C. family history of psoriasis vulgaris D. presence of atopic dermatitis

B. history of blistering sunburn

85. To prevent an outbreak of hepatitis D infection, an NP plans to: A. promote a campaign for clean food supplies. B. immunize the population against hepatitis B. C. offer antiviral prophylaxis against the agent. D. encourage frequent hand washing.

B. immunize the population against hepatitis B.

89. The mechanism of transmission of Legionella species is primarily via: A. respiratory droplet. B. inhalation of aerosolized contaminated water. C. contact with a contaminated surface. D. hematogenous spread. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 153). F.A. Davis Company. Kindle Edition.

B. inhalation of aerosolized contaminated water.

You see a 28-year-old man who is having an anaphylactic reaction following a bee sting and is experiencing trouble breathing. Your initial response is to administer: A. oral antihistamine B. injectable epinephrine C. supplemental oxygen D. vasopressor therapy

B. injectable epinephrine

Oral antimicrobial treatments recommended for rosacea include all of the following except: A. metronidazole B. levofloxacin C. erythromycin D. doxycycline

B. levofloxacin

105. Current limitations of screening smokers with LDCT include all of the following except: A. a high false-positive rate. B. low sensitivity. C. radiation exposure from multiple CT scans. D. patient anxiety. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 158). F.A. Davis Company. Kindle Edition.

B. low sensitivity.

22. Risk factors for the development of cholelithiasis include all of the following except: A. rapid weight loss.B. male gender.C. obesity.D. Native American ancestry.

B. male gender.

153. An example of a medication with prokinetic activity is: A. dicyclomine (Bentyl®). B. metoclopramide (Reglan®). C. loperamide (Imodium®). D. psyllium (Metamucil®).

B. metoclopramide (Reglan®).

176. In assessing a person with suspected pancreatic cancer, the nurse practitioner anticipates which of the following findings? A. palpable midline abdominal mass B. midepigastric pain that radiates to the midback or lower back region C. presence of Cullen's sign D. positive obturator and psoas signs

B. midepigastric pain that radiates to the midback or lower back region

In a pregnant woman, asymptomatic bacteruria: A. should be treated only if bladder instrumentation or surgery is planned B. needs to be treated to avoid complicated UTI C. is a common, benign finding D. is a risk factor for the development of HTN

B. needs to be treated to avoid complicated UTI

The use of lindane (Kwell) to treat scabies is discouraged because of its potential for: A. hepatotoxicity B. neurotoxicity C. nephrotoxicity D. pancreatitis

B. neurotoxicity

Which of the following is FDA pregnancy risk category B until the 36th week of pregnancy? A. gentamicin B. nitrofurantoin C. clarithromycin D. ciprofloxacin

B. nitrofurantoin

All of the following establish a provider-patient relationship except: A. professional advice given over the phone to a person who is not officially a patient of the clinic B. observing an accident victim being attended to by paramedics C. helping a neighbor select an OTC cough medicine in the local pharmacy D. covering patients for a colleague who had to leave the clinic for a personal emergency

B. observing an accident victim being attended to by paramedics

53. In the evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule out free air in the abdomen includes: A. barium enema.B. plain abdominal film.C. abdominal ultrasound.D. lower endoscopy.

B. plain abdominal film.

6. Peak expiratory flow meters: A. should only be used in the presence of a medical professional. B. provide a convenient method to check lung function at home. C. are as accurate as spirometry. D. should not be used more than once daily. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition.

B. provide a convenient method to check lung function at home.

Medicaid is best defined as: A. an entitlement program to provide healthcare coverage for unemployed families B. publicly financed health and long-term care coverage for low-income people C. free acute care coverage for those who meet special criteria D. publicly supported healthcare for low-income people under the age of 65 years

B. publicly financed health and long-term care coverage for low-income people

161. A gallstone that is not visualized on standard x-ray is said to be: A. radiopaque. B. radiolucent. C. calcified. D. unclassified.

B. radiolucent.

Psoriatic lesions arise from: A. decreased skin exfoliation. B. rapid skin cell turnover, leading to decreased maturation and keratinization. C. inflammatory changes in the dermis. D. lichenification

B. rapid skin cell turnover, leading to decreased maturation and keratinization

48. Rebound tenderness is best described as abdominal pain that worsens with: A. light palpation at the site of the discomfort.B. release of deep palpation at the site of the discomfort.C. palpation on the contralateral side of the abdomen.D. deep palpation at the site of the discomfort.

B. release of deep palpation at the site of the discomfort.

82. Which of the following best describes the mechanism of transmission in an atypical pneumonia pathogen? A. microaspiration B. respiratory droplet C. surface contamination D. aerosolized contaminated water Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

B. respiratory droplet

Common clinical conditions included in the atopy subgroup of type I hypersensitivity reactions include all of the following except: A. allergic rhinitis B. rosacea C. atopic dermatitis D. allergic gastroenteropathy

B. rosacea

Maternal iron requirements are greatest during what part of pregnancy? A. first trimester B. second and third trimesters C. equal throughout pregnancy D. preconception

B. second and third trimesters This is in part because of the fetus's need to build iron stores during these trimesters.

The spectrum of antimicrobial activity of mupirocin(Bactroban) includes: A. primarily gram-negative organisms. B. select gram-positive organisms. C. Pseudomonas species and anaerobic organisms. D. only organisms that do not produce beta-lactamase.

B. select gram-positive organisms.

108. You prescribe a fluoroquinolone antibiotic to a 54-year-old woman who has occasional GERD symptoms that she treats with an antacid. When discussing appropriate medication use, you advise that she should take the antimicrobial: A. with the antacid. B. separated from the antacid use by 2 to 4 hours before or 4 to 6 hours after taking the fluoroquinolone. C. without regard to antacid use. D. apart from the antacid by about 1 hour on either side of the fluoroquinolone dose.

B. separated from the antacid use by 2 to 4 hours before or 4 to 6 hours after taking the fluoroquinolone.

A 29-year-old woman has a sudden onset of right-sided facial asymmetry. She is unable to close her right eyelid tightly or frown or smile on the affected side. Her examination is otherwise unremarkable.Which of the following represents the most important diagnostic test? A. complete blood cell count with white blood cell differential B. serum testing for Borrelia burgdorferi infection C. computed tomography (CT) scan of the head with contrast enhancement D. serum protein electrophoresis

B. serum testing for Borrelia burgdorferi infection

Risk factors for the development of postherpetic neuralgia include: A. age younger than 50 years at the time of the outbreak B. severe prodromal symptoms C. lumbar location of lesions D. low volume of lesions

B. severe prodromal symptoms

Match sign with correct characteristic. Hegar sign A. blue-violet vaginal color B. softening of uterus isthmus C. softening of vaginal portion of the cervix

B. softening of uterus isthmus

A 56-year-old truck driver presents with a new nodular, opaque lesion with non distinct borders on his left forearm. This most likely represents a(n): A. actinic keratosis B. squamous cell carcinoma C. basal cell carcinoma D. malignant melanoma

B. squamous cell carcinoma

Which of the following statements about standard of care is true? A. standard of care is rarely argued incur during malpractice claims B. standard of care generally refers to the care that a reasonable, similarly educated and situated professional would provide to a patient C. standard of care is constant regardless of geographic area D. standard of care does not typically apply to NPs

B. standard of care generally refers to the care that a reasonable, similarly educated and situated professional would provide to a patient

When counseling a patient about the use of tacrolimus (Protopic) or pimecrolimus (Elidel), you mention that: A. this is the preferred atopic dermatitis treatment in infants B. there is a possibility of increased cancer risk with its use. C. the product is used interchangeably with topical corticosteroids. D. the product is a potent antihistamine

B. there is a possibility of increased cancer risk with its use

The components of HELLP syndrome include all of the following except: A. hepatic enzyme elevations B. thrombocytosis C. hemolysis D. eclampsia

B. thrombocytosis H - hemolysis with resulting anemia EL - elevated liver enzymes indicating hepatocellular damage LP - low platelet count and eclampsia

For severe, recalcitrant psoriasis that affects more than30% of the body, all of the following treatments are recommended except: A. methotrexate B. topical anthralin (Drithocreme) C. tumor necrosis factor (TNF) modulators D. cyclosporine

B. topical anthralin (Drithocreme)

Which of the following is recommended for preventing a burn wound infection? A. topical corticosteroid B. topical silver sulfadiazine C. oral erythromycin D. oral moxifloxacin

B. topical silver sulfadiazine

When prescribing tretinoin (Retin-A), the NP advises the patient to: A. use it with benzoyl peroxide to minimize irritating effects. B. use a sunscreen because the drug is photosensitizing. C. add a sulfa-based cream to enhance anti acne effects. D. expect a significant improvement in acne lesions after approximately 1 week of use

B. use a sunscreen because the drug is photosensitizing

51. Which of the following best describes the role of theophylline in COPD treatment? A. routinely indicated in moderate to very severe COPD B. use limited by narrow therapeutic profile and drug-drug interaction potential C. a potent bronchodilator D. available only in parenteral form Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

B. use limited by narrow therapeutic profile and drug-drug interaction potential

Clinical features of bullous impetigo include: A. intense itch. B. vesicular lesions. C. dermatomal pattern. D. systemic symptoms such as fever and chills.

B. vesicular lesions

57. A 36-year-old man complains of nausea, fever, malaise, and abdominal pain. He shows signs of jaundice and reports darkly colored urine. Diagnostic results show elevated serum aminotransferase less than 10 times the upper limit of normal (ULN). His most likely diagnosis is: A. GERD.B. viral hepatitis.C. Crohn's disease.D. Barrett esophagus.

B. viral hepatitis.

143. Long-term, recurrent, high-dose, oral use of mineral oil can lead to deficiency in: A. iron. B. vitamin A. C. vitamin C. D. vitamin B12.

B. vitamin A.

125. Which of the following is most likely to be found in a person with acute cholecystitis? A. fever B. vomiting C. jaundice D. palpable gallbladder

B. vomiting

You examine a patient with psoriasis vulgaris and expect to find the following lesions: A. lichenified areas in flexor areas B. well-demarcated plaques on the knees C. greasy lesions throughout the scalp D. vesicular lesions over the upper thorax

B. well-demarcated plaques on the knees

50. With a COPD exacerbation, a chest x-ray should be obtained: A. routinely in all patients. B. when attempting to rule out a concomitant pneumonia. C. if sputum volume is increased. D. when work of breathing is increased. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

B. when attempting to rule out a concomitant pneumonia.

27. Subcutaneous immunotherapy is recommended for use in patients: A. with well-controlled asthma and infrequent exacerbations. B. with allergic-based asthma. C. with moderate persistent asthma who are intolerant of ICS. D. with poorly-controlled asthma who fail therapy with omalizumab. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

B. with allergic-based asthma.

16. After inhaled corticosteroid is initiated, improvement in control is usually seen: A. on the first day of use. B. within 2 to 8 days. C. in about 3 to 4 weeks. D. in about 1 to 2 months. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

B. within 2 to 8 days.

Postpartum "baby blues" typically begin": A. 1 to 2 weeks prior to the birth B. within a few days following the birth C. 1 to 2 weeks following the birth D. approximately 1 month following the birth

B. within a few days following the birth

Cardiovascular effects of hyperinsulinemia include: A. Decreased renal sodium reabsorption. B. Constricted circulating volume. C. Greater responsiveness to angiotensin II. D. Diminished sympathetic activation.

Is parotid gland enlargement associated with anorexia nervosa, bulimia nervosa, or both disorders (Ch. 14 Fitzgerald)

Both

A 22 year old woman wants to know whether she can start a walking program. She has a diagnosis of MVP, with echocardiogram revealing trace mitral regurgitation. You respond that: A. she should have an exercise tolerance test. B. an ECG should be obtained. C. she may proceed in the absence of symptoms of activity intolerance. D. running should be avoided. (Ch. 9 Fitzgerald)

A 24-year-old female runner is diagnosed with Addison's disease. In counseling her about exercise, you recommend: A. tapering her running to only 10 minutes per day for 2 to 3 days per week. B. ceasing any prolonged strenuous exercise. C. ensuring an ample amount of sodium is ingested. D. switching to a nonimpact exercise.

A 36 year old man has experienced shoulder pain associated with tendonitis for the past 4 weeks despite the use of ice and analgesics (NSAIDs) and undergoing physical therapy. An appropriate next step would include: A. systemic corticosteroid use. B. x-ray of the shoulder. C. MRI of the shoulder. D. use of an upper arm sling. (Ch. 9 Fitzgerald)

A 42 year old man who has a long-standing history of alcohol abuse presents for primary care. He admits to drinking 12 to 16 beers daily for 10 years. He states, "I really do not feel like the booze is a problem. I get to work every day." Your most appropriate response is: A. "Work is usually the last thing to go in alcohol abuse." B. "Your family has suffered by your drinking." C. "I am concerned about your health and safety." D. "Participating in a support group can help you understand why you drink." (Ch. 14 Fitzgerald)

A 44 year old man has been taking an SSRI for the past 4 months and complains of new onset of sexual dysfunction and difficulty achieving orgasm. You advise him that: A. this is a transient side effect often seen in the first weeks of therapy. B. switching to another SSRI would likely be helpful. C. this is a common adverse effect of SSRI therapy that is unlikely to resolve without adjustment in his therapy. D. he should see a urologist for further evaluation (Ch. 14 Fitzgerald)

A 52 year old woman has RA. She now presents with decreased tearing, "gritty" feeling eyes, and a dry mouth. You consider a diagnosis of: A. systemic lupus erythematosus. B. vasculitis C. Sjorgren syndorome D. scleroderma (Ch. 9 Fitzgerald)

A 6-year-old boy has a 1-year history of moderate persistent asthma that is normally well controlled with budesonide via dry powder inhaler (DPI) twice a day and the use of albuterol once or twice a week as needed for wheezing. Three days ago, he developed a sore throat, clear nasal discharge, and a dry cough. In the past 24 hours, he has had intermittent wheezing, necessitating the use of albuterol two puffs with use of an age-appropriate spacer every 3 hours) with partial relief. Your next most appropriate action is to obtain: A. a chest radiograph. B. an oxygen saturation measurement. C. a peak expiratory flow (PEF) measurement. D. a sputum smear for WBCs.

A 68-year old man presents with suspected bladder cancer. You consider that its most common presenting sign or symptoms is: A. painful urination B. fever and flank pain C. painless gross hematuria D. palpable abdominal mass (Ch. 12 Fitzgerald)

A 7-year-old child with type 1 diabetes mellitus is about to receive injectable influenza vaccine. His parents and he should be advised that: A. the vaccine is more than 90% effective in preventing influenza. B. use of the vaccine is contraindicated during antibiotic therapy. C. localized immunization reactions are common. D. a short, intense, flu-like syndrome typically occurs after immunization.

A 72 year old man presents at an early stage of osteoarthritis in his left knee. He mentions that he heard about the benefits of using glucosamine and chondroitin for treating joint problems. In consulting the patient you mention all of the following except: A. any benefit can take at least 3 months of consistent use before observed. B. glucosamine is not associated with any drug interactions C. clinical studies have consistently shown benefit of long-term use of glucosamine and chondroitin for treating OA of the knee. D. chondroitin should be used with caution because of its antiplatelet effect. (Ch. 9 Fitzgerald)

A 9 year-old child with no documentation of vaccinations comes in for an MMR immunization update. Her parent states that child has received "some" vaccinations, but no documentation is available. How many doses of MMR should the child receive and at what frequency? A. one MMR dose B. two MMR doses together at the same time C. two MMR doses 1 month apart D. no MMR immunization is needed

A middle-school student presents, asking for a letter stating that he should not participate in gym class because he has asthma. The most appropriate response is to: A. write the note because gym class participation could trigger an asthma flare. B. excuse him from outdoor activities only to avoid pollen exposure. C. remind him that with appropriate asthma care, he should be capable of participating in gym class. D. excuse him from indoor activities only to avoid dust mite exposure.

A patient with sciatica will typically report: A. loss of bladder control. B. stiffness, spasm, and reduced ROM C. shooting pain that starts at the hip and radiates to the foot. D. pain at its worst when lying down. (Ch. 9 Fitzgerald)

A pound of fat contains approximately _____ stored calories. 2500 3000 3500 4000

A preparticipation physical screening examination should include: A. CBC B. urinalysis. C. blood pressure measurement D. radiograph of the spine. (Ch. 9 Fitzgerald)

A short leg cast is often needed for what type of ankle sprain? A. grade I B. grade II C. grade III D. grade IV (Ch. 9 Fitzgerald)

A young child should use a rear-facing car seat until at least age ____. A. 12 months B. 18 months C. 24 months D. 30 months

After inhaled corticosteroid or leukotriene modifier therapy is initiated, clinical effects are seen: A. immediately. B. within the first week. C. in about 1 to 2 weeks. D. in about 1 to 2 months.

All of the following agents can be considered for the treatment of severe cases of SLE except: A. leflunomide. B. azathioprine. C. rituximab. D. belimumab. (Ch. 9 Fitzgerald)

All of the following are common signs of osteoporosis except: A. gradual loss of height with stooped posture. B. hip or wrist fracture C. increase in waist circumference. D. patient report of back pain. (Ch. 9 Fitzgerald)

All of the following diagnostic findings are expected in a patient with SLE except: A. elevated ESR B. anemia C. negative ANA test D. proteinuria (Ch. 9 Fitzgerald)

All of the following medications are recommended for treatment of concomitant HTN when seen in a T2DM except: A. beta blockers B. CCB C. alpha adrenergic receptor antagonist D. ARB

All of the following pharmacological interventions are used in the treatment of patients with bulimia nervosa except: A. fluoxetine (Prozac) B. desipramine (Norpramin) C. bupropion (Wellbutrin) D. paraxetine (Paxil) (Ch. 14 Fitzgerald)

Among individuals younger than 35 years, the most common cause of sudden cardiac death is: A. non-ST segment myocardial infarction. B. ST - segment myocardial infarction. C. a congenital cardiac malformation. D. aortic stenosis. (Ch. 9 Fitzgerald)

An innocent heart murmur has which of the following characteristics? A. occurs late in systole B. has localized area of auscultation C. becomes softer when the patient moves from supine to standing position D. frequently obliterates the second heart sound (S2)

At which of the following ages in an infant's life is parental anticipatory guidance about teething most helpful? A. 1 to 2 months B. 2 to 4 months C. 4 to 6 months D. 8 to 10 months

Characteristics of H. influenzae include: A. rare beta-lactamase production. B. antimicrobial resistance because of altered protein binding sites. C. organism most commonly isolated from mucoid middle ear effusion. D. gram-positive organism.

Clinical disorders that increase the risk for osteoporosis include all of the following except: A. rheumatoid arthritis. B. celiac disease. C. hyperlipidemia. D. hyperprolactinemia. (Ch. 9 Fitzgerald)

Clinical findings of the knee in a patient with OA include all of the following except: A. coarse crepitus. B. joint effusion. C. warm joint. D. knee often locks or a pop is heard. (Ch. 9 Fitzgerald)

Common causes of chronic renal failure include all of the following except: A. type 2 diabetes B. recurrent pyelonephritis C. hypotension D. polycystic kidney disease (Ch. 12 Fitzgerald)

Comprehensive treatment for PAD and DM includes all of the following except: A. daily ASA use B. lipid lowering with a statin C. topical antimicrobial to affected area D. maintenance of glycemic control

Cushing's syndrome results from an excess of: A. luteinizing hormone. B. follicle stimulating hormone. C. cortisol. D. aldosterone.

Cyclooxygenase-1-(COX-1) contributes to: A. inflammatory response. B. pain transmission C. maintenance of gastric protective mucosal layer. D. renal arteriole function. (Ch. 9 Fitzgerald)

Evidence-based factors that prevent or minimized the risk of UTIs include all of the following except: A. male gender B. longer urethra-to-anus length in women C. timed voiding schedule D. zinc-rich prostatic secretion (Ch. 12 Fitzgerald)

Extracorporeal shock-wave therapy can be used in the treatment of epicondylitis as a means to: A. improve ROM B. build forearm strength. C. promote the natural healing process D. stretch the extensor tendon. (Ch. 9 Fitzgerald)

In a person diagnosed with superficial bladder cancer without evidence of metastases, you realize that: A. The prognosis for 2 year survival is poor B. a cystectomy is indicated C. despite successful initial therapy, local recurrence is common D. systemic chemotherapy is the treatment of choice (Ch. 12 Fitzgerald)

In caring for elderly patient, the NP considers that all of the following is true except: A. many older patients with dementia have a component of depression B. dementia signs and symptoms usually evolve over months, but depression usually has a more rapid onset. C. with dementia, a patient is aware of difficulties with cognitive ability D. treating concurrent depression can help improve symptoms of dementia. (Ch. 14 Fitzgerald)

In infants, solid foods are best introduced no earlier than: A. 1 to 3 months. B. 3 to 5 months. C. 4 to 6 months. D. 6 to 8 months.

In prescribing levothyroxine therapy for an elderly patient, which of the following is true? Elderly persons require a rapid initiation of levothyroxine therapy. TSH should be checked about 2 days after dosage adjustment. The levothyroxine dose needed by elderly persons is 75% less of that needed by younger adults. TSH should be suppressed to a nondetectable level.

In reference to reactive arthritis (also known as Reiter syndrome), which of the following statements is false? A. When the disease is associated with urethritis, the male:female ratio is about 9:1. B. When the disease is associated with infectious diarrhea, the male and female incidences are approximately equal. C. ANA analysis reveals a speckled pattern. D. Results of joint aspirate culture are usually unremarkable. (Ch. 9 Fitzgerald)

In treating a person with panic disorder using an SSRI, the NP should consider that there is: A. considerable abuse potential with these medications B. no significant therapeutic advantage over TCAs C. a reduction in number and severity of panic attacks D. significant toxicity in overdose. (Ch. 14 Fitzgerald)

In treatment-resistant patients with panic disorder, which drug class is occasionally used? A. atypical antipsychotic B. selective dopamine reuptake inhibitor C. monoamine oxidase inhibitor D. neuroleptic (Ch. 14 Fitzgerald)

Loss of Achilles tendon reflex most likely indicates a lesion at: A. L1 to L2. B. L3 to L4. C. L5 to S1. D. S2 to S3. (Ch. 9 Fitzgerald)

Loss of posterior tibial reflex often indicates a lesion at: A. L3. B. L4. C. L5. D. S1. (Ch. 9 Fitzgerald)

Metformin has all of the following effects except: Improved insulin mediated glucose uptake. Modest weight loss with initial use. Enhanced fibrinolysis. Increased LDL production.

Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of: A. hypoglycemia B. hepatic impairment C. lactic acidosis D. interaction with most anesthetic agents

Most cases of roseola caused by human herpesvirus-6 occur in: A. newborns who contracted the virus in utero. B. infants younger than 3 months old. C. children younger than 24 months old. D. children older than 2 years.

Most drugs pass into breast milk through: A. active transport. B. facilitated transfer. C. simple diffusion. D. creation of a pH gradient.

Of the following individuals in need of an antidepressant who is the best candidate for fluoxetine (Prozac) therapy? A. an 80 year old woman with depressed mood 1 year after the death of her husband B. a 45 year old man with mild hepatic dysfunction C. a 28 year old man who occasionally "skips a dose" of his prescribed medication D. a 44 year old man with decreased appetite. (Ch. 14 Fitzgerald)

Osteoporosis is defined as having a bone density more than ______ standard deviation(s) below tha average bone mass for women younger than 35 years old. A. 1 B. 1.5 C. 2.5 D. 4 (Ch. 9 Fitzgerald)

Osteoporosis prevention measures include all of the following except: A. calcium supplementation. B. selective estrogen receptor modulator use. C. vitamin B6 supplementation. D. weight-bearing and muscle-strengthening exercises. (Ch. 9 Fitzgerald)

What advice should you give to a breastfeeding mother whose 4-month-old has gastroenteritis and reports 2 loose stools and 2 episodes of vomiting within the past 4 hours? A. Switch to soy-based formula. B. Give the infant oral rehydration solution only. C. Continue breastfeeding. D. Supplement with a sugar water solution.

What percentage of body weight is typically lost in a child with moderate dehydration? A. 2% to 3% B. 3% to 5% C. 6% to 10% D. 11% to 15%

What percentage of children have an episode of pneumonia before the age of age 5? A. 18% to 20% B. 9% to 10% C. 3% to 4% D. 20% to 30%

When advising a patient about immunization with the nasal spray flu vaccine, the NP considers the following: A. its use is acceptable during pregnancy. B. its use is limited to children younger than age 2 years. C. it contains live virus. D. A potentially harmful virus can be shed to vulnerable household members post vaccination.

When discontinuing benzodiazepine treatment after prolonged use, you recommend: A. terminating treatment immediately. B. decreasing the dose 20% per day. C. decreasing the dose 25% per week. D. Decreasing the dose 50% per week. (Ch. 14 Fitzgerald)

When discussing physical activity with a 40 year old woman with fibromyalgia, you advise, that: A. limiting exercise is an important component of symptom management. B. weight-bearing exercise would be most helpful C. physical activity aimed at increasing flexibility is an important part of treatment. D. although possibly helpful in minimizing pain, physical activity usually significantly worsens fatigue (Ch. 9 Fitzgerald)

When prescribing Niacin, the NP expects to see what change in the lipids? A. marked decrease in LDL B. increase in HDL C. no effect on TG D. increase in VLDL

When prescribing a benzodiazepine, the NP should consider that: A. the ingestion of 3 to 4 days of therapeutic dose can be life-threatening. B. the medication must be taken at the same hour every day. C. concomitant use of alcohol should be avoided. D. onset of therapeutic effect takes many days. (Ch. 14 Fitzgerald)

Which is the most common presentation in a patient with Raynaud phenomenon? A. digital ulceration B. worsening of symptoms in warm weather C. a period of intense itchiness after blanching D. unilateral symptoms

Which is the most potent risk factor for PVD? A. HTN B. older age C. cigarette smoking D. leg injury

Which of the following SSRIs is most likely to significantly interact with warfarin? A. citaloproam B. paroxetine C. duloxetine D. sertraline (Ch. 14 Fitzgerald)

Which of the following best describes the pathophysiology and resulting clinical presentation of asthma? A. intermittent airway inflammation with occasional bronchospasm B. a disease of bronchospasm leading to airway inflammation C. chronic airway inflammation with superimposed bronchospasm D. relatively fixed airway constriction

Which of the following diagnostic approaches is used for confirmation of sarcoidosis? A. chest x-ray B. high-resolution CT scan C. biopsy D. ANA fluorescent staining (Ch. 9 Fitzgerald)

Which of the following hemograms would be expected for a 46 year old woman with poorly controlled RA? A. Hg = 11.1 g/dL (12-14 g/dL); MCV = 66 fL (80-90 fL); reticulocytes = 0.8% (1% - 2%). B. Hg = 10.1 g/dL (12-14 g/dL); MCV = 103 fL (80-90 fL); reticulocytes = 1.2% (1% - 2%). C. Hg = 9.7 g/dL (12-14 g/dL); MCV = 87 fL (80-90 fL); reticulocytes = 0.8% (1% - 2%). D. Hg = 11.4 g/dL (12-14 g/dL); MCV = 84 fL (80-90 fL); reticulocytes = 2.3% (1% - 2%). (Ch. 9 Fitzgerald)

Which of the following is least likely to be reported by patients with CTS? A. worst symptoms during the day B. burning sensation in the affected hand C. tingling pain that radiates to the forearm D. nocturnal numbness (Ch. 9 Fitzgerald)

Which of the following is most consistent with the diagnosis of dysthymia? A. a 23 year old man with a 2 month episode of depressed mood after a job loss B. a 45 year old woman with "jitteriness" and difficulty initiating sleep for the past 6 months. C. a 38 year old woman with fatigue and anhedonia for the past 2 years D. a 15 year old boy with a school adjustment problem and weekend marijuana use for the past year. (Ch. 14 Fitzgerald)

Which of the following is not characteristic of rheumatoid arthritis (RA)? A. It is more common in women at a 3:1 ratio. B. Family history of autoimmune conditions often is reported. C. Peak age for disease onset in individuals is age 50 to 70 years. D. Wrists, ankles, and toes often are involved. (Ch. 9 Fitzgerald)

Which of the following is noted in a child with premature adrenarche? A. breast development. B. accelerated linear growth. C. pubic hair. D. menstruation.

Which of the following is the anticipated clinical effect of acamprosate (Campral) in the treatment of alcohol dependence? A. modifies intoxicating effects of alcohol B. causes unpleasant adverse effects of alcohol C. helps to reduce the urge to drink D. minimizes alcohol withdrawal symptoms (Ch. 14 Fitzgerald)

Which of the following is the most accurate information in the caring for a 40 year old man with cystitis? A. This is a common condition in men of this age B. A gram-positive organism is the likely causative pathogen C. A urological evaluation should be considered D. Pyuria is rarely found (Ch. 12 Fitzgerald)

Which of the following provides the least amount of vitamin D A. fortified milk (8oz.) B. fortified orange juice (8oz.) C. 1 egg yolk D. infant formula (8oz.) (Ch. 9 Fitzgerald)

Which of the following should be periodically monitored with the use of a thiazolidinedione? A. CK B. ALP C. ALT D. Cr

Which of the following should not receive vaccination against influenza? A. a 19 year old with a history of hive-form reaction to eating eggs B. A 24-year-old woman who is 8 weeks pregnant C. a 4-month-old infant who was born at 32 weeks' gestation D. A 28-year-old woman who is breastfeeding a 2 week old

Which of the following statements is most accurate in the assessment of a patient with varicose veins? A. The degree of venous tortuosity is well-correlated with the amount of leg pain reported. B. As the number of affected veins increases, so does the degree of patient discomfort. C. Symptoms are sometimes reported with minimally affected vessels. D. Lower-extremity edema is usually seen only with severe disease.

Which of the following statements is true concerning anorexia nervosa? A. The disease affects men and women equally. B. Onset is usually in the mid-20s for men and women. C. Depression is often found concomitantly. D. Individuals with anorexia nervosa are aware of the extreme thinness associated with the disease. (Ch. 14 Fitzgerald)

Which of the following statements is true concerning domestic violence? A. It is found largely among people of lower socioeconomic status. B. The person in an abusive relationship usually seeks help. C. Routine screening is indicated during pregnancy. D. A predictable cycle of violent activity followed by a period of calm is the norm. (Ch. 14 Fitzgerald)

Which of the following statements is true regarding depression and relapse? A. Without maintenance therapy, the relapse rate is typically less than 50% in the first year. B. The risk of relapse is less for those who have experienced multiple episodes of major depressive disorder. C. The risk of relapse is greatest in the first 2 months after discontinuation of therapy. D. Relapse rarely occurs if there is an absence of symptoms after 9 months of treatment discontinuation. (Ch. 14 Fitzgerald)

Which of the following tests yields the greatest amount of clinical information in a patient with acute lumbar radiculopathy? A. lumbosacral radiograph series B. ESR measurement C. MRI D. bone scan (Ch. 9 Fitzgerald)

Which of the following viruses is a potent teratogen? A. measles B. mumps C. rubella D. influenza

Without intervention, approximately 40% of infants born to mothers with HBV infection will go on to: A. develop acute hepatitis B infection. B. die from chronic liver disease. C. develop chronic hepatitis B. D. develop lifelong immunity to the hepatitis B virus.

You anticipate that adult car seat belts fit correctly when a child is approximately _____ tall and is____ old. A. 51 inches (129.5 cm), 6 to 8 years B. 53 inches (134.6 cm), 5 to 7 years C. 57 inches (144.8 cm), 8 to 12 years D. 59 inches (150 cm), 12 to 14 years

You are seeing 17 yo Cynthia. As part of the visit, you consider her risk factors for T2DM would likely include all of the following except: A. obesity B. Native American ancestry C. family history of T1DM D. personal history of polycystic ovary syndrome

You are seeing a patient who is taking warfarin and cholestyramine and provide the following advice: A. "Take both medications together. " B. "You need to have additional hepatic monitoring tests while on this combination. " C. "Separate the cholestyramine from other medications by at least 2 hours. " D. "Make sure you take these medications on an empty stomach. "

You examine a 64 yo man with HTN and T2DM. HDL=38, LDL=135, TG=180, 10 yr ASCVD=5%. Meds include sulfonylurea, biguanide, ACEI, thiazide diuretic, and he has acceptable glycemic and BP control. He states, " I really watch the fats and sugars in my diet". Which of the following interventions is most appropriate? A. No further intervention is needed. B. His lipid profile should be repeated in 6 months C. Lipid lowering drugs with a moderate intensity statin should be initiated D. The patient's dietary intervention appears adequate.

You note that a 25 year old woman has bruises on her right shoulder. She states: "I fell up against the wall." The bruises appear finger-shaped. She denies that another person injured her. What is your best choice of statement in response to this? A. "Your bruises really look as if they were caused by someone grabbing you." B. "Was this really an accident?" C. "I notice the bruises are in the shape of a hand." D. "How did you fall?" (Ch. 14 Fitzgerald)

You see a 26 year old woman who has been recently diagnosed with SLE and has initiated therapy to control moderate symptoms of the disease, including fatigue and joint pain. She mentions that she and her husband are hoping to start a family soon. In counseling her about pregnancy, you consider that: A. there is a low probability of conception during symptomatic flares of SLE B. most treatments of SLE must be discontinued once a woman becomes pregnant. C. SLE is associated with a high risk of pregnancy loss. D. there is a higher risk of gestational diabetes in women with SLE (Ch. 9 Fitzgerald)

You see a 37 year old man with rheumatoid arthritis who has been treated with hydroxychloroquine and oral NSAIDs for the past 3 months with little improvement in symptoms. Radiography indicates slight progression of RA in several major joints. You recommend: A. maintaining the current regimen B. increasing the dose of NSAIDs C. adding methotrexate to his regimen. D. switching from hydroxychloroquine to a biologic agent. (Ch. 9 Fitzgerald)

You see a 4-year-old girl who has a 2-day history of signs and symptoms of an acute asthma flare resulting from viral upper respiratory tract infection. She is using inhaled budesonide and albuterol as directed and continues to have difficulty with increased occurrence of coughing and wheezing. Her respiratory rate is within 50% of upper limits of normal for her age. Her medication regimen should be adjusted to include: A. oral theophylline. B. inhaled salmeterol (Serevent). C. oral prednisolone. D. oral montelukast (Singulair).

You see a 58 year old man diagnosed with a kidney stone who reports pain primarily during urination. You consider all of the following except: A. improved hydration B. alpha blocker use C. prescribing a diuretic D. analgesia use (Ch. 12 Fitzgerald)

You see a 63 year old man with a suspected upper gastrointestinal bleed. Expected laboratory findings would include: A. elevated BUN; elevated serum creatinine B. normal BUN; elevated serum creatinine C. elevated BUN; normal serum creatinine D. lowered BUN; elevated serum creatinine (Ch. 12 Fitzgerald)

You see a 70 year old woman in a walk-in center with a chief complaint of increased urinary frequency and dysuria. Urinalysis reveals pyuria and positive nitrites. She mentions she has a "bit of kidney trouble, not too bad." Recent evaluation of renal status is unavailable. In considering antimicrobial therapy for this patient, you prescribe: A. nitrofurantoin B. fosfomycin C. ciprofloxacin D. doxycycline (Ch. 12 Fitzgerald)

You see an 82 year old woman with early onset dementia and urge incontinence. Which of he following medications is least likely to contribute to worsening mental status? A. oxybutynin (Ditropan) B. tolterodine (Detrol) C. darifenacin (Enablex) D. solifenacin (Vesicare) (Ch. 12 Fitzgerald)

A diet low in these nutrients encourages lead absorption: A. protein B. carbohydrates C. zinc D. magnesium

C, D

Klinefelter syndrome and risk for having a child with this condition can be accurately identified by: A. urine test B. literacy assessment C. amniocentesis D. blood test for carrier state

C, D

Regarding physiologic jaundice in the newborn, select all that are correct. A. It occurs between 12 and 24 hours of life. B. It progresses from the abdomen toward the head of the infant C. Unconjugated bilirubin is elevated. D. Risk of development of hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding every 2 to 3 hours per 24 hours. E. It can be avoided by supplemental water and dextrose feedings between breastfeeding in the first 3 to 4 days of life to increase hydration while mother's milk come in.

C, D

Risk factors for dyslipidemia in children include: A. BP at 70-80th percentile B. breastfeeding into the toddler years C. family history of lipid abnormalities D. family history of T2DM

C, D

23. The most common source of hepatitis A infection is: A. sharing intravenous drug equipment.B. cooked seafood.C. contaminated water supplies.D. sexual contact.

C. contaminated water supplies

Stage 3 Lyme disease, characterized by joint pain and neuropsychiatric symptoms, typically occurs how long after initial infection? A. 1 month B. 4 months C. 1 year D. 5 years

C. 1 year

168. Which of the following best represents the peak ages for occurrence of acute appendicitis? A. 1 to 20 years B. 20 to 40 years C. 10 to 30 years D. 30 to 50 years

C. 10 to 30 years

The "quad screen" should be obtained at about _____ weeks of pregnancy. A. 6 to 10 B. 11 to 15 C. 16 to 20 D. 21 to 25

C. 16 to 20 Quad screen = maternal analysis for AFP, hCG, inhibin-A, & unconjugated estriol levels Abnormal quad screen is not diagnostic of any condition, but raises risks for open NTDs, trisomy 21 (Downs syndrome) and trisomy 18 (Edwards syndrome).

Edwards syndrome is the clinical manifestation of trisomy _____. A. 13 B. 15 C. 18 D. 21

C. 18

In health, the ratio of Hgb to Hct is known as: A. 1:1 B. 1:2 C. 1:3 D. 1:4

C. 1:3

Preeclampsia presentation is noted after the _____ week of pregnancy. A. 10th B. 15th C. 20th D. 25th

C. 20th

The recommended weight gain during pregnancy for a woman with a desirable or healthy pre-pregnancy BMI is: A. 15 to 20 lb (6.8 to 9.1 kg) B. 20 to 30 lb (9.1 to 13.6 kg) C. 25 to 35 lb (11.3 to 15.9 kg) D. 35 to 45 lb (15.9 to 20.4)

C. 25 to 35 lb (11.3 to 15.9 kg)

How many grams of a topical cream or ointment are needed for a single application to an arm? A. 1 B. 2 C. 3 D. 4

C. 3

96. Cough associated with acute bronchitis can typically last up to: A. 1 week. B. 2 weeks. C. 3 weeks. D. 3 months. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 156). F.A. Davis Company. Kindle Edition.

C. 3 weeks.

The rate of spontaneous fetal loss related to amniocentesis that is done at a facility that performs these procedures on a regular basis is approximately 1 in _____ procedures. A. 75 B. 200 C. 400 D. 800

C. 400 The rate of spontaneous fetal loss related to amniocentesis done in general is about 1 in every 200-400 procedures.

103. Guidelines from the National Comprehensive Cancer Network (NCCN) recommend screening high-risk smokers beginning at age: A. 40 years. B. 45 years. C. 50 years. D. 55 years. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 158). F.A. Davis Company. Kindle Edition.

C. 50 years.

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb=9.1g (12-14 g) Hct=28% (36-42%) RBC=5 million mm3 (3.2-4.3 million) MCV=68 fL (80-96 fL) MCHC=33.2 g/dL (32-36 g/dL) RDW= 13% (</= 15%) Reticulocytes: 1.5% This is most consistent with he laboratory assessment of: A. IDA B. Cooley anemia C. Alpha-thalassemia minor D. Hgb Barts

C. Alpha-thalassemia minor Microcytic anemias (MCV < 80) - IDA (increased RDW) - Alpha or Beta thalassemia (normal RDW)

An increase in the normal variation of RBC size is known as: A. Poikilocytosis B. Granulation C. Anisocytosis D. Basophilic stippling

C. Anisocytosis

72. Is the following statement most consistent with IBD, with IBS, or with both conditions? Onset of symptoms is before age 30 to 40 years in most cases. A. IBDB. IBSC. Both IBD and IBS

C. Both IBD and IBS

A drug shown to cause teratogenic effect in animal studies, but for which no human study is available, is assigned FDA risk category: A. A B. B C. C D. D

C. C

5. In a patient who presents with a history consistent with anal fissure but with notation of an atypical anal lesion, alternative diagnoses to consider include all of the following except: A. condyloma acuminata.B. Crohn's disease.C. anal squamous cell carcinoma.D. C. difficile colitis.

C. C. diff colitis

107. You are seeing Mr. Lopez, a 68-year-old man with suspected acute colonic diverticulitis. In choosing an appropriate imaging study to support this diagnosis, which of the following abdominal imaging studies is most appropriate? A. flat plate B. ultrasound C. CT scan with contrast D. barium enema

C. CT scan with contrast

A common cause of angular cheilitis is infection by: A. Escherichia coli B. Streptococcus pneumoniae C. Candida species D. Aspergillus species

C. Candida species

47. A 56-year-old woman is diagnosed with mild diverticulitis. In addition to counseling her about increased fluid intake and adequate rest, you recommend antimicrobial treatment with: A. amoxicillin with clarithromycin. B. linezolid with daptomycin. C. ciprofloxacin with metronidazole. D. nitrofurantoin with doxycycline.

C. Ciprofloxacin with metronidazole.

29. IBD is a term usually used to describe: A. ulcerative colitis and irritable bowel syndrome.B. C. difficile colitis and Crohn's disease.C. Crohn's disease and ulcerative colitis.D. inflammatory colitis and ileitis.

C. Crohn's disease and ulcerative colitis.

87. "Skip lesions" are usually reported during colonoscopy in: A. irritable bowel syndrome. B. ulcerative colitis. C. Crohn's disease. D. C. difficile colitis.

C. Crohn's disease.

The benzodiazepines are FDA pregnancy risk category: A. B B. C C. D D. X

C. D

In Down syndrome, which of the following is true? A. Most infants affected with Down syndrome are born to women older than age 35 years B. Down syndrome is noted in about 1 in 10,000 live births C. Down syndrome is associated with decreased maternal serum AFP level D. Antenatal serum analysis is sufficient to make the diagnosis

C. Down syndrome is associated with decreased maternal serum AFP level Down syndrome occurs approximately in 1 in 1000 live births. This number increases to 1 in 270 in women 35 to 40 yo & 1 in 100 in women older than 40 years. Maternal levels of AFP is decreased in trisomy 21 and and trisomy 18.

Treatment of postpartum depression can typically include all of the following except: A. counseling B. antidepressants C. ECT D. HT

C. ECT ECT is commonly used to treat postpartum psychosis.

A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus? A. Iron B. Niacin C. Folic acid D. Vitamin C

C. Folic acid

85. Findings of increased tactile fremitus and dullness to percussion at the right lung base in the person with CAP likely indicate an area of: A. atelectasis. B. pneumothorax. C. consolidation. D. cavitation. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

C. consolidation.

Which of the following is not consistent with ACD? A. NL RDW B. NL MCHC C. Hct < 24% D. NL to slightly elevated serum ferritin

C. Hct < 24% Rarely does Hct go below 24% in a person with ACD

In the first weeks of anemia therapy with parenteral vitamin B12 in a 68-year-old woman with HTN who is taking a thiazide diuretic, the patient should be carefully monitored for: A. Hypernatremia B. Dehydration C. Hypokalemia D. Acidemia

C. Hypokalemia

You note that a 28 yo woman who is 4 months pregnant has bruises on her right shoulder. She states, "I fell up against the wall." The bruises appear finger-shaped. She denies that another person injured her. What is your best response to this? A. Your bruises really look as if they were caused by someone grabbing you B. Was this really an accident? C. I notice the bruises are in the shape of a hand D. How did you fall?

C. I notice the bruises are in the shape of a hand

70. The presence of esophageal cancer is commonly associated with: A. renal impairment.B. chronic bronchitis.C. iron-deficiency anemia.D. unexplained weight gain.

C. IDA

Which of the following would not be recommended to prevent Lyme disease when visiting a Lyme-endemic area?A. Wear long pants and long-sleeved shirts. B. Use insect repellent. C. If a tick bite occurs, wait until after consulting a healthcare provider before removing the insect. D. If a tick bite occurs and the tick is engorged, administer a single 200-mg dose of doxycycline

C. If a tick bite occurs, wait until after consulting a healthcare provider before removing the insect.

Type I hypersensitivity reactions, such as atopic dermatitis, involve the action of which antibodies binding to receptor sites on mast cells? A. IgG B. IgM C. IgE D. IgA

C. IgE

Type I hypersensitivity reaction is mediated through: A. TNF-binding to T cells. B. IgG antibodies binding to T cells. C. IgE antibodies binding to mast cells. D. IL-10 binding to basophils.

C. IgE antibodies binding to mast cells

Which of the following represents the most accurate patient information when using permethrin (Elimite) for treating scabies? A. To avoid systemic absorption, the medication should be applied over the body and rinsed off within 1 hour. B. The patient should notice a marked reduction in pruritus within 48 hours of using the product. C. Itch often persists for a few weeks after successful treatment. D. It is a second-line product in the treatment of scabies

C. Itch often persists for a few weeks after successful treatment

According to Hale's Lactation Risk Category, a medication in which there is evidence of risk for its use in lactation, but it can be used if there is a maternal life-threatening situation, is listed as category: A. L2 B. L3 C. L4 D. L5

C. L4

In ectopic pregnancy, all of the following statements are true except: A. hCG is low for gestational age and is not increasing normally B. US evaluation fails to reveal abnormality in 20% to 30% of cases C. Location of the pregnancy is often on the ovary or cervix D. Risk factors include current pregnancy via assisted reproduction

C. Location of the pregnancy is often on the ovary or cervix Instead, location is often in the fallopian tube.

39. Which of the following statements is true when evaluating a patient with acute pancreatitis? A. Diagnosis can be made by clinical assessment alone.B. The pancreas can be clearly visualized by abdominal ultrasound.C. Measuring serum lipase level along with amylase level increases diagnostic specificity in acute pancreatitis.D. Hypocalcemia is a nearly universal finding.

C. Measuring serum lipase level along with amylase level increases diagnostic specificity in acute pancreatitis.

When the cause of a macrocytic anemia is uncertain, the most commonly recommended additional testing includes with the following? A. Haptoglobin and reticulocyte count B. Schiling test and gastric biopsy C. Methylmalonic acid and homocysteine D. Transferrin and prealbumin

C. Methylmalonic acid and homocysteine Elevated serum MMA and homocysteine levels are found with pernicious anemia Normal serum MMA and elevated homocysteine levels are found in folic acid deficiency

Concerning the use of alcohol during pregnancy, which of the following statements is most accurate? A. Although potentially problematic, maternal alcohol intake does not increase the risk of miscarriage B. Risk to the fetus from alcohol exposure is greatest in the third trimester C. No level or time of exposure is considered to be safe D. Risk of fetal alcohol syndrome is present only if alcohol exposure has occurred throughout the pregnancy

C. No level or time of exposure is considered to be safe

74. Concerning IBS, which of the following statements is most accurate? A. Patients most often report chronic diarrhea as the most distressing part of the problems.B. Weight gain is often reported. C. Patients can present with bowel issues ranging from diarrhea to constipation. D. The condition is associated with a strongly increased risk of colorectal cancer.

C. Patients can present with bowel issues ranging from diarrhea to constipation.

Results of hemogram in a person with ACD include: A. Microcytosis B. Anisocytosis C. Reticulocytopenia D. Macrocytosis

C. Reticulocytopenia ACD is caused by reduced erythropoietin response in the marrow, resulting in RBC hypoproliferation

A 48-year-old woman developed IDA after excessive perimenopausal bleeding, successfully treated by endometrial ablation. Her Hct level is 25% and she is taking iron therapy. At 5 days into therapy, one possible observed change in lab parameters would include: A. A correction of MCV B. An 8% increase in Hct level C. Reticulocytosis D. A correction in ferritin level

C. Reticulocytosis Reticulocytosis count peaks 7-10 days into therapy

Which of the following statements is true concerning domestic violence during pregnancy? A. This is found largely among women of lower socioeconomic status B. Women in an abusive relationship usually seek help C. Routine screening is indicated during pregnancy D. A predictable cycle of violent activity followed by a period of calm is the norm

C. Routine screening is indicated during pregnancy

A 25 yo woman presents in the 10th week of gestation requesting antenatal screening for Down syndrome. What advice should the NP give? A. Because of her age, no specific testing is recommended B. She should be referred for second-trimester US C. Screening that combines nuchal translucency measurement and biochemical testing is available D. She should be referred to a genetic counselor

C. Screening that combines nuchal translucency measurement and biochemical testing is available When first-trimester testing is desired, screening using nuchal translucency is detected by US and serological testing for decreased free beta-hCG is effective in the general population and is more effective than nuchal translucency alone.

Poikilocytosis refers to alterations in a RBC's: A. Thickness B. Color C. Shape D. Size

C. Shape

Match uterine size with stage of pregnancy. Nongravid A. Size of a baseball B. Size of a softball or grapefruit C. Size of a large lemon D. Size of a tennis ball or orange E. Uterine fundus at umbilicus F. Uterine fundus halfway between symphysis pubis and umbilicus

C. Size of a large lemon Mobile, firm, nontender

81. Which of the following most accurately describes sputum analysis in the evaluation of the person with community-acquired pneumonia? A. Gram stain is routinely advised. B. Antimicrobial therapy should not be initiated until sputum specimen for culture has been obtained. C. Sputum analysis is not recommended in the majority of patients with community-acquired pneumonia. D. If required, chest physical therapy can be used to facilitate sputum production. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

C. Sputum analysis is not recommended in the majority of patients with community-acquired pneumonia.

24.Which of the following is true regarding the use of systemic corticosteroids in the treatment of asthma? A. Frequent short bursts are preferred over daily inhaled corticosteroids. B. The oral corticosteroid should be started at day 3-4 of the asthma flare for optimal effect. C. The oral route is preferred over parenteral therapy. D. The adult dose to treat an asthma flare should not exceed the equivalent of prednisone 40 mg daily. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

C. The oral route is preferred over parenteral therapy.

Match the clinical presentation of the following. Complete abortion A. Uterine contents include a nonviable pregnancy that is in the process of being expelled B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable C. The products of conception have been completely expelled D. US evaluation shows a viable pregnancy, although vaginal bleeding is present

C. The products of conception have been completely expelled

A healthy 34-year-old man asks whether he should take an iron supplement. You respond that: A. This is a pruduent measure to ensure health B. Iron-deficiency anemia is a common problem in men of his age C. Use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload D. Excess iron is easily excreted

C. Use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload Men >/= 50 with IDA should be evaluated for GI tract bleeds.

C. VII

53. You examine a 28-year-old woman who has emigrated from a country where tuberculosis (TB) is endemic. She has documentation of receiving Bacille CalmetteGuérin (BCG) vaccine as a child. With this information, you consider that: A. she will always have a positive tuberculin skin test (TST) result. B. biannual chest radiographs are needed to assess her health status accurately. C. a TST finding of 10 mm or more induration should be considered a positive result. D. isoniazid therapy should be given for 6 months before TST is undertaken. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

C. a TST finding of 10 mm or more induration should be considered a positive result.

20. Clinical findings characteristic of poorly controlled asthma include all of the following except: A. a recurrent spasmodic cough that is worse at night. B. recurrent shortness of breath and chest tightness with exercise. C. a congested cough that is worse during the day. D. wheezing with and without associated respiratory infections. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

C. a congested cough that is worse during the day.

One of the mechanisms of action of a topical corticos-teroid preparation is as: A. an antimitotic B. an exfoliant C. a vasoconstrictor D. a humectant

C. a vasoconstrictor

The placenta is best described as: A. poorly permeable B. an effective drug barrier C. able to transport lipophilic substances D. capable of impeding substances with molecular weight less than or equal to 300 daltons

C. able to transport lipophilic substances Drugs with a low molecular weight (</= 500 daltons) cross the placental barrier more easily than drugs with a molecular weight greater than 500 daltons. Highly lipophilic drugs penetrates the placenta more easily. Drugs with a long half-life or extended-release formulations are usually held in maternal ciruclation longer and have the potention to have greater effect ont he fetus than similar drugs with shorter half-lives.

Psoriasis vulgaris is a chronic skin disease caused by: A. bacterial colonization. B. absence of melanin. C. accelerated mitosis. D. type I hypersensitivity reaction

C. accelerated mitosis

Of the following medications, which is least likely to be implicated as a trigger for anaphylaxis? A. ibuprofen B. amoxicillin C. acetaminophen D. aspirin

C. acetaminophen

91. A 58-year-old man recently began taking an antihypertensive medication and reports that his "heartburn" has become much worse. He is most likely taking: A. atenolol. B. trandolapril. C. amlodipine. D. losartan.

C. amlodipine.

Seborrheic dermatitis is likely caused by: A. accelerated mitosis of skin cells. B. colonization of skin by Staphylococcus aureus. C. an inflammatory reaction to Malassezia species on skin. D. exposure to excessive UV radiation.

C. an inflammatory reaction to Malassezia species on skin

126. Which of the following diagnostic tests is most effective in determining whether a pseudocyst is benign? A. CT scan B. MRI scan C. analysis of cyst fluid D. serum amylase and lipase levels

C. analysis of cyst fluid

Tom is a 19-year-old man who presents with sudden onset of edema of the lips and face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical exam reveals inspiratory and expiratory wheezing. BP is 78/44 mm Hg, HR is 102 bpm, and RR is 24/min. His clinical presentation is most consistent with the dx of: A. urticaria B. angioedema C. anaphylaxis D. reactive airway disease

C. anaphylaxis Although the dx of anaphylaxis usually involves 2 or more organs (ie, skin plus respiratory), anaphylaxis may present with single-organ involvement such as respiratory event or hypotension alone. Anaphylaxis includes one of three clinical scenarios: 1. The acute onset of a reaction (minutes to hours) with involvement of the skin, mucosal tissue, or both AND AT LEAST ONE OF THE FOLLOWING: (a) respiratory compromise, or (b) reduced BP or sxs of end-organ dysfunction or... 2. Two or more the the following that occur rapidly after exposure to a LIKELY allergen for that patient: involvement of the skin/mucosal tissue, respiratory compromise, reduced BP or associated sxs, and/or persistent GI sxs or... 3. Reduced BP after exposure to a KNOWN allergen.

147. When choosing pharmacological intervention to prevent recurrence of duodenal ulcer in a middle-aged man, you prescribe: A. a proton pump inhibitor (PPI). B. timed antacid use. C. antimicrobial therapy. D. a histamine2-receptor antagonist (H2RA).

C. antimicrobial therapy.

150. Which of the following is an appropriate treatment for IBS? A. high-fat, low-residue diet. B. high-fiber, low-fat diet and stress modification. C. antispasmotics and loperamide for diarrhea predominance. D. tricyclic antidepressants for constipation predominance

C. antispasmotics and loperamide for diarrhea predominance.

The most important aspect of skin care for individuals with atopic dermatitis is: A. frequent bathing with antibacterial soap. B. consistent use of medium-potency to high-potency topical steroids. C. application of lubricants. D. treatment of dermatophytes.

C. application of lubricants

14. An 18-year-old high school senior presents, asking for a letter stating that he should not participate in gym class because he has asthma. The most appropriate action is to: A. write the note because gym class participation could trigger asthma symptoms. B. excuse him from outdoor activities only to avoid pollen exposure. C. assess his level of asthma control and make changes in his treatment plan if needed so he can participate. D. write a note excusing him from gym until his follow-up examination in 2 months. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

C. assess his level of asthma control and make changes in his treatment plan if needed so he can participate.

37. An 8-year-old girl is diagnosed with celiac disease. When counseling her parents, you advise that the child should: A. consume whole grains, especially wheat, oats, and barley. B. carefully plan exercise to minimize symptoms. C. avoid intake of semolina, spelt, and rye. D. avoid birthday parties or other gatherings that could expose the child to offending foods.

C. avoid intake of semolina, spelt, and rye.

First-line therapy for acne vulgaris with closed comedones includes: A. oral antibiotics. B. isotretinoin. C. benzoyl peroxide. D. hydrocortisone cream

C. benzoyl peroxide

Definitive diagnosis of skin cancer requires: A. skin examination B. CT scan C. biopsy D. serum antigen testing

C. biopsy

Antihistamines exhibit therapeutic effect by: A. inactivating circulating histamine. B. preventing the production of histamine. C. blocking activity at histamine receptor sites. D. acting as a procholinergic agent.

C. blocking activity at histamine receptor sites

127. Which of the following patient complaints should be evaluated further when making the differential diagnosis of irritable bowel syndrome (IBS)? A. a 52-year-old female with a first-degree family history of colorectal cancer, recent constipation, and abdominal pain B. a middle-aged adult with low albumin and leukocytosis C. both patients outlined in responses A and B D. a 16-year-old female with chronic, alternating constipation and diarrhea when she is studying for high school exams and worrying about her parents' impending divorce

C. both patients outlined in responses A and B

38. When used in treating COPD, ipratropium bromide (Atrovent®) is prescribed to achieve which of the following therapeutic effects? A. increase mucociliary clearance B. reduce alveolar volume C. bronchodilation D. mucolytic action Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 143). F.A. Davis Company. Kindle Edition.

C. bronchodilation

A 62-year-old woman presents 2 days after noticing a"bug bite" on her left forearm. Examination reveals a warm, red, edematous area with sharply demarcated borders. The patient is otherwise healthy with no fever. This most likely represents: A. contact dermatitis. B. an allergic reaction. C. cellulitis. D. erysipelas

C. cellulitis

1. Which of the following best describes asthma? A. intermittent airway inflammation with occasional bronchospasm B. a disease of bronchospasm that leads to airway inflammation C. chronic airway inflammation with superimposed bronchospasm D. relatively fixed airway constriction Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition.

C. chronic airway inflammation with superimposed bronchospasm

119. In a well adult with modest hepatic enzyme elevation and hepatitis B surface antigen (HBsAg) positive, these findings are most consistent with: A. no evidence of hepatitis B infection. B. resolved hepatitis B infection. C. chronic hepatitis B. D. evidence of effective hepatitis B immunization.

C. chronic hepatitis B.

80. Risk factors for pneumonia caused by P. aeruginosa include all of the following except: A. mechanical ventilation. B. cystic fibrosis. C. community residence. D. chronic tracheostomy. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

C. community residence.

The principle of "minimum necessary" disclosure relates to which of the following? A. covered entities must provide the requested protected health information in as short a time as possible B. covered entities can only charge a nominal fee for providing requested protected health information C. covered entities must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed D. covered entities must make reasonable efforts to provide electronic records, including medical images, of protected health information in as small a file as possible

C. covered entities must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed

64. Choose the therapy for: a 46-year-old well woman with a history of a bilateral tubal ligation who is macrolide intolerant? A. clarithromycin B. amoxicillin C. doxycycline D. fosfomycin Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

C. doxycycline

An impetigo lesion that becomes deeply ulcerated is known as: A. cellulitis. B. erythema. C. ecthyma. D. empyema

C. ecthyma

75. Which of the following characteristics applies to macrolides? A. consistent activity against DRSP B. contraindicated in pregnancy C. effective against atypical pathogens D. unstable in the presence of beta-lactamase Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

C. effective against atypical pathogens

An example of an antimicrobial that is FDA pregnancy risk category B is: A. clarithromycin B. doxycycline C. erythromycin D. ofloxacin

C. erythromycin

You write a prescription for a topical agent and anticipate the greatest rate of absorption when it is applied to the: A. palms of the hands B. soles of the feet C. face D. abdomen

C. face

81. Which of the following is most likely to be noted in a person with colorectal cancer? A. gross rectal bleeding B. weight loss C. few symptoms D. nausea and vomiting

C. few symptoms

Concerning long-term care coverage, Medicaid: A. does not provide any coverage of long-term care expenses B. only covers eligible individuals younger than 65 years of age C. finances approx. 40% of all long-term care spending D. provides coverage only for those with physical disabilities

C. finances approx. 40% of all long-term care spending

100. A 48-year-old man with obesity and a 1-year history of classic GERD symptoms has been on the consistent use of a therapeutic dose of a PPI for the past 6 months. He states he is "really no better with the medicine and I have cut out most of the food that bothers my stomach. I even cut out all alcohol and soda." Physical examination reveals stable weight, mildly erythematous pharynx, and epigastric tenderness without rebound. Next step options include: A. obtaining an upper GI series. B. referral for GERD surgery. C. further evaluation with upper GI endoscopy. D. obtaining FOBT testing.

C. further evaluation with upper GI endoscopy.

148. An ulcer that is noted to be located in the region below the lower esophageal sphincter and before the pylorus is usually referred to as a(n) ________ ulcer. A. duodenal B. esophageal C. gastric D. stomach

C. gastric

A 24-year-old man arrives at the walk-in center. He reports that he was bitten in the thigh by a raccoon while walking in the woods. The examination reveals a wound that is 1 cm deep on his right thigh. The wound is oozing bright red blood. Your next best action is to: A. administer high-dose parenteral penicillin B. initiate antibacterial prophylaxis with amoxicillin C. give rabies immune globulin and rabies vaccine D. suture the wound after proper cleansing

C. give rabies immune globulin and rabies vaccine

69. Criteria to distinguish whether pneumonia is community-acquired include all of the following except that the person: A. lives in the community. B. is not a resident of a long-term care facility. C. had no prior antimicrobial use in the previous 3 months. D. had no recent hospitalization. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

C. had no prior antimicrobial use in the previous 3 months.

84. All of the following antimicrobial strategies help facilitate the development of resistant pathogens except: A. longer course of therapy. B. lower antimicrobial dosage. C. higher antimicrobial dosage. D. prescribing a broader spectrum agent. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

C. higher antimicrobial dosage.

A risk factor for postpartum psychosis is: A. hx of depression B. multiple births (i.e. twins, triplets, etc) C. hx of bipolar disorder D. illegal drug use

C. hx of bipolar disorder

Risk factors for postpartum depression include all of the following except: A. hx of depression B. financial problems C. hx of carrying two or more pregnancies to term D. unplanned pregnancy

C. hx of carrying two or more pregnancies to term

Which of the following is the least potent topical corticosteroid? A. betamethasone dipropionate 0.1% (Diprosone) B. clobetasol propionate 0.05% (Cormax) C. hydrocortisone 2.5% D. fluocinonide 0.05% (Lidex)

C. hydrocortisone 2.5%

41. You see a 48-year-old woman with nonalcoholic fatty liver disease. Evaluation of infectious hepatitis includes the following: Anti-HAV IgG—negative Anti-HBs—negative Anti-HCV—negative When considering her overall health status, you advise receiving which of the following vaccines? A. immunization against hepatitis A and B as based on her lifestyle risk factorsB. immunization against hepatitis B and CC. immunization against hepatitis A and BD. immunization against hepatitis A, B, and C

C. immunization against hepatitis A and B why?

In the treatment of acne vulgaris, which lesions respond best to topical antibiotic therapy? A. open comedones B. cysts C. inflammatory lesions D. superficial lesions

C. inflammatory lesions

23. Which of the following is the therapeutic objective of using inhaled ipratropium bromide? A. as an anti-inflammatory. B. an increase in vagal tone in the airway C. inhibition of muscarinic cholinergic receptors D. an increase in salivary and mucous secretions Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

C. inhibition of muscarinic cholinergic receptors

The existence of damages that flow from an injury such that the level process can provide redress: A. duty of care B. breach of the standard of care C. injury D. proximal cause

C. injury

You see a 28-year-old man who was involved in a fight approximately 1 hour ago with another person. The patient states, "He bit me in the arm." Examination of the left forearm reveals an open wound consistent with this history. Your next best action is to: A. obtain a culture and sensitivity of the wound site B. refer for rabies prophylaxis C. irrigate the wound and débride as needed D. close the wound with adhesive strips

C. irrigate the wound and débride as needed

Nonchemical means to eliminate bed bugs can include all of the following except: A. vacuuming crevices. B. washing bedding and other items in hot water. C. isolating the infested area from any hosts for at least 2 weeks. D. running bedding and other items in a dryer on high heat for 20 minutes

C. isolating the infested area from any hosts for at least 2 weeks.

171. Ms. Lane, a 38-year-old woman with a long-standing history of alcohol abuse, presents with a 4-day history of a midabdominal ache that radiates through to the back, remains relatively constant, and has been accompanied by nausea and three episodes of vomiting. She has tried taking antacids without relief. Her skin is cool and moist with a blood pressure of 90/72 mm Hg, pulse rate of 120 bpm, and respiratory rate of 24/min. Findings that would support a diagnosis of acute pancreatitis include all of the following except: A. elevated serum amylase level. B. elevated lipase level. C. jaundice. D. upper abdominal tenderness without localization or rebound.

C. jaundice.

175. Common signs and symptoms of a pancreatic pseudocyst include all of the following except: A. abdominal pain that radiates to the back. B. nausea and vomiting. C. jaundice. D. a mass that can be palpated in the upper abdomen.

C. jaundice.

The classic clinical triad of ectopic pregnancy includes all of the following except: A. abdominal pain B. vaginal bleeding C. large-for-gestational-age uterus D. adnexal mass

C. large-for-gestational-age uterus

21. IBD is associated with all of the following types of anemia except: A. anemia of chronic disease.B. iron-deficiency anemia.C. megaloblastic anemia.D. anemia associated with acute blood loss.

C. megaloblastic anemia. why?

Oral antifungal treatment options for onychomycosis include all of the following except: A. itraconazole B. fluconazole C. metronidazole D. terbinafine

C. metronidazole

In diagnosing onychomycosis, the NP considers that: A. nails often have a single midline groove. B. pitting is often seen. C. microscopic examination reveals hyphae. D. Beau lines are present

C. microscopic examination reveals hyphae

9. Which of the following is inconsistent with the presentation of asthma that is not well controlled? A. a troublesome nocturnal cough at least 2 nights per week B. need for albuterol to relieve shortness of breath at least twice a week C. morning sputum production D. two or more exacerbations/year requiring oral corticosteroids Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

C. morning sputum production

4. Diagnostic testing in IBS often reveals: A. evidence of underlying inflammation.B. anemia of chronic disease.C. normal results on most testing.D. mucosal thickening on abdominal radiological imaging.

C. normal results on most testing.

A 28-year-old woman presents to your practice with chief complaint of a cat bite sustained on her right ankle. Her pet cat had bitten her after she inadvertently stepped on its paw while she was in her home. Her cat is 3 years old, is up-to-date on immunizations, and does not go outside. Physical examination reveals pinpoint superficial puncture wounds on the right ankle consistent with the presenting history. She washed the wound with soap and water immediately and asks if she needs additional therapy. Treatment for this patient's cat bite wound should include standard wound care with the addition of: A. oral erythromycin B. topical bacitracin C. oral amoxicillin-clavulanate D. parenteral rifampin

C. oral amoxicillin-clavulanate

The risk of infanticide is greatest in a woman with which of the following conditions? A. postpartum depression B. postpartum "baby blues" C. postpartum psychosis D. there is little risk of infanticide with any of the above conditions

C. postpartum psychosis

4. You examine Jane, a 24-year-old woman who has an acute asthma flare following a 3-day history of upper respiratory tract symptoms (clear nasal discharge, dry cough, no fever). She has a history of moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PEF). She is using budesonide (Pulmicort®) and albuterol as directed and continues to have difficulty with coughing and wheezing. At home, her PEF is 55% of personal best. In the office, her forced expiratory volume at 1 second (FEV1) is 65% of predicted. Her medication regimen should be adjusted to include: A. theophylline. B. salmeterol (Serevent®). C. prednisone. D. montelukast (Singulair®). Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition.

C. prednisone.

A patient presents with a painful, blistering thermal burn involving the first, second, and third digits of his right hand. The most appropriate plan of care is to: A. apply an anesthetic cream to the area and open the blisters B. apply silver sulfadiazine cream (Silvadene) to the area followed by a bulky dressing C. refer the patient to burn specialty care D. wrap the burn loosely with a nonadherent dressing and prescribe an analgesic agent

C. refer the patient to burn specialty care

35. A 62-year-old man presents with a 2-month history of noting a "bit of dark blood mixed in with my stool most days." Physical examination reveals external hemorrhoids, no rectal mass, and a small amount of dark brown stool on the examining digit. In-office fecal occult blood test is positive, and hemogram reveals a microcytic hypochromic anemia. The next best step in his care is to: A. perform in-office anoscopy.B. advise the patient to use sitz baths post-bowel movement.C. refer to gastroenterology practice for colonoscopy.D. order a double contrast barium enema.

C. refer to gastroenterology practice for colonoscopy.

133. You are caring for a 45-year-old woman from a developing country. She reports that she had "yellow jaundice" as a young child. Her physical examination is unremarkable. Her laboratory studies are as follows: AST, 22 U/L (normal, 0 to 31 U/L); alanine aminotransferase (ALT), 25 U/L (normal, 0 to 40 U/L); hepatitis A virus immunoglobulin G (HAV IgG) positive. Laboratory testing reveals: A. chronic hepatitis A. B. no evidence of prior or current hepatitis A infection. C. resolved hepatitis A infection. D. prodromal hepatitis A.

C. resolved hepatitis A infection.

46. Which of the following pathogens is often implicated in a COPD exacerbation caused by respiratory tract infection? A. Legionella species B. Streptococcus pyogenes C. respiratory tract viruses D. Staphylococcus aureus Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

C. respiratory tract viruses

Match sign with correct characteristic. Goodell sign A. blue-violet vaginal color B. softening of uterus isthmus C. softening of vaginal portion of the cervix

C. softening of vaginal portion of the cervix

101. Symptoms of lung cancer caused by a primary tumor include all of the following except: A. chest discomfort. B. dyspnea. C. strider. D. hemoptysis. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 157). F.A. Davis Company. Kindle Edition.

C. strider.

3. Esophageal adenocarcinoma is usually located: A. in the upper esophagus.B. near the upper esophageal sphincter.C. at the junction of the esophagus and stomach.D. in the lower esophagus.

C. the junction of the esophagus and the stomach.

Aneuploidy is defined as: A. a physical malformation of the fetus of unknown origin B. a birth defect originating from the use of a teratogenic drug C. the presence of an abnormal number of chromosomes D. a birth defect originating from a nutritional deficiency

C. the presence of an abnormal number of chromosomes

In counseling women about SSRI use during pregnancy, the NP considers that studies reveal: A. a clear teratogenic pattern has been identified for all drugs in this class B. the drugs have a negative effect on intellectual development C. the use of paroxetine during pregnancy is associated with an increase in risk for congenital cardiac defect D. an increased rate of seizure disorder in exposed offspring

C. the use of paroxetine during pregnancy is associated with an increase in risk for congenital cardiac defect Paroxetine - Category D.

In counseling a patient on the use of topical products to treat nail fungal infections, the NP considers that: A. nail lacquers, such as ciclopirox olamine 8% solution (Penlac), offer similar effectiveness to oral antifungals. B. some herbal products, such as tea tree oil, can be an effective alternative to oral agents. C. topical products have limited penetration through the nail matrix to reach the site of infection. D. cream-based products are more effective than gel-based products in treating nail fungal infections

C. topical products have limited penetration through the nail matrix to reach the site of infection

92. A 26-year-old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a white blood cell (WBC) count with differential and anticipate the following results: A. total WBCs, 4500/mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45%. B. total WBCs, 14,000/mm3; neutrophils, 55%; bands, 3%; lymphocytes, 38%. C. total WBCs, 16,500/mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%. D. total WBCs, 18,100/mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28%.

C. total WBCs, 16,500/mm3; neutrophils, 66%; bands, 8%; lymphocytes, 22%.

140. A 58-year-old man reports intermittent right upper quadrant abdominal pain. He is obese and being actively treated for hyperlipidemia. Imaging in a patient with suspected symptomatic cholelithiasis usually includes obtaining an abdominal: A. MRI. B. CT scan. C. ultrasound of the right upper quadrant. D. flat plate.

C. ultrasound of the right upper quadrant.

118. A 57-year-old male is in need of evaluation for Barrett esophagus. You recommend: A. H. pylori testing. B. CT scan. C. upper GI endoscopy with biopsy. D. barium swallow.

C. upper GI endoscopy with biopsy.

The most common clinical manifestation of systemic anaphylaxis typically is: A. dizziness B. airway obstruction C. urticaria D. GI upset

C. urticaria

A. Ovaries

Common site of C. trachomatis infection in women include all of the following except: A. Ovaries B. Cervix C. Endometrium D. Urethra

C. Acute pyelonephritis

Complications of gonococcal and chlamydial genitourinary infection in women include all of the following except: A. Pelvic inflammatory disease (PID) B. Tubal scarring C. Acute pyelonephritis D. Acute peritoneal inflammation

D. Osteoporosis risk is reduced with use

Concerning selective estrogen receptor modulator therapy such as raloxifene (Evista), which of the following statements is correct? A. Concurrent progestin opposition is needed B. Hot flashes are reduced in frequency and severity C. Use is contraindicated when a women has a history of breast cancer D. Osteoporosis risk is reduced with use

C. Mast cell stabilizer

Cromolyn' mechanism of action is as a/an: A. Anti-immunoglobulin E antibody B. Vasoconstrictor C. Mast cell stabilizer D. Leukotriene modifier

A 12-month-old boy with fever who has a suspected UTI who has vomited 5 times in the past 7 hours. His last wet diaper was approximately 6 hours ago. He is accompanied by his parents. The following action should be taken: A. Recommend continued observation at home. B. Recommend antimicrobial therapy. C. Conduct renal ultrasound. D. Arrange for the child to be admitted to the hospital.

A 22 year old man presents with new onset of pain and swelling in his feet and ankles, conjunctivitis, oral lesions, and dysuria. To help confirm a diagnosis of reactive arthritis, the most important test to obtain is: A. ANA analysis B. ESR measurement C. rubella titer measurement D. urethral cultures. (Ch. 9 Fitzgerald)

A 24 year old woman has a new onset of panic disorder. As part of her clinical presentation, you expect to find all of the following except: A. peak symptoms at 10 minutes into the panic attack. B. history of agoraphobia C. report of chest pain during panic attack. D. history of thought disorder (Ch. 14 Fitzgerald)

A 3-year-old boy with AOM continues to have otalgia and fever (≥39°C [≥102.2°F]) after 3 days of amoxicillin 80 mg/kg/d with an appropriate dose of clavulanate (Augmentin) therapy. Which of the following is recommended? A. Watch and wait while using analgesics. B. Start antimicrobial therapy with oral azithromycin. C. Initiate therapy with oral clindamycin. D. Administer intramuscular ceftriaxone.

A 34-year-old woman complains of progressive weakness, fatigue, poor appetite, and weight loss. She has also noticed the development of hyperpigmentation, mainly on the knuckles, elbows, and knees. All of the following blood tests can be used to help confirm a diagnosis of Addison's disease except: A. sodium. B. potassium. C. cortisol. D. folate.

A 35 year old man presents with edema of the face, hands, and ankles along with hypertension (175/115). He reports urine that is darkly colored and foamy. You suspect acute glomerulonephritis and would expect urinalysis results to include all of the following findings except: A. elevated level of protein B. presence of red blood cells C. presence of renal casts. D. abnormally high glucose levels (Ch. 12 Fitzgerald)

A fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise the suspicion of: A. adenomatous lesion B. Graves disease C. Hashimotos D. thyroid malignancy

A parent asks about varicella-zoster immune globulin, and you reply that it is a: A. synthetic product that is well tolerated. B. derived blood product that has been known to transmit infectious disease. C. blood product obtained from a single donor. D. pooled blood product with an excellent safety profile.

A patient has been taking fluoxetine for 1 week and complains of mild nausea and diarrhea. You advise that: A. this is a common, long lasting side effect of SSRI therapy. B. he should discontinue the medication. C. another antidepressant should be substituted. D. he should be taking the medication with food (Ch. 14 Fitzgerald)

Acanthosis nigricans is commonly noted in all of the following areas except: A. Groin folds. B. Axilla. C. Nape of neck. D. Face.

All of the following are common precipitating factors in acute renal failure except: A. anaphylaxis B. infection C. myocardial infarction D. type 1 diabetes (Ch. 12 Fitzgerald)

All of the following can negatively impact perivaginal lactobacilli colonization except: A. recent antimicrobial use B. exposure to the spermicide nonoxynol-9 C. estrogen deficiency D. postcoital voiding (Ch. 12 Fitzgerald)

All of the following electrolyte disorders are commonly found in a person with chronic renal failure except: A. hypernatremia B. hypercalcemia C. hyperkalemia D. hypophosphatemia (Ch. 12 Fitzgerald)

HA1C best provides information on glucose control over the past: A. 1-29 days B. 21-47 days C. 48-63 days D. 64-90 days

All of the following statements about electromyography (EMG) are true except: A. EMG measures electrical impulses caused by muscles. B. diagnosis of carpal tunnel syndrome involves comparing EMG results of the muscles at rest versus contraction. C. EMG can detect muscle damage D. EMG involves sending a small electrical impulse through the muscles tissue. (Ch. 9 Fitzgerald)

All of the following uropathogens are capable of reducing urinary nitrates to nitrites except: A. E. coli. B. Proteus species. C. K. pneumoniae. D. S. saprophyticus.

Among surgical and procedural interventions, AAOS strongly recommends the use of which of the following for the management of symptomatic OA of the knee? A. intraarticular corticosteroid use B. hyaluronic acid injections C. arthroscopy with lavage and/or debridement D. none of the above. (Ch. 9 Fitzgerald)

Among the preferred first-line pharmacological treatment options for patients with PTSD include the use of: A. methyphenidate (Ritalin) B. oxazepam (Serax) C. lithium carbonate. D. sertraline. (Ch. 14 Fitzgerald)

Among young adults with an implantable cardioverter defibrillator (ICD), participation in sports should be: A. generally cautioned against. B. limited to noncontact sports. C. limited to anaerobic activities. D. determined on an individual basis. (Ch. 9 Fitzgerald)

Approximately what percent of patients experiencing low back pain will have the symptoms resolve within 1 month without specific therapy? A. 33% B. 57% C. 78% D. 90% (Ch. 9 Fitzgerald)

Characteristics of binge eating disorder include all of the following except: A. lack of control over the amount and type of food eaten. B. behavior present for at least 6 months C. marked distress, self-anger, shame, and frustration as a result of binging. D. purging activity after an eating binge. (Ch. 14 Fitzgerald)

Clinical features of shigellosis include all of the following except: A. bloody diarrhea. B. high fever. C. malaise. D. vomiting.

Clinical manifestations of vitamin D deficiency include all of the following except: A. rickets. B. osteomalacia. C. antigravity muscle weakness. D. azotemia. (Ch. 9 Fitzgerald)

Clinical presentation of advanced PVD includes all of the following except: A. resting pain B. absent posterior tibialis pulse C. blanching of foot with elevation D. spider varicosities

Common causes of sciatica indlude all of the following except: A. herniated disk. B. spinal stenosis. C. compression fracture. D. soft tissue abnormality. (Ch. 9 Fitzgerald)

Common signs and symptoms of pertussis in a 3-year-old child include all of the following except: A. uncontrollable cough. B. vomiting. C. fatigue. D. diffuse rash.

Common symptoms of a patient with sarcoidosis include all of the following except: A. arthraliga. B. dyspnea upon exertion C. blurred vision D. cardiac palpitations (Ch. 9 Fitzgerald)

Compared to younger women, uncomplicated UTI in an elderly woman is more likely to be associated with each of the following signs and symptoms except: A. new onset urinary incontinence B. delirium C. weakness D. hematuria (Ch. 12 Fitzgerald)

Concerning the use of antipyretics in a febrile young child, which of the following statements is false? A. A child with a serious bacterial infection usually does not have fever reduction with an antipyretic. B. The degree of temperature reduction in response to antipyretic therapy is not predictive of presence or absence of bacteremia. C. Compared with ibuprofen, acetaminophen has a shorter duration of antipyretic action. D. Ibuprofen should not be used if a child is also taking a macrolide antimicrobial.

Criteria for the diagnosis of T2DM include: A. classic symptoms regardless of FPG B. plasma glucose of 126 as a random measurement C. a 2 hour glucose measurement of 156 after a 75g anhydrous glucose load D. plasma glucose of 126 after an 8 hour fast on more than one occasion

DSM-5 criteria for a substance abuse include all of the following except: A. desire to cut down and/or has tried unsuccessfully in the past. B. inability to maintain major role obligations C. excessive time spent obtaining substance, using substance, or recovering from its effects. D. involved in at least one incarceration related to substance use int eh past 6 months (Ch. 14 Fitzgerald)

DSM-5 criteria for anorexia nervosa include all of the following except: A. refusal to maintain body weight at or above the minimum normal weight for age and height. B. intense fear of gaining weight or becoming fate despite being underweight C. distorted experience and significance of body weight and shape. D. absence of at least three consecutive menstrual cycles. (Ch. 14 Fitzgerald)

Drug classes used in the treatment of fibromyalgia include all of the following except: A. tricyclic antidepressants. B. antiepiliptics. C. SSRIs D. opioids. (Ch. 9 Fitzgerald)

Drug therapy that had previously thought to worsen symptoms in lower extremity PAD includes the use of: A. Beta2- adrenergic blockers B. CCB C. direct thrombin inhibitors D. beta-adrenergic blockers

During a preparticipation cardiovascular history, all of the following questions should be included except: A. past detection of a heart murmur. B. excessive, unexplained, and unexpected shortness of breath. C. prior occurrence of exertional chest pain/discomfort. D. prior use of NSAID use. (Ch. 9 Fitzgerald)

Dysthymia is characterized by: A. suicidal thoughts B. multiple incidents of harming oneself. C. social isolation. D. low level depression (Ch. 14 Fitzgerald)

Fibromyalgia is caused by: A. increased production of serotonin. B. an autoimmune reaction following infection. C. a genetic autoimmune disorder that targets neuronal axons. D. a largely unknown mechanism. (Ch. 9 Fitzgerald)

First-line treatment options for bursitis usually include: A. corticosteroid bursal injection B. heat to area. C. weight-bearing exercises. D. nonsteroidal anti-inflammatory drugs (NSAIDs) (Ch. 9 Fitzgerald)

Immediate diagnostic imaging for low back pain should be reserved for all of the following except: A. presence of signs of the cauda equina syndrome. B. presence of severe neurologic deficits. C. presence of risk factors for cancer D. presence of moderate pain lasting at least 2 weeks (Ch. 9 Fitzgerald)

In an older adult with T2DM and gastroparesis, the use of which of the following medications should be avoided? A. insulin glargine B. insulin aspart C. glimepiride D. exenatide

In general, children should ride in the back seat of the car until age: A. 10 years. B. 11 years. C. 12 years. D. 13 years.

In patients with varicose veins, which vessel is most often affected? A. femoral vein B. posterior tibial vein C. peroneal vein D. saphenous vein

In the report of a thyroid scan done on a 48 yo woman with a thyroid mass, a "cold spot" is reported. This finding is most consistent with: autonomously functioning adenoma Graves disease Hashimotos disease thyroid cyst

In the treatment of acute otitis media in the child, which of the following antimicrobial agents affords the most effective activity against Streptococcus pneumoniae? A. nitrofurantoin. B. cefixime C. trimethoprim-sulfamethoxazole (TMP-SMX) D. cefuroxime

Increased risk of thyroid disorder is found in individuals who are: Obese Hypertensive Treated with systemic corticosteroids Elderly

Initial preparticipation screening of athletes should include: A. a resting 12-lead EKG B. echocardiogram C. both a resting 12-lead ECG and echocardiogram. D. neither a resting 12-lead ECG nor echocardiogram. (Ch. 9 Fitzgerald)

Initial treatment for meniscal tear includes all of the following except: A. NSAID use B. applying ice to the affected area. C. elevation of the affected limb D. joint aspiration of the affected knee. (Ch. 9 Fitzgerald)

Kawasaki disease most commonly occurs in what age group? A. infants B. children aged 2 to 3 years. C. children approaching puberty D. children aged 1 to 8 years

Likely sequelae of intrabursal corticosteroid injection include: A. irreversible skin atrophy B. infection C. inflammatory reaction D. soreness at the site of injection (Ch. 9 Fitzgerald)

Lorazepam or oxazepam is the preferred benzodiazepine for treating alcohol withdrawal symptoms when there is a concomitant history of: A. seizure disorder. B. folate deficiency anemia. C. multiple substance abuse. D. hepatic dysfunction (Ch. 14 Fitzgerald)

Of the following individuals, who is at highest risk for NSAID-induced gastropathy? A. a 28 year old man with an ankle sprain who has taking ibuprofen for the past week and who drinks four to six beers every weekend. B. a 40 year old woman who smokes and takes about six doses of naproxen sodium per month to control dysmenorrhea C. a 43 year old man with dilated cardiomyopathy who uses ketoprofen one to two times per week for low back pain. D. a 72 year old man who takes aspirin for times a day for pain control of osteoarthritis. (Ch. 9 Fitzgerald)

Optimally, at what interval should TSH be rechecked after a levothyroxine dose adjustment? A. 1-2 weeks B. 2-4 weeks C. 4-6 weeks D. 6-8 weeks

Patients with a Grade III ankle sprain should be advised that full recovery is likely to take: A. a few days B. 2 to 3 weeks C. 4 to 6 weeks D. many months (Ch. 9 Fitzgerald)

Patients with lateral epicondylitis typically present with : A. electric-like pain elicited by tapping over the median nerve B. reduced joint ROM C. pain that is worst with elbow flexion D. decreased hand grip strength. (Ch. 9 Fitzgerald)

Patients with medial epicondylitis typically present with: A. forearm numbness B. reduction in ROM C. pain on elbow flexion. D. decreased grip strength. (Ch. 9 Fitzgerald)

Patients with plumbism present with which kind of anemia? A. macrocytic, hyperchromic B. normocytic, normochromic C. hemolytic D. microcytic, hypochromic

Patients with urethral stricture often report urine loss: A. with exercise B. during the day C. associated with urgency D. as dribbling after voiding (Ch. 12 Fitzgerald)

Pseudogout is caused by the formation of what type of crystals in joints? A. uric acid B. calcium oxalate C. struvite D. calcium pyrophosphate dihydrate (Ch. 9 Fitzgerald)

Rates of sepsis in children have lowered in recent years mainly because of: A. more stringent screening and diagnosis of febrile illness. B. increased use of antipyretics. C. longer obseVrvation period in children with febrile illness. D. higher rates of select immunization.

Recommended exercises for patients with OA of the hip include all of the following except: A. stretching exercises of the gluteus muscles. B. straight-leg raises without weights C. isometric exercises of the iliopsoas and gluteus muscles. D. weight-bearing aerobic exercises. (Ch. 9 Fitzgerald)

Regarding the current scientific evidence on the use of glucosamine and chondroitin for the management of symptomatic OA of the knee, AAOS: A. strongly favors their use B. provides a moderate-strength recommendation for their use C. cannot recommend for or against the use of these supplements (Limited evidence). D. cannot recommend the use of these supplements (Ch. 9 Fitzgerald)

Results of a nerve conduction study in a person with carpal tunnel syndrome (CTS) would reveal: A. erratic nerve impulses during forearm muscle contraction B. a lack of nerve impulses in the carpal tunnel. C. continued firing of the median nerve while the forearm muscles are at rest. D. slowing of nerve impulses in the carpal tunnel. (Ch. 9 Fitzgerald)

Risk factors for ABRS include all of the following except: A. viral infection. B. environmental allergies. C. tobacco smoke exposure. D. beta-thalassemia minor.

Risk factors for CTS include all of the following except: A. pregnancy B. untreated hypothyroidism C. repetitive motion D. Multiple sclerosis. (Ch. 9 Fitzgerald)

Which of the following is most likely to be noted in a 45 year old woman with laboratory evidence of chronic excessive alcohol ingestion? A. alanine aminotransferase (ALT) 202 U/L (0-31 U/L), mean corpuscular volume (MCV) 70 fL (80 to 96 fL) B. aspartate transaminase (AST) 149 U/L (0-31 U/L), MCV 140 fL (80 to 96 fL) C. ALT 88 U/L (0 to 31 U/L), MCV 140 fL (80 to 96 fL) D. AST 80 U/L (0 to 31 U/L), MCV 103 fL (80 to 96 fL) (Ch. 14 Fitzgerald)

Which of the following is not a component of the CAGE questionnaire? A. Have you ever felt you should cut down on your drinking? B. Have you been annoyed by people criticizing your drinking C. Have you ever felt guilty about your drinking D. Have you ever engaged in a violent act while drinking? (Ch. 14 Fitzgerald)

Which of the following is not a gram-negative organism A. E coli B. k pneumoniae C. P. mirabilis D. saprophyticus (Ch. 12 Fitzgerald)

Which of the following is not a risk factor for asthma death? A. hospitalization or an emergency department visit for asthma in the past month. B. current use of systemic corticosteroids or recent withdrawal from systemic corticosteroids. C. difficulty perceiving airflow obstruction or its severity. D. rural residence.

Which of the following is not a risk factor for bladder cancer? A. occupational exposure to textile dyes B. cigarette smoking C. occupational exposure to heavy metals D. long-term aspirin use (Ch. 12 Fitzgerald)

Which of the following is one of the more common sources of hepatitis A infection in the United States? A. receiving blood products B. ingestion of raw shellfish C. drinking municipally sourced tap water drinking water D. exposure to fecally contaminated food

Which of the following is true regarding panic disorder and agoraphobia? A. More men than women experience panic disorder without agoraphobia B. More women than men experience panic disorder without agoraphobia C. More men than women experience panic disorder with agoraphobia D. More women than men experience panic disorder with agoraphobia (Ch. 14 Fitzgerald)

Which of the following statements is correct about the varicella vaccine? A. This vaccine contains killed varicella-zoster virus (VZV). B. A short febrile illness is common during the first days after vaccination. C. Children should have a varicella titer drawn before receiving the vaccine. D. Rarely, mild cases of chickenpox have been reported in immunized patients.

Which of the following statements is not true concerning the effects of exercise and IR? A. Approximately 80% of the body's insulin mediated glucose uptake occurs in skeletal muscle B. With regular aerobic exercise, IR is reduced by approximately 40%. C. The IR reducing effects of exercise persist for 48 hours after activity D. Hyperglycemia can occur as a result of aerobic exercise

Which urine culture result is needed to confirm a UTI in an asymptomatic woman who has not had recent use of a urinary catheter? A. 10 squared cfu/mL or more B. 10 cubed cfu/mL or more C. 10 to the 4th cfu/mL or more D. 10 to the fifth cfu/mL or more (Ch. 12 Fitzgerald)

Which would not be found in newborns? A. best vision at a range of 8-12 inches B. presence of red reflex C. light sensitive eyes D. lack of defensive blink

Who is most likely to have new onset primary Raynaud phenomenon? A. a 68 yo man B. a 65 yo woman C. a 25 yo man D. an 18 yo woman

You examine a 46 yo male who is a one-half pack per day smoker with HTN. He has no evidence of ASCVD and his estimated risk is 10%. LDL=192, HDL=48, TG=110. He had been on a low cholesterol diet when these labs were drawn. What is the next best step? A. No further intervention B. A fibrate C. a low intensity statin D. a high intensity statin

You see a 28 year old Italian-American man who participates in recreational basketball and has mild hypertension. In considering treatment, you consider all of the following as viable options except: A. Calcium channel blocker. B. angiotensin converting enzyme inhibitors. C. angiotensin receptor antagonists. D. beta-adrenergic antagonists. (Ch. 9 Fitzgerald)

You see a 34 year old woman with an uncomplicated UTI. She is otherwise healthy but reports having a sulfa allergy. Appropriate therapy would include: A. TMP-SMX B. amoxicillin C. Azithromycin D. Ciprofloxacin (Ch. 12 Fitzgerald)

You see a 37 year old man complaining of low back pain consisting of stiffness and spasms but without any sign of neurologic involvement. You recommend all of the following interventions except: A. application of cold packs for 20 minutes 3 - 4 times a day. B. use of NSAIDs or acetaminophen for pain control. C. initiation of aerobic and toning exercises. D. bed rest for at least 5 days. (Ch. 9 Fitzgerald)

You see a 58 year old woman who is being treated for a renal stone. Analysis of a stone passed in the urine reveals that it is composed of calcium oxalate In counseling the patient about preventing future stones, you consider all of the following except: A. reducing sodium in her diet B. limiting consumption of beets, rhubarb, nuts, and chocolate C. encouraging getting her daily calcium requirement from food D. if calcium supplements are needed, this medication should be taken on an empty stomach (Ch. 12 Fitzgerald)

49. You see a 67-year-old man with very severe (GOLD 4) COPD who asks, "When should I use my home oxygen?" You respond: A. "As needed when short of breath." B. "Primarily during sleep hours." C. "Preferably during waking hours." D. "For at least 15 hours a day." Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

D. "For at least 15 hours a day."

All of the following uropathogens are capable of reducing urinary nitrates to nitrites except: A. E. coli B. Proteus spp. C. Klebsiella pneumoniae D. Staphylococcus sparophyticus

D. Staphylococcus sparophyticus

The penalty for the sale of individually identifiable health information for personal gain is: A. $100 fine and up to 1 year of probation B. $5,000 fine and up to 60 days of imprisonment C. $25,000 fine and up to 1 years of imprisonment D. $250,000 fine and up to 10 years of imprisonment

D. $250,000 fine and up to 10 years of imprisonment

Recommended calcium intake for a woman during pregnancy is _____ mg of elemental calcium per day. A. 400 to 600 B. 600 to 800 C. 800 to 1000 D. 1000 to 1300

D. 1000 to 1300 The required amount of calcium can usually be met by ensuring 3 to 4 services of high-quality diary products per day. Examples of single dairy serving: 8 oz (240 ml) milk, 1-1.5 oz (28-35g) cheese, 1 cup (240 ml) yogurt, or 1 cup (240 ml) of calcium-fortified juice. The recommended daily intake of calcium for women 19-50 years of age is 1000 mg. Women 14-18 years of age require 1300 mg daily.

To transmit the bacterium that causes Lyme disease, an infected tick must feed on a human host for at least: A. 5 minutes B. 30 minutes C. 2 hours D. 24 hours

D. 24 hours

In a pregnant woman with asthma, in what part of her pregnancy do symptoms and bronchospasm often worsen? A. 6 to 14 weeks B. 15 to 23 weeks C. 24 to 33 weeks D. 29 to 36 weeks

D. 29 to 36 weeks This is due to esophageal irritation from GERD. Sxs usually improve late in gestation when gradual fetus descent occurs. Lifestyle changes that help with GERD helps with asthma management.

For a pregnant woman with asthma, bronchospasm symptoms are often reported to improve during _____ weeks of gestation A. 8 to 13 B. 20 to 26 C. 29 to 36 D. 36 to 40

D. 36 to 40

97. Approximately of acute bronchitis cases are caused by a viral infection. A. 15% B. 30% C. 65% D. 90% Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 157). F.A. Davis Company. Kindle Edition.

D. 90%

In children younger than age 6 years, accidental overdose of iron-containing products is: A. Easily treated B. A source of significant GI upset C. Worrisome but rarely causes significant harm D. A leading cause of fatal poisoning in the age group

D. A leading cause of fatal poisoning in the age group

38. Which of the following is an expected laboratory result in a patient with acute hepatitis A infection (normal values: AST, 0 to 31 U/L; ALT, 0 to 40 U/L)? A. AST, 55 U/L; ALT, 50 U/LB. AST, 320 U/L; ALT, 190 U/LC. AST, 320 U/L; ALT, 300 U/LD. AST, 640 U/L; ALT, 870 U/L

D. AST, 640 U/L; ALT, 870 U/L

Which of the following statements is most accurate regarding the use of emergency department (ED) services by Medicaid patients? A. the majority of ED visits by medicaid patients is for non-urgent symptoms B. those with medicaid are more than twice as likely to use the ED for non urgent symptoms compared with those with private insurance C. medicaid patients use Eds at a similar rate when compared with people with private insurance D. ED visits by medicaid patients more often involve multiple diagnoses compared with those with private insurance

D. ED visits by medicaid patients more often involve multiple diagnoses compared with those with private insurance

Leonard is an 18-year-old man who has been taking isotretinoin (Accutane) for the treatment of acne for the past 2 months. Which of the following is the most important question for the clinician to ask at his follow-up office visit? A. Are you having any problems remembering to take your medication? B. Have you noticed any dry skin around your mouth since you started using Accutane? C. Do you notice any improvement in your skin? D. Have you noticed any recent changes in your mood?

D. Have you noticed any recent changes in your mood?

Folate deficiency anemia causes which of the following changes in the RBC indices? A. Microcytic, normochromic B. Normocytic, normochromic C. Microcytic, hypochromic D. Macrocytic, normochromic

D. Macrocytic, normochromic

Pernicious anemia causes which of the following changes in the RBC indices? A. Microcytic, normochromic B. Normocytic, normochromic C. Microcytic, hypochromic D. Macrocytic, normochromic

D. Macrocytic, normochromic

A "dual eligible" beneficiary is an individual who receives Medicaid and: A. private insurance B. social security C. government welfare benefits D. Medicare

D. Medicare

Recommended non pharmacological options to treat actinic keratosis include all of the following except: A. chemical peel B. cryotherapy C. laser resurfacing D. Mohs micrographic surgery

D. Mohs micrographic surgery

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb=10.1g (12-14 g) Hct=32% (36-42%) RBC=2.9 million mm3 (3.2-4.3 million) MCV=72 fL (80-96 fL) MCHC=28.2 g/dL (32-36 g/dL) RDW= 18.9% (</= 15%) Physical exam is likely to include: A. Conjunctiva pallor B. Hemic murmur C. Tachycardia D. No specific anemia-related findings

D. No specific anemia-related findings

48. Which is the most appropriate statement about therapy for a severe COPD exacerbation in a 52-year-old man? A. A 5-day course of azithromycin should be prescribed. B. A 10-day course of amoxicillin/clavulanate is advisable, C. A 7-day course of trimethoprim-sulfamethoxazole (TMP-SMX) is recommended. D. The role of antimicrobial therapy is debated, even for a severe exacerbation. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

D. The role of antimicrobial therapy is debated, even for a severe exacerbation.

Which of the following is the best answer regarding anaphylaxis? A. Adults usually do not develop new anaphylaxis triggers such as food allergies B. Peanuts are the primary food that can cause a severe allergic reaction C. Future anaphylactic reactions will become increasingly more severe D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction

D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction

Match the clinical presentation of the following. Threatened abortion A. Uterine contents include a nonviable pregnancy that is in the process of being expelled B. Some portion of the products of conception remains in the uterus, although the pregnancy is no longer viable C. The products of conception have been completely expelled D. US evaluation shows a viable pregnancy, although vaginal bleeding is present

D. US evaluation shows a viable pregnancy, although vaginal bleeding is present

Match the stage of pregnancy with the appropriate term. Fertilized ovum A. Embryo B. Fetus C. Blastocyst D. Zygote

D. Zygote

When examining a mole for malignant melanoma, allof the following characteristics can indicate a melanoma except: A. asymmetry with nonmatching sides. B. color is not uniform. C. a recently formed lesion. D. a lesion that has been present for at least 2 years

D. a lesion that has been present for at least 2 years

Written authorization by the individual is not needed prior to disclosure of protected health information in all of the following circumstances except: A. cases of child abuse or neglect B. domestic violence incidents C. when a covered entity believes it is necessary to prevent a serious and imminent threat to the public D. a request of information from a family member

D. a request of information from a family member

Preferred treatment options for a pregnant woman in the second trimester with migraine include: A. sumatriptan B. codeine C. aspirin D. acetaminophen

D. acetaminophen

1. Other than the pancreas, other sources of amylase include all of the following except: A. salivary glands.B. lung cancer.C. ovarian cyst.D. adipose tissue.

D. adipose tissue.

Prenatal assessment for aneuploidy should be offered to: A. only women older than 35 years of age B. only women younger than 21 years of age C. only women either younger than 21 years or older than 35 years of age D. all women regardless of age

D. all women regardless of age One finding leading to this recommendation is that approximately 75% of all infants with Down syndrome are born to mothers younger than 35. This is result of the fact that women in this age group are more likely to give birth compared with older women and bc of the lower rate of antenatal diagnostic testing being performed in younger women giving birth.

52. Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of: A. loperamide (Imodium®).B. dicyclomine (Bentyl®).C. bismuth subsalicylate (Pepto-Bismol®).D. amitriptyline (Elavil®).

D. amitriptyline

Which of the following is a diagnostic test? A. cell free fetal DNA test B. serum alpha-fetoprotein C. serum inhibin-A D. amniocentesis

D. amniocentesis Amniocentesis and chorionic villi sampling are diagnostic tests.

47. Which is the most appropriate choice of therapy in the treatment of a mild acute COPD exacerbation in a 42-year-old man? A. a 5-day course of levofloxacin B. a 7-day course of amoxicillin C. a 10-day course of doxycycline D. antimicrobial therapy usually not indicated Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

D. antimicrobial therapy usually not indicated

166. Current vaccine guidelines recommend administering the immunization against HAV to: A. those living in or traveling to areas endemic for the disease. B. food handlers and day-care providers. C. military personnel. D. any person who wishes to receive the vaccine.

D. any person who wishes to receive the vaccine.

Benzodiazepine withdrawal syndrome is best characterized as: A. bothersome but not life-threatening B. not observed during pregnancy C. most often seen with agents that have a long half-life D. associated with seizure risk

D. associated with seizure risk

42. When managing patients with COPD who continue to smoke cigarettes, a discussion on the importance of smoking cessation should occur: A. at the initial diagnosis visit. B. with each COPD flare. C. once inhaled corticosteroid therapy is initiated. D. at every office visit. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

D. at every office visit.

All of the following criteria can be used to distinguish a level 3 office visit for an established patient except: A. at least 6 elements of physical exam B. at least 1 element of HPI and at least 1 positive or negative response to a ROS question C. medical decision making of low complexity D. at least 1 new prescription or a prescription refill

D. at least 1 new prescription or a prescription refill

41. The most effective nonpharmacologic method to prevent exacerbations in patients with COPD is: A. weight loss for those with a body mass index (BMI) greater than 25 kg/m2. B. avoid exposure to children or day-care centers. C. brisk walking for at least 5 minutes 3-5 times a day as tolerated. D. avoid exposure to pulmonary irritants, such as cigarette smoke. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 144). F.A. Davis Company. Kindle Edition.

D. avoid exposure to pulmonary irritants, such as cigarette smoke.

71. A diagnosis of pneumonia is confirmed by: A. sputum culture. B. sputum gram stain C. bronchoalveolar lavage. D. chest radiograph. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

D. chest radiograph.

A skin biopsy results indicate the presence of malignant melanoma for a 53-year-old woman. You recommend: A. excision of the entire lesion B. electrodissection with curettage C. initiating treatment with topical cancer chemotherapy D. consultation with a skin cancer expert to directnext best action

D. consultation with a skin cancer expert to directnext best action

Increased risks for fatal reactions from anaphylaxis include all of the following except: A. personal history of asthma B. delay in administering epinephrine C. age in the teen years D. delay in administering antihistamines

D. delay in administering antihistamines

141. Which of the following findings would you expect to encounter in a 33-year-old man with appendiceal abscess? A. leukopenia with lymphocytosis B. positive Cullen's sign C. protracted nausea and vomiting D. dullness to percussion in the abdominal right lower quadrant

D. dullness to percussion in the abdominal right lower quadrant-percuss somebody with suspected appendicitis? wtf

112. Risk factors for hepatitis B virus (HBV) infection include all of the following except: A. having multiple sexual partners. B. having an occupation that exposes you to human blood. C. being an injection drug user. D. eating food prepared by a person with an HBV infection.

D. eating food prepared by a person with an HBV infection.

59. Antiviral treatment for chronic HBV infection includes all of the following except: A. entecavir. B. tenofovir. C. lamivudine. D. fidaxomicin.

D. fidaxomicin

A common site for atopic dermatitis in an adult is on the: A. dorsum of the hand. B. face. C. neck. D. flexor surfaces

D. flexor surfaces

A fee-for-servive system is best defined as which of the following? A. up front payments are made prior to any service B. a practice gets a set amount each month for all services needed by a patient C. payment for each service is based on a sliding scale according to patient income D. for every procedure, there is an associated payment

D. for every procedure, there is an associated payment

62. Clinical presentation of progressive primary TB most commonly includes all of the following except: A. malaise. B. fever. C. dry cough. D. frank hemoptysis. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

D. frank hemoptysis.

Persons eligible for Medicare include all of the following except: A. individuals age 65 and older B. individuals younger than 65 years of age with certain permanent disabilities C. certain individuals concurrently receiving Medicaid D. healthy individuals younger than 65 years with income below 150% of the federal poverty line

D. healthy individuals younger than 65 years with income below 150% of the federal poverty line

Medicare Part B: A. allows beneficiaries to enroll in private plan as an alternative to the traditional fee-for-service plan B. covers inpatients and hospital services C. provides outpatient prescription drug benefits D. helps pay for physician, NP, outpatient, home health, and preventive services

D. helps pay for physician, NP, outpatient, home health, and preventive services

You see a 67-year-old man with seborrheic dermatitis that has failed to respond to treatment with ketoconazole shampoo. An appropriate second-line treatment option can include all of the following except: A. oral fluconazole. B. a topical immune modulator. C. topical propylene glycol. D. high-potency topical corticosteroid

D. high-potency topical corticosteroid

2. The patient you are evaluating is having a severe asthma flare. You have assessed that his condition is appropriate for office treatment. You expect to find the following on physical examination: A. tripod posture. B. inspiratory crackles. C. increased vocal fremitus. D. hyperresonance on thoracic percussion. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition.

D. hyperresonance on thoracic percussion.

Common clinical manifestations of anaphylaxis can include all of the following except: A. upper airway edema B. itch without rash C. dizziness with syncope D. hypertension

D. hypertension

"Incident to" billing does not apply to services provided: A. in home care B. in a nursing home C. in the physician office D. in a hospital

D. in a hospital

87. While seeing a 62-year-old who is hospitalized with CAP, the NP considers that: A. pneumococcal vaccine should be given when antimicrobial therapy has been completed. B. pneumococcal vaccine can be given today, and influenza vaccine can be given in 2 weeks. C. influenza vaccine can be given today, and pneumococcal vaccine can be given in 2 weeks. D. influenza and pneumococcal vaccines should be given today. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

D. influenza and pneumococcal vaccines should be given today.

10. The cornerstone of moderate persistent asthma drug therapy is the use of: A. oral theophylline. B. mast cell stabilizers. C. short-acting beta2-agonists (SABA). D. inhaled corticosteroids. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 134). F.A. Davis Company. Kindle Edition.

D. inhaled corticosteroids.

Regarding the risk for neonatal group B streptococcus (GBS) disease, the NP considers that: A. about 50% to 70% of all pregnant women harbor this organism B. there is no risk of disease with cesarean birth C. the organism is most often acquired by vertical transmission in the second trimester of pregnancy D. intrapartum antimicrobials should be given to all women with evidence of GBS colonization

D. intrapartum antimicrobials should be given to all women with evidence of GBS colonization

55. Compared with TST, potential advantages of the QuantiFERON®-TB Gold test (QTF-G) include all of the following except: A. the ability to have the entire testing process complete with one clinical visit. B. the results are available within 24 hours. C. the interpretation of the test is not subject to reader bias. D. it is able to predict who is at greatest risk for active disease development. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

D. it is able to predict who is at greatest risk for active disease development.

61. Risk factors for development of infection reactivation in patients with latent TB infection include all of the following except: A. diabetes mellitus. B. immunocompromise. C. long-term oral corticosteroid therapy. D. male gender. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 149). F.A. Davis Company. Kindle Edition.

D. male gender.

106. All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except: A. epigastric pain. B. positive obturator sign. C. rebound tenderness. D. marked febrile response.

D. marked febrile response.

Which of the following types of clinical studies provides the highest level of evidence? A. retrospective case-control study B. prospective cohort study C. case series D. meta-analysis

D. meta-analysis

97. Which of the following WBC forms is an ominous finding in the presence of severe bacterial infection? A. neutrophil B. lymphocyte C. basophil D. metamyelocyte

D. metamyelocyte

34. Nonsteroidal anti-inflammatory drug (NSAID)-induced peptic ulcer can be best limited by the use of: A. timed antacid doses.B. an H2RA.C. an appropriate antimicrobial.D. misoprostol.

D. misoprostol.

68. Choose the therapy for: a 47-year-old woman who was recently treated within the past 2 months with a beta-lactam for acute bacterial sinusitis? A. amoxicillin-clavulanate B. high-dose amoxicillin C. clarithromycin D. moxifloxacin Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 151). F.A. Davis Company. Kindle Edition.

D. moxifloxacin

4. You examine Jane, a 24-year-old woman who has an acute asthma flare following a 3-day history of upper respiratory tract symptoms (clear nasal discharge, dry cough, no fever). She has a history of moderate persistent asthma that is in good control and an acceptable peak expiratory flow (PEF). She is using budesonide (Pulmicort®) and albuterol as directed and continues to have difficulty with coughing and wheezing. At home, her PEF is 55% of personal best. In the office, her forced expiratory volume at 1 second (FEV1) is 65% of predicted. You also prescribe: A. amoxicillin. B. azithromycin. C. levofloxacin. D. no antimicrobial therapy. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 133). F.A. Davis Company. Kindle Edition.

D. no antimicrobial therapy.

116. A 38-year-old nonsmoking man presents with signs and symptoms consistent of GERD. He has self-treated with over-the-counter antacids and acid suppression therapy with effect. His weight is stable, and he denies nausea, vomiting, diarrhea, or melena. Which of the following represents the most appropriate diagnostic plan for this patient? A. fecal testing for H. pylori antigen B. upper GI endoscopy C. barium swallow D. no specific diagnostic testing is needed

D. no specific diagnostic testing is needed

Risk factors for angular cheilitis in adults include allof the following except: A. advanced age B. HIV infection C. alteration of facial vertical dimension due to loss of teeth D. obesity

D. obesity

You prescribe a topical medication and want it to have maximum absorption, so you choose the following vehicle: A. gel B. lotion C. cream D. ointment

D. ointment

Examples of neural tube defects include all of the following except: A. anencephaly B. spina bifida C. encephalocele D. omphalocele

D. omphalocele

Increased folic acid intake before conception is likely to reduce the risk of which of the following birth defects? A. congenital cataract B. pyloric stenosis C. clubfoot D. open neural tube defects

D. open neural tube defects

You see a 52-year-old woman who was bitten by a rat while opening a Dumpster. The examination reveals a wound approximately 1 cm deep that is oozing bright red blood. Treatment of this patient should include standard wound care with the addition of: A. rabies immune globulin B. rabies vaccine C. oral ciprofloxacin D. oral amoxicillin-clavulanate

D. oral amoxicillin-clavulanate

Nonsurgical options for the treatment of squamous and basal cell carcinoma include all of the following except: A. cryotherapy B. electrodissection with curettage C. topical cancer chemotherapy D. oral hydroxyurea

D. oral hydroxyurea

30. Which of the following is the most common serious complication of cholecystitis? A. adenocarcinoma of the gallbladderB. gallbladder empyemaC. hepatic failureD. pancreatitis

D. pancreatitis

Which of the following food-based allergies is likely to be found in adults and children? A. milk B. egg C. soy D. peanut

D. peanut

In a 22-year-old woman using isotretinoin (Accutane) therapy, the NP ensures follow-up to monitor for all ofthe following tests except: A. hepatic enzymes B. triglyceride measurements C. pregnancy test D. platelet count

D. platelet count

Pica during pregnancy should be considered: A. a harmless practice common in certain ethnic groups B. problematic only if more nutritious food sources are left out of the diet and are replaced by the nonfood substance C. a way of providing select micronutrients not usually found in food products D. potentially dangerous because of contaminants in the nonfood substance

D. potentially dangerous because of contaminants in the nonfood substance

Match each hypertensive disorder with its characteristic. HELLP syndrome A. high BP diagnosed after 20th week of pregnancy B. presence of tonic-clonic seizures or other alteration in mental status C. high BP diagnosed before pregnancy D. preeclampsia accompanied by elevated hepatic enzymes and low platelets E. high BP diagnosed after the 20th week of pregnancy and accompanied by significant proteinura

D. preeclampsia accompanied by elevated hepatic enzymes and low platelets

Components of the antenatal screening test known as the "quad screen" include all of the following except: A. AFP B. hCG C. unconjugated estriol D. progesterone

D. progesterone

Which of the following statements is false regarding Medicaid premiums and cost-sharing? A. states have limited flexibility to charge Medicaid premiums based on income level B. preventive services for children are exempt from cost-sharing C. states can terminate Medicaid coverage if premiums are not paid by an individual D. providers cannot deny care to Medicaid patients even if cost-sharing amounts are not paid

D. providers cannot deny care to Medicaid patients even if cost-sharing amounts are not paid

A causal relationship between a failure to provide standard of care and harm to a patient: A. duty of care B. breach of the standard of care C. injury D. proximal cause

D. proximal cause

The use of TNF modulators for the treatment of psoriasis is associated with an increased risk for: A. gastrointestinal disorders B. nephrotoxicity C. QTc prolongation D. reactivation of latent tuberculosis

D. reactivation of latent tuberculosis

54. You see a woman who has been sexually involved without condom use with a man newly diagnosed with acute hepatitis B. She has not received hepatitis B immunization. You advise her to: A. start hepatitis B immunization series.B. limit the number of sexual partners.C. be tested for HBsAb.D. receive hepatitis B immune globulin and start hepatitis B immunization series.

D. receive hepatitis B immune globulin and start hepatitis B immunization series.

110. Hyperbilirubinemia can cause all of the following except: A. potential displacement of highly protein-bound drugs. B. scleral icterus. C. cola-colored urine. D. reduction in urobilinogen.

D. reduction in urobilinogen.

63. Measures to prevent colonic diverticulosis and diverticulitis include all of the following except: A. increased whole grain intake.B. regular aerobic exercise.C. adequate hydration.D. refraining from excessive alcohol intake.

D. refraining from excessive alcohol intake.

40. Celiac disease's classic presentation can include all of the following except: A. weight loss, chronic diarrhea, and muscle wasting.B. flatulence and abdominal distension.C. as growth restriction when diagnosed in children younger than 2 years old.D. reported egg intolerance.

D. reported egg intolerance.

A person with latex allergy also often has a cross-allergy to all of the following except: A. banana B. avocado C. kiwi D. romaine lettuce

D. romaine lettuce Cross-sensitivity may occur between natural rubber latex protein and certain fruit proteins, potentially causing a reaction if the patient eats bananas, avocados, kiwi, melons, or chestnuts.

156. A 54-year-old man with an anal fissure responds inadequately to dietary intervention and standard therapy during the past 2 weeks. Additional treatment options include all of the following except: A. intra-anal nitroglycerine ointment. B. botulinum toxicum injection to the internal anal sphincter. C. surgical sphincterotomy. D. rubber band ligation of the lesion.

D. rubber band ligation of the lesion.

25. Compared with short-acting beta2-agonists, long-acting beta2-agonists: A. are recommended as a first-line therapy in mild intermittent asthma. B. have a significantly different pharmacodynamic profile. C. have a rapid onset of action across the drug class. D. should be added to therapy only when ICS use does not provide adequate asthma control. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

D. should be added to therapy only when ICS use does not provide adequate asthma control.

120. Colonic diverticulosis most commonly occurs in the walls of the: A. ascending colon. B. descending colon. C. transverse colon. D. sigmoid colon.

D. sigmoid colon.

Which of the following findings is often found in a person with stage 1 Lyme disease? A. peripheral neuropathic symptoms B. high-grade atrioventricular heart block C. Bell's palsy D. single painless annular lesion

D. single painless annular lesion

121. Celiac disease is also called all of the following except: A. gluten-induced enteropathy. B. celiac sprue. C. sprue. D. small bowel malabsorption syndrome.

D. small bowel malabsorption syndrome.

Treatment options in generalized psoriasis vulgaris include all of the following except: A. psoralen with ultraviolet A light (PUVA) therapy. B. methotrexate. C. cyclosporine. D. systemic corticosteroids

D. systemic corticosteroids

All of the following statements are true regarding skinreactions to bed bugs except: A. skin reactions are more common with repeated exposure to bed bug bites. B. skin reactions can typically involve papules, macules, or wheals. C. allergic reactions can be treated with topical corticosteroids. D. systemic skin reactions frequently occur following an initial exposure to bed bug bites

D. systemic skin reactions frequently occur following an initial exposure to bed bug bites

113. A 54-year-old man has been recently diagnosed with HAV infection. You recommend all of the following except: A. eating smaller, more frequent meals to help combat nausea. B. avoiding consumption of any alcohol. C. reviewing current medication use for consideration of discontinuation. D. taking daily acetaminophen to alleviate joint pains.

D. taking daily acetaminophen to alleviate joint pains.

The most common sites for squamous and basal cell carcinoma include: A. palms of hands and soles of feet B. pelvic and lumbar regions C. the abdomen D. the face and scalp

D. the face and scalp

151. A 38-year-old man with a recent history of injection drug use presents with malaise, nausea, fatigue, and "yellow eyes" for the past week. After ordering diagnostic tests, you confirm the diagnosis of acute hepatitis B. Anticipated laboratory results include: A. the presence of hepatitis B surface antibody (HBsAb). B. neutrophilia. C. thrombocytosis. D. the presence of HBsAg.

D. the presence of HBsAg.

All of the following characteristics about bed bugs are true except: A. they can be found in furniture, carpeting, and floorboards. B. their peak feeding time is at dawn. C. during feeding, they are attracted to body heat and carbon dioxide. D. they prefer to harbor unsanitary environments.

D. they prefer to harbor unsanitary environments

88. Risk factors for infection with DRSP include all of the following except: A. systemic antimicrobial therapy in the previous 3 months. B. exposure to children in day care. C. age older than 65 years. D. use of inhaled corticosteroids. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

D. use of inhaled corticosteroids.

B. X-ray imaging

Diagnostic approaches commonly used to identify malignant otitis externa include all of the following except: A. CT Scan B. X-ray imaging C. Radionucleotide bone scanning D. Gallium scanning

C. Positive virological test result and negative serological test result

Diagnostic testing of a person with primary HSV-2 infection would likely show: A. Negative virological and serological test results B. Negative virological test result and positive serological test result C. Positive virological test result and negative serological test result D. Positive virological and serological test results

D. Respiratory fluoroquinolones

Drug-resistant S. Pneumoniae is least likely to exhibit resistance to which of the following antimicrobial classes? A. Advanced macrolides B. Tetracycline forms C. First-generation cephalosporins D. Respiratory fluoroquinolones

B. 31-year-old woman with history of naturally occurring multiple gestation pregnancy

Due to an increased risk of blood clots, an alternative to the contraceptive ring (NuvaRing) or patch (Ortha Evra) is preferred in all of the following women except: A. 42-year-old nulliparous woman B. 31-year-old woman with history of naturally occurring multiple gestation pregnancy C. 28-year-old who smokes one pack per day D. 33-year-old woman with a family history of venous thrombosis

A. Symptoms are most likely in the week before the onset of the menses

During perimenopause, which of the following is likely to be noted? A. Symptoms are most likely in the week before the onset of the menses B. The length of the perimenopausal period is predictable C. Symptoms are less severe in women who smoke D. Hot flashes are uncommon

B. HPV testing

During well-woman visits for 21- to 29- year old sexually active women who report more than 1 sex partner within the past 6 months, all of the following are appropriate screening tests except: A. Pap smear B. HPV testing C. Pelvic examination D. STI screening

Match uterine size with stage of pregnancy. 20 weeks A. Size of a baseball B. Size of a softball or grapefruit C. Size of a large lemon D. Size of a tennis ball or orange E. Uterine fundus at umbilicus F. Uterine fundus halfway between symphysis pubis and umbilicus

E. Uterine fundus at umbilicus ~1-cm gain in fundal height per week. Uterine fundus usually concordant with gestational age, plus or minus 1 cm.

Match each hypertensive disorder with its characteristic. Preeclampsia A. high BP diagnosed after 20th week of pregnancy B. presence of tonic-clonic seizures or other alteration in mental status C. high BP diagnosed before pregnancy D. preeclampsia accompanied by elevated hepatic enzymes and low platelets E. high BP diagnosed after the 20th week of pregnancy and accompanied by significant proteinura

E. high BP diagnosed after the 20th week of pregnancy and accompanied by significant proteinura

T/F in a normal pregnancy Decrease in transverse thoracic diameter and diaphragmatic contraction

T/F in a normal pregnancy Fasting plasma glucose increases slightly

T/F in a normal pregnancy Increased intestinal motility

Match uterine size with stage of pregnancy. 16 weeks A. Size of a baseball B. Size of a softball or grapefruit C. Size of a large lemon D. Size of a tennis ball or orange E. Uterine fundus at umbilicus F. Uterine fundus halfway between symphysis pubis and umbilicus

F. Uterine fundus halfway between symphysis pubis and umbilicus Quickening first noted in woman who has been pregnant before (second trimester or beyond) during 16-17 weeks, at ~18 weeks with first pregnancy.

True or False: All CA-MRSA strains are capable of causing necrotizing infection

False

True or False: CA-MRSA is most commonly spread from one person to another via airborne pathogen transmission

False

True or False: If a skin and soft tissue infection does not improve in 48 to 72 hours with antimicrobial therapy, infection with a resistant pathogen is virtually the only cause

False

True or False: Most acute-onset necrotic skin lesions reported in North America are caused by spider bites

False

B. Warm compresses to the affected area

First-line treatment for uncomplicated hordeolum is: A. Topical corticosteroid B. Warm compresses to the affected area C. Incision and drainage D. Oral antimicrobial therapy

D. Clonidine

For a woman with bothersome hot flashes who cannot take HT, alternative options with demonstrated efficacy and limited adverse effects include the use of all of the following except: A. Venlafaxine B. Sertraline C. Gabapentin D. Clonidine

Hyperthyroid, Hypothyroid, or Both? Heat intolerance

HYPER

frequent, low volume loose stools

HYPER

hyperreflexia with characteristic quick out, quick back action at patellar reflex

HYPER

proximal muscle weakness

HYPER

smooth, silky skin

HYPER

tachycardia with hypertension

HYPER

coarse hair with tendency to break easily

HYPO

coarse, dry skin

HYPO

constipation

HYPO

hyporeflexia with a characteristic hung up reflex

HYPO

menorrhagia

HYPO

secondary hypertriglyeremia

HYPO

thick, dry nails

HYPO

Cirrhosis complications

Hepatic encephalopathy Damaged liver cells can't remove bacterial waste products Mental status change + cirrhosis = ammonia level? Hepatic carcinoma Hepatorenal syndrome Renal vasoconstriction Looks like CKD Hepatopulmonary syndrome Vascular dilation in pulmonary system hypoxia Dyspnea relieved by recumbency! (platypnea) Portal hypertension (may need TIPS) Esophageal varices Ascites Bacterial peritonitis Ascites is the most common complication of cirrhosis Patients with compensated cirrhosis often do not have signs or symptoms related to their cirrhosis, although they may have evidence of portal hypertension, such as esophageal or gastric varices.[8,9,10] In contrast, patients with decompensated cirrhosis have symptomatic complications related to cirrhosis, including those related to hepatic insufficiency (jaundice or hepatic encephalopathy), and those related to portal hypertension (ascites or variceal hemorrhage).[11] Anti-aldosterone drugs are given with loop diuretics to increase diuretic response or when renal perfusion is impaired. Dietary salt intake should be restricted to approximately 88 mmol/day (2000 mg/d). hepatic encephalopathy is thought to be related to toxic compounds generated by gut bacteria, such as ammonia, mercaptans, and short-chain fatty acids and phenols. These compounds are transported by the portal vein to the liver, where most are normally metabolized or excreted immediately. In patients with cirrhosis, damaged hepatocytes are unable to metabolize these waste products, and portal venous blood can bypass the liver through collateral circulation (such as varices) or a medically constructed shunt.

C. 2 to 4 weeks

How long after contact do clinical manifestation of syphilis typically occur? A. Less than 1 week B. 1 to 3 weeks C. 2 to 4 weeks D. 4 to 6 weeks

178. Is the following statement most consistent with IBD, with IBS, or with both conditions? The etiology likely involves an autoimmune response to the GI tract.

IBD (Crohn's/ UC)

66: respiratory syncytial virus - yes 67: herpes simplex virus 2 - no 68: influenza virus - yes 69: rhinovirus - yes

Indicate which of the following viruses are implicated in causing acute otitis media (AOM). 66: respiratory syncytial virus 67: herpes simplex virus 2 68: influenza virus 69: rhinovirus

B. Hot flashes and night sweats occur in about 60% to 90% of women

In advising a woman about menopause, the NP considers that: A. The average age at last menstrual period for a North American woman is 47 to 48 years B. hot flashes and night sweats occur in about 60% to 90% of women C. Women with surgical menopause usually have milder symptoms D. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels are suppressed

A. Inhibiting embryo implantation

In contrast to progestin-only emergency contraception, a possible mechanism of action of ulipristal is: A. Inhibiting embryo implantation B. Impairing sperm transport C. Through spontaneous abortion D. Impairing ovum transport

D. Amoxicillin

In patients with infectious mononucleosis, which medication should be avoided due to a risk of rash development? A. Acetaminophen B. Sulfamethoxazole C. Erythromycin D. Amoxicillin

B. Reduced risk of recurrent UTIs

In postmenopausal women, a major benefit from the use of topical or local estrogen is: A. Decreased rate of breast cancer B. reduced risk of recurrent UTIs C. Reduced risk of type 2 diabetes D. Increased levels of androgens

D. All of the above

In the person with HSV-2 infection, the virus can spread via: A. Genital secretions B. Oral secretions C. Normal-looking skin D. All of the above

B. An inflammatory inhibitor

In the treatment of allergic rhinitis, leukotriene modifiers should be used as: A. An agent to relieve nasal itch B. An inflammatory inhibitor C. A rescue drug D. An intervention in acute inflammation

70: S. Pneumoniae - yes 71: H. Influenzae - Yes 72: E. Coli - No 73: M. Catarrhalis - yes

Indicate which of the following bacteria are commonly implicated in causing acute otitis media (AOM). 70: S. Pneumoniae 71: H. Influenzae 72: E. Coli 73: M. Catarrhalis

B. Anticholinergic effect

Ipratropium bromide (Atrovent) helps control nasal secretions through: A. Antihistamine action B. Anticholinergic effect C. Vasodilation D. Vasoconstriction

A. Acetaminophen

Irregular bleeding associated with DMPA (Depo-Provera) can be minimized with the use of all of the following except: A. Acetaminophen B. Ibuprofen C. Naproxen sodium D. Estrogen supplements

Cirrhosis: co-management

Limit sodium Help prevent edema/ascites Avoid NSAIDS increased sodium retention Spironolactone/Lasix combo If ascites refractory -> albumin Beta blockers (decrease HR by 25%) (or ligation) Prevent esophageal bleeding Vit D & bisphosphonates Osteoporosis Rifaximin/Lactulose - titrate for 2-3 soft BM per day Hepatic encephalopathy Screen for depression and other problems Often co-morbid depression Vaccinations, health promotion Liver US and serum alpha feta-protein screen q 6-12 months Hepatocellular carcinoma monitoring Medication monitoring No benzos or other CNS depressants However, aetiology of bone loss is multifactorial and not entirely understood. Patients with cholestatic liver disease are particularly susceptible to osteoporosis due to the interference of cholestasis with vitamin D metabolism. Cirrhosis doubles the risk for pathologic fractures. TIPS for varices

B. 50%

Long term calcium supplementation is recommended in postmenopausal women as its use reduces the risk of fracture by approximately: A. 25% B. 50% C. 65% D. 80%

C. Angle-closure glaucoma

Mrs. Murphy is a 58-year-old woman presenting with a sudden left-sided headache that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, and the eyeball is firm. Vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely diagnosis is: A. Unilateral herpetic conjunctivitis B. Open-angle glaucoma C. Angle-closure glaucoma D. Anterior uveitis

C. Cardiovascular disease

Oral decongestant use should be discouraged in patients with: A. Allergic rhinitis B. Migraine headache C. Cardiovascular disease D. Chronic bronchitis

Based on the CURB-65 criteria, indicate which patients should be treated as an inpatient (I) or outpatient (O). 77. a 47-year-old man with no confusion, blood urea nitrogen (BUN) = 22 mg/dL, respiratory rate = 32/min, and blood pressure = 110/72 mm Hg Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 152). F.A. Davis Company. Kindle Edition.

Outpatient

Compensated cirrhosis vs. decompensated.

Patients with compensated cirrhosis often do not have signs or symptoms related to their cirrhosis, although they may have evidence of portal hypertension, such as esophageal or gastric varices.[8,9,10] In contrast, patients with decompensated cirrhosis have symptomatic complications related to cirrhosis, including those related to hepatic insufficiency (jaundice or hepatic encephalopathy), and those related to portal hypertension (ascites or variceal hemorrhage).[11]

B. 24

Patients with strep throat can be cleared or return to work or school after ____ hours of antimicrobial therapy. A. 12 B. 24 C. 36 D. 48

D. Restricting fluid intake

Prevention and prophylaxis in Meniere's disease include all of the following except: A. Avoiding ototoxic drugs B. Protecting the ears from loud noise C. Limiting sodium intake D. Restricting fluid intake

D. Blue eye color

Risk factors for POAG include all of the following except: A. African ancestry B. Type 2 diabetes mellitus C. Advanced age D. Blue eye color

A. Frequent air travel

Risk factors for otitis externa include all of the following except: A. Frequent air travel B. Vigorous use of cotton swab C. Frequent swimming D. Cerumen impaction

D. Recent history of epistaxis

Risk factors for ABRS include all of the following except: A. Viral infection B. Allergies C. Tobacco use D. Recent history of epistaxis

D. Aggressive ear canal hygiene

Risk factors for AOM include all of the following except: A. Upper respiratory tract infection B. Untreated allergic rhinitis C. Tobacco use D. Aggressive ear canal hygiene

C. Saliva and droplet contact

S. Pyogenes is transmitted primarily through: A. Sexual intercourse B. Skin-to-skin contact C. Saliva and droplet contact D. Contaminated surfaces

D. Fixed drug eruptions

Serious allergic reactions caused by the use of trimethoprim-sulfamethoxazole include all of the following except: A. Anaphylaxis B. Stevens-Johnson syndrome C. Toxic epidermal necrolysis D. Fixed drug eruptions

D. 70% to 80%

Suppressive therapy reduces the frequency of genital herpes recurrences by: A. 5% to 10% B. 20% to 25% C. 40% to 50% D. 70% to 80%

T/F Child abuse is present in about half of all homes where partner mistreatment occurs.

T/F in a normal pregnancy Dilation of renal collecting system

T/F in a normal pregnancy Gallbladder doubles in size

T/F in a normal pregnancy Insulin levels increase by 2-fold to 10-fold over pre-pregnancy levels

T/F in a normal pregnancy Lower esophageal sphincter more relaxed

B. Adenovirus

The most common virological cause of conjunctivitis is: A. Coronavirus B. Adenovirus C. Rhinovirus D. Human papillomavirus

C. Oropharyngeal secretions

The Epstein-Barr virus is primarily transmitted via: A. Skin-to-skin contact B. Contact with blood C. Oropharyngeal secretions D. Genital contact

Present in Meniere's Disease

The Rinne's test reveals that air exceeds bone conduction.

Not present in Meniere's disease

The Romberg test is negative.

B. 40 to 45 years

The average onset of perimenopause is between the ages of: A. 35 to 40 years B. 40 to 45 years C. 45 to 50 years D. 50 to 55 years

B. IgE antibodies

The physiological response causing allergic rhinitis is primarily mediated through: A. IL-10 B. IgE antibodies C. Anti-IgM antibodies D. Anti-TNF antibodies

D. A tubo-ovarian abscess

The presence of an adnexal mass in the woman with PID most likely indicates the presence of: A. Uterine fibroids B. An ectopic pregnancy C. Ovarian malignancy D. A tubo-ovarian abscess

B. Minimize endometrial hyperplasia

The progestin component of HT is given to: A. Counteract the negative lipid effects of estrogen B. Minimize endometrial hyperplasia C. Help with vaginal atrophy symptoms D. Prolong ovarian activity

Perception of abnormal hearing or head noises

Tinnitus

A. Symptomatic treatment

Treatment of otitis media with effusion usually includes: A. Symptomatic treatment B. Antimicrobial therapy C. An antihistamine D. A mucolytic

C. TMP-SMX

Treatment of scarlet fever in a 19-year-old woman with no allergy to penicillin can include all of the following except: A. Penicillin B. Cefdinir C. TMP-SMX D. Cefpodoxime

D. No antibiotic therapy needed

Treatment of viral conjunctivitis can include: A. Moxifloxacin ophthalmic drops B. Polymyxin B ophthalmic drops C. Oral acyclovir D. No antibiotic therapy needed

B. Clotrimazole cream

Treatment of vulvovaginitis caused by Candida albicans includes: A. Metronidazole gel B. Clotrimazole cream C. Hydrocortisone ointment D. Clindamycin cream

C. Famciclovir

Treatment options for HSV-2 genital infection include: A. Ribavirin B. Indinavir C. Famciclovir D. Cyclosporine

True

True/False: Calcium and vitamin D supplementation is recommended for those taking DMPA (Depo-Provera) injections to minimize the risk of a loss in bone density.

True

True/False: The use of combine oral contraception (COC) reduces menstrual volume by approximately 60%, thereby reducing the risk of iron deficiency anemia.

Perception that the person or the environment is moving

Vertigo

D. easily irritated and prone to bleeding, especially following intercourse

Which of the following include characteristics of a friable cervix? A. Presence of a dull pain, particular prior to menses B. A constant burning sensation C. Presence of multiple polyps D. Easily irritated and prone to bleeding, especially following intercourse

A. Verruciform

Which of the following best describes lesions associated with condyloma acuminatum? A. Verruciform B. Plaque-like C. Vesicular-form D. Bullous

C. Stringy and clear

Which of the following findings is most consistent with vaginal discharge during ovulation? A. Dry and sticky B. Milky and mucoid C. Stringy and clear D. Tenacious and odorless

Yes

Yes/No: According to the U.S. Medical Eligibility Criteria for Contraception Use, who is a candidate for a copper-containing intrauterine device (IUD)? A 33-year-old woman who smokes two packs per day

C. Some isolates exhibit antimicrobial resistance via production of beta-lactamase

Which of the following is a characteristic of H. Influenzae? A. Newer macrolides are ineffective against the organism. B. Its antimicrobial resistance results from altered protein-binding sites within the wall of the bacteria C. Some isolates exhibit antimicrobial resistance via production of beta-lactamase D. This is a gram-negative organism

B. Mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell.

Which of the following is a characteristic of S. Pneumoniae? A. Mechanism of antimicrobial resistance primarily because of the production of beta-lactamase B. Mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell C. Organisms most commonly isolated from mucoid middle ear effusion D. Gram-negative organisms

A. Peripheral vision loss

Which of the following is a common vision problem in the person with untreated primary open-angle glaucoma (POAG)? A. Peripheral vision loss B. Blurring of near vision C. Difficulty with distant vision D. Need for increased illumination

C. Presence of factor V Leiden mutation

Which of the following is a contraindication to estrogen/progestin-containing methods (combined oral contraception [COC], patch [Ortho Evra], or ring [NuvaRing])? A. Mother with a history of breast cancer B. Personal history of hepatitis A at age 10 years C. Presence of factor V Leiden mutation D. Cigarette smoking one pack per day in a 22-year-old

A. Amoxicillin-clavulanate

Which of the following is a first-line therapy for the treatment of ABRS in an adult with no recent antimicrobial use? A. Amoxicillin-clavulanate B. Trimethoprim-sulfamethoxazole C. Clarithromycin D. Moxifloxacin

D. Gumma

Which of the following is found in tertiary syphilis? A. Arthralgia B. Lymphadenopathy C. Macular or papular lesions involving the palms and soles D. Gumma

B. Acts as an abortifacient

Which of the following is likely not among the proposed mechanisms of action of all forms of oral emergency contraception? A. Inhibits ovulation B. Acts as an abortifacient C. Slows sperm transport D. Slows ovum transport

C. Minimized hot flashes

Which of the following is likely to be noted with short-term (less than 1 to 2 years) HT use in a postmenopausal woman? A. Reduction in dementia risk B. Significant increase in breast cancer risk C. Minimized hot flashes D. Increase in cardiovascular risk

A. Short course of an oral corticosteroids

Which of the following is most appropriate for the treatment of moderate-to-severe allergic rhinitis and conjunctivitis when symptoms are not controlled with current therapy? A. Short course of an oral corticosteroids B. Single dose of a long-acting parenteral or IM corticosteroids C. Daily dose of oral first-generation antihistamine D. Immediate initiation of allergy immunotherapy

B. Lymphocytosis with atypical lymphocytes

Which of the following is most likely to be found in the laboratory data of a person with infectious mononucleosis? A. Neutrophilia with reactive forms B. Lymphocytosis with atypical lymphocytes C. Thrombocytosis D. Macrocytosis

A. Excessive cupping of the optic disk

Which of the following is most likely to be found on the funduscopic examination in a patient with untreated POAG? A. Excessive cupping of the optic disk B. Arteriovenous nicking C. Papilledema D. Flame-shaped hemorrhages

D. Vaginal epithelial cells with adherent bacteria

Which of the following is not a normal finding in a woman during the reproductive years? A. Vaginal pH of 4.5 or less B. Lactobacillus as the predominant vaginal organism C. Thick, white vaginal secretions during the luteal phase D. Vaginal epithelial cells with adherent bacteria

A. Over 55 years of age

Which of the following is not part of the criteria for an older woman to cease having any future Pap tests performed? A. Over 55 years of age B. Negative screening results on three consecutive cytology or two consecutive co-test results with in 10 years C. The most recent cytology occurring within the past 5 years D. No history of cervical intraepithelial neoplasm (CIN) 2 or greater within the past 20 years

C. Flu-like symptoms

Which of the following is not representative of the presentation of primary syphilis? A. Painless ulcer B. Localized lymphadenopathy C. Flu-like symptoms D. Spontaneously healing lesion

B. Chancre

Which of the following is not representative of the presentation of secondary syphilis? A. Generalized rash B. Chancre C. Arthralgia D. Lymphadenopathy

C. "Depo-Provera (medroxprogesterone acetate in a depot injection [DMPA]) use will likely not interact with your seizure medication. "

Which of the following is the most appropriate response to a 27-year-old woman who is taking phenytoin (Dilantin) for the treatment of a seizure disorder and is requesting hormonal contraception? A. "A barrier method would be the preferable choice." B. " COC is the best option." C. "Depo-Provera (medroxprogesterone acetate in a depot injection [DMPA] use will likely not interact with your seizure medication." D. "Copper-containing IUD use is contraindicated."

B. Prednisone

You examine a 25-year-old man who has infectious mononucleosis with tonsillar hypertrophy, exudative pharyngitis, poor fluid intake due to difficultly swallowing, and a patent airway. You prescribe: A. Amoxicillin B. Prednisone C. Ibuprofen D. Acyclovir

C. An ulcerated lesion with indurated margins

You inspect the oral cavity of a 69-year-old man who has a 100-pack per year cigarette smoking history. You find a lesion suspicious for malignancy and describe it as: A. Raised, red and painful B. A denuded patch with a removable white coating C. An ulcerated lesion with indurated margins D. A vesicular-form lesion with macerated margins

B. If he experiences any allergic reaction, he should stop taking the antibiotic and contact a healthcare provider immediately

You prescribe a regimen of doxycycline to treat an acute exacerbation of chronic bronchitis for a 56-year-old man. This is his first exposure to this antimicrobial. You advise that: A. He should not experience an allergic reaction since he has no reported penicillin allergy B. If he experiences any allergic reaction, he should stop taking the antibiotic and contact a healthcare provider immediately C. If he experiences an allergic reaction, he should continue taking the medication until he meets with a healthcare provider to avoid resistance development D. Any allergic reaction will eventually resolve once the regimen is complete.

C. A few days to a week

You prescribe nasal corticosteroid spray for a patient with perennial allergic rhinitis. What is the anticipated onset of symptom relief with its use? A. Immediately with the first spray B. 1 to 2 days C. A few days to a week D. 2 or more weeks

C. Referral for colposcopy

You see a 14-year-old woman whose Pap smear result reveals high-grade squamous intraepithelial lesion (HSIL). The HPV test is negative. You recommend: A. Repeating the Pap test in 3 to 4 months B. Repeating the Pap test in 1 year C. Referral for colposcopy D. Referral for biopsy

A. Conducting a pap test

You see a 24-year-old woman who received the HPV vaccine (three doses) as a teenager. She had a normal Pap test 3 years ago. You recommend: A. Conducting a Pap test B. Conducting a Pap test and HPV testing C. Waiting 2 years for the next Pap test D. Ceasing future Pap tests until she turns 30 years old

C. Referral for colposcopy

You see a 33-year-old woman whose Pap smear result reveals atypical cells of undetermined significance (ASC-US). She is also positive for HPV, with genotype testing revealing the presence of HPV type 16. You recommend: A. Repeating Pap test immediately B. Repeating the Pap test in 3 to 4 months C. Referral for colposcopy D. Administering the HPV vaccine

B. Ulipristal

You see a 34-year-old woman who reports having unprotected sexual intercourse 4 days ago and requests emergency contraception. She has a recent history of gonorrhea that was treated successfully. This most acceptable and effective option in this clinical scenario is: A. Progestin-only emergency contraception B. Ulipristal C. Copper-containing IUD D. Nothing, as 4 days is too long for emergency contraception to be effective

which of the following meds can contribute to the development of acute urinary retention in an older man with BPH? a. amitriptyline b. loratadine c. enalapril d. lorazepam

a. amitriptyline

sequelae of genital human papilomavirus infection in a man can include: a. anorectal carcinoma b. low sperm count c. paraphimosis d. Reiter syndrome

a. anorectal carcinoma

which of the following is recommended by the CDC as single dose txment for uncomplicated urethritis caused by N. gonorrhoeae when an oral product is the most appropriate option? a. cefixime b. metronidazole c. azithromycin d. amoxicillin

a. cefixime

the preferred txment for uncomplicated gonococcal proctitis is: a. ceftriaxone 250mg IM as a single dose plus a single dose of azithromycin 1g PO b. oral erythromycin 500mg bid for 7 days c. oral norfloxacin 400mg bid with metronidazole 500mg bid for 3 days d. azithromycin 1g po as a single dose plus single dose of injectable doxycyline 100mg

a. ceftriaxone 250mg IM as a single dose plus a single dose of azithromycin 1g PO

txment options for lymphogranuloma venereum include: a. doxycycline b. penicillin c. ceftriaxone d. dapsone

a. doxycycline

which of the following is a reasonable txment option for a 30 y/o with acute epididymitis who presents without GI upset and will be txed as an outpatient? a. doxycycline with ceftriaxone b. amoxicillin with clavulanate c. metronidazole with linezolid d. clindamycin with cefixime

a. doxycycline with ceftriaxone

indicate whether each finding normally would be present in gonorrheal urethritis in an otherwise well 28 y/o (yes or no) a. dysuria - yes b. dysuria - no

a. dysuria - yes

indicate whether each finding would be present in acute epididymitis (yes or no) a. epididymoorchitis in later stages of disease - yes b. epididymoorchitis in later stages of disease - no

a. epididymoorchitis in later stages of disease - yes

indicate whether each finding would be present in acute epididymitis (yes or no) a. irritative voiding sxs - yes b. irritative voiding sxs - no

a. irritative voiding sxs - yes

in gonococcal infection, which of the following statements is true? a. risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act b. most men have symptomatic infection c. the incubation period is about 2-3 weeks d. the organism rarely produces beta-lactamase

a. risk of transmission from an infected woman to a male sexual partner is about 20% to 30% with a single coital act

indicate whether each finding would be present in acute epididymitis (yes or no) a. scrotal swelling - yes b. scrotal swelling - no

a. scrotal swelling - yes

which of the following best describes the lesions associated with condyloma acuminatum? a. verruciform b. plaquelike c. vesicular d. bullous

a. verruciform

PDE-5 inhibitors (sildenafil, vardenafil, avanafil, and tadalafil) should be taken when?

approximately one hr before the anticipated sexual activity

Identify the following organisms as a grampositive, gram-negative, or atypical pathogen. 93. Legionella species Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 153). F.A. Davis Company. Kindle Edition.

atypical

Identify the following organisms as a grampositive, gram-negative, or atypical pathogen. 94. Chlamydophila pneumoniae Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 153). F.A. Davis Company. Kindle Edition.

atypical

Identify the following organisms as a grampositive, gram-negative, or atypical pathogen. 95. Mycoplasma pneumoniae Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 153). F.A. Davis Company. Kindle Edition.

atypical

sxs of lymphogranuloma venereum typically occur how long after contact with an infected host? a. 5-7 days b. 1-4 weeks c. 4-6 weeks d. 2-3 months

b. 1-4 weeks

approximately what percentage of sexually active adults has serological evidence of human herpesvirus 2? a. 5 b. 15 c. 25 d. 40

b. 15

according to recent epidemioloic studies, prostate cancer is the number __ cause of cancer death in men residing within the US? a. 1 b. 2 c. 3 d. 4

b. 2

anticipated organ survival exceeds 85% with testicular decompression within how many hrs or torsion? a. 1 b. 6 c. 16 d. 24

b. 6

which HPV are most likely to cause condyloma acuminatum? a. 1, 2, and 3 b. 6 and 11 c. 16 and 19 d. 22 and 24

b. 6 and 11

appropriate antimicrobial txment for a 25 y/o with acute bacterial prostatitis is: a. oral azithromycin b. IM ceftriaxone followed by oral doxycycline c. oral ofloxacin d. oral amoxicillin-clavulanate

b. IM ceftriaxone followed by oral doxycycline

a 30 y/o with prostatitis presents with a fever of 102.3F (39.1C). what would be the expected CBC findings from this pt? a. WBC = 15,000/mm3, neutrophils= 4,000/mm3 b. WBC = 18,000/mm3, neutrophils= 11,500/mm3 c. WBC = 7,200/mm3, neutrophils= 3,200/mm3 a. WBC = 4,000/mm3, neutrophils= 1,200/mm3

b. WBC = 18,000/mm3, neutrophils= 11,500/mm3

when prescribing antihypertensive txment for a man with BPH and hypertension, the NP considers that: a. loop diuretics are the tx of choice b. an alpha1 antagonist should NOT be used as a solo or first-line txment agent c. angiotensin receptor antagonist use is contraindicated d. beta-adrenergic antagonist use often enhances urinary flow

b. an alpha1 antagonist should NOT be used as a solo or first-line txment agent

indicate whether each finding would be present in acute epididymitis (yes or no) a. boggy prostate - yes b. boggy prostate - no

b. boggy prostate - no

risk factors for prostate cancer include all of the following EXCEPT: a. African ancestry b. hx of genital trauma c. family hx of prostate cancer d. high-fat diet

b. hx of genital trauma

PE findings in lymphogranuloma venereum include: a. verruciform lesions b. lesions that fuse and create multiple draining sinuses c. a painless crater d. plaquelike lesions

b. lesions that fuse and create multiple draining sinuses

when discussing ED with a 70 y/o, the NP considers that: a. it is a normal consequence of aging b. most cases have an underlying contributing cause c. although depression is common in older men, it is usually not correlated with increased rates of ED d. txment options for younger men are seldom effective in older men

b. most cases have an underlying contributing cause

the most common causative organisms of acute bacterial prostatitis in men <35 yrs are: a. e coli and k. penumoniae b. n. gonorrhoeae and c. trachomatis c. pseudomonas and acinetobacter species d. enterococci

b. n. gonorrhoeae and c. trachomatis

finasteride (proscar, propecia) and dutasteride (avodart) are helpful in the txment of BPH because of their effect on: a. bladder contractility b. prostate size c. activity at select bladder receptor sites d. bladder pressure

b. prostate size

a 54 y/o white man with no obvious risk for prostate cancer opted to undergo PSA screening and DRE testing. the DRE findings are normal and his PSA is 3.7 ng/mL. you recommend: a. repeating the PSA immediately b. repeat screening in 1 yr c. repeat screening in 2 yrs d. repeat screening in 5 yrs

b. repeat screening in 1 yr

indicate whether each finding normally would be present in gonorrheal urethritis in an otherwise well 28 y/o (yes or no) a. scrotal swelling - yes b. scrotal swelling - no

b. scrotal swelling - no

which of the following meds for ED txment has the longest half-life? a. sildenafil (viagra) b. tadafil (cialis) c. vardenafil (levitra) d. avanafil (stendra)

b. tadafil (cialis)

concerning BPH, which of the following statements is true? a. digital rectal exam is accurate in dxing the condition b. the use of a validated pt sx tool is an important part of dx the condition c. prostate size directly correlates with sxs and bladder emptying d. bladder distention is usually present in early disease

b. the use of a validated pt sx tool is an important part of dx the condition

indicate whether each finding would be present in acute epididymitis (yes or no) a. ulcerative lesion - yes b. ulcerative lesion - no

b. ulcerative lesion - no

Are dysthythmias associated with anorexia nervosa, bulimia nervosa, or both disorders (Ch. 14 Fitzgerald)

both

Are esophageal tears associated with anorexia nervosa, bulimia nervosa, or both disorders (Ch. 14 Fitzgerald)

both

how long after contact does the onset of clinical manifestations of syphilis typically occur? a. less than 1 week b. 1 to 3 weeks c. 2 to 4 weeks d. 4 to 6 weeks

c. 2 to 4 weeks

the average American man has an approximately ___% lifetime risk of prostate cancer and an approximately __% likelihood of clinical disease a. 15, 5 b. 25, 8 c. 40, 10 d. 60, 15

c. 40, 10

the most likely causative pathogens in a 26 y/o with acute epididymitis include: a. escherichia coli b. enterobacteriaceae c. C. trachomatis d. pseudomonas species

c. C. trachomatis

tamsulosin (flomas) is helpful in the txment of BPH because of its effect on: a. bladder contractility b. prostate size c. activity at select bladder receptor sites d. bladder pressure

c. activity at select bladder receptor sites

you see a 42 y/o man with uncomplicated urogenital gonorrhea. his medical records indicate a severe allergic rx to penicillin that includes difficulty breathing and diffuse urticaria. you recommend txment with: a. cefixime b. levofloxacin c. azithromycin d. tigecycline

c. azithromycin

all of the following are typical findings for a pt with chancroid except: a. multiple lesions b. spontaneous rupture of affected nodes c. blood-tinged penile discharge d. dense, matted lymphadenopathy on the ipsilateral side of the legion

c. blood-tinged penile discharge

when choosing an antimicrobial agent for the txment of chronic bacterial prostatitis, the NP considers that: a. gram positive organisms are the most likely cause of infection b. cephalosporins are the first-line choice of txment c. choosing an antibiotic with gram-negative coverage is critical d. length of antimicrobial txment is typically 5 days

c. choosing an antibiotic with gram-negative coverage is critical

syphilis is most contagious at which of the following times? a. before onset of s/s b. during the primary stage c. during the 2nd stage d. during the tertiary stage

c. during the 2nd stage

txment options for HSV-2 genital infection include: a. ribavirin b. indinavir c. famciclovir d. cyclosporine

c. famciclovir

which of the following is NOT representative of the presentation of primary syphilis? a. a painless ulcer b. localized lymphadenopathy c. flulike sxs d. a spontaneously healing lesion

c. flulike sxs

for pts with ED who fail txment with a PDE-5 inhibitor, alternative approaches include all of the following EXCEPT: a. alprostadil injection into the penis b. mechanical vacuum devices c. insertion of a nitroglycerin pellet in the urethra d. implantation of a prosthetic device

c. insertion of a nitroglycerin pellet in the urethra

in assessing a man with testicular torsion, the NP is most likely to note: a. elevated PSA level b. white blood cells reported in urinalysis c. left testicle most often affected d. increased testicular blood flow by color-flow Doppler ultrasound

c. left testicle most often affected

appropriate txment of acute epididymitis for a 32 y/o who has sex with other men is: a. ceftriaxone b. azithromycin c. levofloxacin d. TMP-SMX

c. levofloxacin

all of the following are likely to be reported by pts with acute bacterial prostatitis except: a perineal pain b. irritative voiding sxs c. penile discharge d. fever

c. penile discharge

diagnostic testing of a person with primary HSV-2 infection would likely show: a. negative virologic and serologic test results b. negative virologic test result and positive serologic test rest c. positive virologic test result and negative serologic test result d. positive virologic and serologic test results

c. positive virologic test result and negative serologic test result

txment options for pts with condyloma acuminatum include all of the following EXCEPT: a. imiquimod b. podofilox c. topical acyclovir d. cryotherapy

c. topical acyclovir

txment options for varicocele repair include all of the following EXCEPT: a. open surgery b. laparoscopic surgery c. txment with a thrombolytic agent d. percutaneous embolization

c. txment with a thrombolytic agent

suppressive tx reduces the frequency of genital herpes recurrences by: a. 5-10% b. 20-25% c. 40-50% d. 70-80%

d. 70-80%

surgical intervention in BPH should be considered with all of the following except: a. recurrent UTI b. bladder stones c. persistent obstruction despite medical txment d. acute tubular necrosis

d. acute tubular necrosis

risk factors for acute bacterial prostatitis include all of the following except: a. having unprotected sex b. use of a urinary catheter c. prior bladder infection d. age >70 yrs

d. age >70 yrs

routine anal Pap smears can be considered for all of the following pt populations EXCEPT: a. men with HIV b. men who have sex with men c. women with a hx of anogenital HPV infection d. all males under age 25 years

d. all males under age 25 years

txment options for chancroid include all of the following EXCEPT: a. azithromycin b. ciprofloxacin c. ceftriaxone d. amoxicillin

d. amoxicillin

which of the following is INCONSISTENT with the description of benign prostatic hyperplasia (BPH)? a. obliteraed mediam sulcus b. size loarger than 2.5cm x 3cm c. sensation of incomplete emptying d. boggy gland

d. boggy gland

appropriate antimicrobial txment for a 65 y/o with acute bacterial prostatitis is: a. erythromycin b. cefepime c. TMP-SMX d. ciprofloxacin

d. ciprofloxacin

which of the following is found in tertiary syphilis? a. arthralgia b. lymphadenopathy c. maculopapular lesions involving the palms and soles d. gumma

d. gumma

a 23 y/o has a nontender "bag of worms" mass within the left scrotum that disappears when he is in the supine position. he is dx with a varicocele. what is a risk factor that may have contributed to this condition? a. younger age b. current cigarette smoker c. multiple sexual partners d. none of the above

d. none of the above

which part of the prostate is readily palpable during a DRE? a. anterior lobe b. median lobe c. lateral lobes d. posterior lobe

d. posterior lobe

a 78 y/o man presents with a 3 day hx of new-onset fatigue and difficulty with bladder emptying. exam reveals a distended bladder but is otherwise unremarkab.e. BUN level is 88mg/dL; creatinine level is 2/8 mg/dL. the most likely dx is: a. prerenal azotemia b. acute glomerulonephritis c. tubular necrosis d. postrenal azotemia

d. postrenal azotemia

all of the following can cause an elevated PSA level except: a. prostate infection b. cystoscopy c. BPH d. prostatectomy

d. prostatectomy

all of the following are likely reported in a man with an initial episode of genital HSV-2 infection except: a. painful ulcer b. inguinal lymphadenopathy c. fever and body aches d. pustular lestions

d. pustular lestions

a 24 y/o presents with sudden onset of left-sided scrotal pain. he reports having intermittent unilateral testicular pain int he past but not as severe this current episode. confirmation of testicular torsion would include all of the following findings EXCEPT: a. unilateral loss of the cremasteric reflex b. the affected testicle held higher in the scrotum c. testicular swelling d. relief of pain with scrotal elevation

d. relief of pain with scrotal elevation

concerning herbal and nutritional txment for BPH tx, which of the following statements is FALSE? a. the mechanism of action of the most effective and best studied products is similar to prescription meds for this condition b. these tx are currently considered emerging tx by the American Urological Association c. major areas of concern with use of these tx include issues of product purity and quality control d. these tx are safest and most effective when used with RX meds

d. these tx are safest and most effective when used with RX meds

true or false. 28. Most prescribers are well-versed in the relative potency of ICS and prescribe an appropriate dose for the patient's clinical presentation. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

false

true or false. 29. Approximately 80% of the dose of an ICS is systemically absorbed. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

false

true or false. 30. A leukotriene modifier and an ICS are interchangeable clinically because both groups of medications have equivalent anti-inflammatory effect. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

false

true or false. 32. Due to safety concerns, mast cell stabilizers are no longer available. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

false

true or false. 36. Cigarette smokers should not receive the pneumococcal vaccine until 65 years of age. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 143). F.A. Davis Company. Kindle Edition.

false

true or false. 37. A 52-year-old immunocompetent patient with COPD who receives the pneumococcal vaccine should get revaccinated in 5 years. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 143). F.A. Davis Company. Kindle Edition.

false

Identify the following organisms as a grampositive, gram-negative, or atypical pathogen. 92. Haemophilus influenzae Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 153). F.A. Davis Company. Kindle Edition.

gram-negative

flat discoloration less than 1 cm in diameter

macule

raised lesion, larger than 1 cm, may be same or different color from the surrounding skin

plaque

true or false. 31. Little systemic absorption of mast cell stabilizers occurs with inhaled or intranasal use. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 135). F.A. Davis Company. Kindle Edition.

true

true or false. 34. Seasonal influenza vaccination is generally recommended for all persons over the age of 6 months. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 143). F.A. Davis Company. Kindle Edition.

true

true or false. 35. A 66-year-old woman is an acceptable candidate for the high-dose inactivated influenza vaccine shot. Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation (Page 143). F.A. Davis Company. Kindle Edition.

true

With an 8 am dose of the insulin glargine, followed by inadequate dietary intake or excessive energy use, at approximately what time would hypoglycemia occur?

would not

A covered entity as defined by the Privacy Rule includes: (yes or no) -hospitals

yes

A covered entity as defined by the Privacy Rule includes: (yes or no) -private healthcare insurance companies

yes

A covered entity as defined by the Privacy Rule includes: (yes or no) -medical assistants

yes

A covered entity as defined by the Privacy Rule includes: (yes or no) -nurse practitioners

yes

In order for an NP to be reimbursed by a third-party payer (Medicare, Medicaid, private insurance)... (yes or no) Is the clinician enrolled with the payer?

yes

In order for an NP to be reimbursed by a third-party payer (Medicare, Medicaid, private insurance)... (yes or no) Is the service covered by the patient's health plan or insurance?

yes

Indicate (yes or no) if eligible for Medicare: a 67 y.o man with multiple comorbidities and high income

yes

Indicate (yes or no) if eligible for Medicare: a 72 y.o permanent legal resident (non-U.S. citizen)

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