Questions 2

A patient's labs have resulted and show a creatinine of 1.0 and a potassium of 5.2. When looking at the patient's list of medications, which medication would the NP consider changing or holding? A. Furosemide 20mg Daily B. Diltiazem 30mg BID C. Acyclovir 200mg BID D. Losartan 50mg Daily

D. Angiotensin II Receptor Blockers can commonly cause hyperkalemia. Patients should have regular BMPs ordered to monitor for hyperkalemia.

A 3-year-old male presents for well child exam. When interviewing his mother about developmental milestones, the nurse practitioner knows what is a normal finding? A. Rides a tricycle with pedals B. Copies a triangle C. Dresses self D. Builds tower of 3-4 cubes

A A 3-year-old can ride a tricycle with pedals. A 6-7-year-old can copy a triangle. A 4-5-year-old can dress themself. An 18-month-old child builds towers of 3-4 cubes, a 3-year-old should build towers with 9-10 cubes

The FNP is reviewing lab work from a 2 year old well-child visit. Which lab finding would be a high priority for the FNP to treat? A) Lead Level greater than 45 mcg/dl B) Lead Level 0.4 mcg/dl C) Lead level 0.45 mcg/dl D) Lead level 2.0 mcg/dl

A A lead level of greater than 5 mcg/dl is considered unsafe. A lead level greater that 45 mcg/dl will need to be treated with chelation. Lead levels greater than 70 mcg/dl may cause significant neurological problems leading to coma

An NP who works in a rural community anticipates seeing a 10 year old child who is coming in for a well visit. The child has not been seen since he was 8 years old. Based on your knowledge of age appropriate screening, what lab would you anticipate ordering? A. Non-fasting Lipid Panel B. Complete Metabolic Panel C. Complete Blood Count D. Thyroid Stimulating Hormone

A A non fasting lipid screen is recommended for children between the age of 9 and 11 at least once. If risk factors are present then a fasting lipid screen would be recommended at an earlier age and again after age 12 if risk factors still present. This is due to cardiovascular disease risk and implementing changes at an early age. Hay, W. W., L

A 35-year-old, previously healthy, individual presents to the clinic with dyspnea, abrupt onset of fever, and cough with no sputum production. On examination of the patient, temperature is 101.0 F with inspiratory crackles heard on auscultation. Chest radiography confirms CAP. What is the most common pathogen and initial treatment for this individual in the outpatient setting with no concern given to resistance of antibiotics? a. S. pneumonia; Azithromycin b. M. pneumonia; Azithromycin c. S. pneumonia; Levaquin d. M. pneumonia; Levaquin

A According to Papadakis and McPhee, CAP is characterized by acute or subacute fever onset with dyspnea, and cough with or without sputum. Also, the patient can have other symptoms such as pleurisy, abdominal pain, fatigue, and etc. CAP can only be diagnosed with chest radiography or CT scan. The book reports S. pneumonia to be the most common cause of CAP. Papadakis and McPhee also state that the choice of antibiotic therapy is tailored to the incidence of resistance to S. pneumonia in the patient's area and whether the patient has taken an antibiotic recently. A macrolide, doxycycline, or amoxicillin is appropriate treatment in a low level of resistance area in a previously healthy individual.

A 44-year-old female, with a history of hyperlipidemia, is taking a moderate intensity statin daily to lower her cholesterol. She asks the Family Nurse Practitioner how much her statin medication will lower her cholesterol. Which response by the practitioner is true? A. "Your medication is estimated to lower your LDL levels by 30-50%" B. "This medication will fix your cholesterol problem completely" C. "Your medication can lower your LDL level by greater than 50%" D. "Your medication may lower your cholesterol by 10-15%

A Moderate intensity statins are estimated to decrease LDL levels by 30-50%. Statin medications alone can bring cholesterol levels back within a normal range in some instances, however, it is best achieved in combination with weight loss and dietary changes. Only PCSK9 inhibitors are known to reduce LDL levels beyond 50%. Moderate intensity statins lower LDL levels more than 10-15%, making choice D incorrect (Blaha & Baron, 2020, p.1280).

PEP exposure in Men who have sex with men should not be given after -------- hours? A. 72 B. 24 C. 48 D. 36

A PEP is not recommended if more than 72 hours have elapsed. PEP should also be taken for 28 days. The sooner the patient takes PEP the sooner, it effective.

A 45-year-old presents for a yearly evaluation. He has gained 20 pounds since his last visit, feels tired, and has daytime sleepiness. He admits that his wife started sleeping in a different room due to his snoring. Which of the following is the best option for treatment? a. sleep study b. marriage counseling c. total cholesterol d. follow-up in 1 month

A Patients with new onset of sleep apnea who are overweight should be encouraged to lose weight through diet and exercise first. Additionally, patients often benefit from diagnosing through sleep study and fitted properly for CPAP during sleep. (Chestnutt, p. 331)

You are examining a 13-year-old adolescent female in the clinic. Her height is increasing, and her breasts are beginning to grow. Her pubic hair is course, darker, and beginning to spread. By these physical exam findings, you know that she is in which Tanner Stage of development? a. Tanner Stage 3 b. Tanner Stage 4 c. Tanner Stage 2 d. Tanner Stage 1

A Tanner stage 3 in females is characterized by the pubic hair becoming more coarse and darker with spreading. The breasts and areola are growing at this time. The female growth spurt marks the beginning of pubertal development. Tanner stage 1 is prepubescent. Tanner stage 2 is characterized by fine pubic hair that is straight and sparse. Breast buds are beginning at this time. Tanner Stage 4 is characterized by pubic hair that resembles an adult's, but hair is limited in area. The nipple and areola form individual mounds. Tanner Stage 5 is adult appearance. Pubic hair is in an inverted triangle pattern. The areola and breast rejoin, and breast development is finished (pg 107).

In pregnancy, when should the Tdap vaccine be administered? A. Between 27 - 36 weeks of pregnancy B. The 1st trimester of pregnancy C. Anytime during pregnancy D. Postpartum

A The Tdap vaccination should be given between 27 & 36 weeks to enable maternal antibodies to form and then cross the placenta to the newborn before birth. The other answers' timings are inaccurate. Papadakis, M., McPhee, S., & Rabow, M. (2019). Obstetrics & obstetric disorders. In Current medical diagnosis and treatment 2020 (59th ed., p. 820). McGraw-Hill Education / Medical.

Jason, a 17-year-old male patient, presents with his mother who is demanding that the NP perform a drug test on him in the office "right now". She further explains that her marijuana edibles have recently gone missing, she wants to make sure that Jason didn't take them. The NP should do all of the following EXCEPT: a. immediately collect a urine sample from Jason to see if he ate them b. Explain to Jason's mother that testing him at her request would be a violation of the patient/NP relationship c. Excuse Jason's mother from the room and privately have a frank discussion with him about drug use d. Obtain informed consent from Jason to do the drug testing

A The healthcare provider's role is to provide education and counseling to the patient and family NOT law enforcement in the form of detection of substances. He may consent to provide a sample for testing but should first privately be given all information to provide informed consent. For all we know he has nothing to do with the disappearance of the marijuana and would like to prove it. Should the NP force the collection of the test against his wishes, the relationship would be forever damaged, and Jason would no longer trust the provider. The American Academy of Pediatrics position is that parental request and consent for drug testing does not justify involuntary drug testing of a competent adolescent patient. He should be provided with education about drug use as a form of health promotion.

A mother of a 6-month-old states that she is concerned that her daughter is not crawling yet. As the NP, what should you tell the mother? a. Do not be concerned, most children do not start crawling until 9 months old. b. Do not be concerned, most children do not start crawling until 12 months old. c. She is behind and should be crawling, we will refer her to physical therapy. d. She is behind and should be crawling, we will reevaluate in 1 month.

A The mother should not be concerned, and no referral is needed at this time. Children should sit independently by 6 months old and start crawling at 9 months old.

A 63 year old male presents to the clinic with complaints of shortness of breath at rest, chills, 100.8F fever, fatigue, and productive cough with yellow sputum for 4 days. He reports no allergies, comorbid conditions, exposure to a child in daycare, or antibiotic use within the past 90 days. Lung auscultation revealed inspiratory crackles in left lower lobe. The patient is alert and oriented, respiratory rate is 33 breaths per minute, blood pressure is 126/86, BUN is 22 mg/dL. Considering his CURB-65 score for pneumonia severity, the nurse practitioner chooses: a) Outpatient treatment with oral azithromycin for 5 days b) Outpatient treatment with oral levofloxacin for 3 days c) Referral for inpatient treatment with intravenous antibiotics d) Watchful waiting with no antibiotics and follow up in 72 hours

A The patient's CURB-65 score is 1 due to increased respiratory rate, which allows to treat pneumonia in the outpatient setting. Although oral levofloxacin can be used in the outpatient setting, it is not indicated because the patient is not at risk for drug resistance (he is yonder than 65 with no comorbid conditions, denies exposure to a child in daycare or antibiotic use within 90 days). Additionally, 3 days course of levofloxacin is not sufficient - according to Infectious Diseases Society of America/American Thoracic Society guidelines, minimum of 5 days of antibiotic therapy is recommended for treating community acquired pneumonia. Inpatient treatment should be considered for CURB-65 score > 2. Watchful waiting is not indicated due to symptoms of bacterial infection.

A 27-year-old female arrives in your clinic with complaints of abnormal vaginal discharge that has a "fishy odor, vaginal itching, and an increase in pelvic pain and discomfort." After completing a vaginosis panel, you confirm the diagnosis of bacterial vaginosis. What is the most appropriate treatment? a. Metronidazole 500mg PO BID for 7 days b. Azithromycin 900mg PO daily for 10 days c. Metronidazole 1000mg PO for 5 days d. Ceftriaxone 1000mg IM

A The recommended treatment for bacterial vaginosis is metronidazole 500mg twice a day for seven days. A clindamycin vaginal cream of 5g daily for 7 days can be used. An alternative treatment can include clindamycin 300mg BID for 7 days

A 46-year-old male presents to the clinic for his wellness visit. He has an elevated blood pressure reading of 150/80. His medication list includes Lisinopril 10mg daily. Which of the following is the most appropriate initial intervention? A.) Assess medication adherence B.) Increase Lisinopril to 20mg daily C.) Prescribe Hydrochlorothiazide 12.5mg daily for dual therapy D.) Follow-up in one week with a home blood pressure monitoring log

A There is an alarmingly high incidence of patients who do not take their antihypertensive medications appropriately. Before changing therapies, make sure patients are taking their medications as prescribed. The NP can increase medication compliance by prescribing once daily pills, using combination pills vs. multiple pills, education, and home BP monitoring. The NP may add dual antihypertensive therapy, increase the antihypertensive dosage, and/or follow up with home blood pressure readings. However, the NP must first assess compliance with the current regimen

A 2-year-old presents to your rural clinic with mother complaining of child being more tired with this stomach virus than he has with other childhood viruses. He has been holding his stomach and crying, has decrease in the number of wet diapers and mom reports bloody diarrhea. The child lives on a dairy farm and mom and dad are not sick. Mom states there have not been any dietary changes, they eat local and drink unpasteurized milk from their cows. Physical exam reveals a pallor, afebrile 2-year-old that is irritable with abdominal tenderness and bloody stool in his diaper. Vital signs are normal, and he is 11.5kg. Urine dipstick reveals hematuria and proteinuria. You suspect this diarrhea is Shiga toxic E. Coli from unpasteurized milk, so you send a stool culture. Which of the following is the most appropriate next step? A. Send the patient to the hospital B. Treat empirically with azithromycin 138mg on day 1 and 69 mg days 2-5 C. Initiate outpatient gastroenterology referral while awaiting stool culture D. Have mom push PO fluids and stop giving unpasteurized milk

A This kid is SICK- get him out of your clinic and to a hospital! He is experiencing hemolytic-uremic syndrome caused by the Shiga toxin found in ingesting unpasteurized foods and found in undercooked meat. Bloody diarrhea is often the presenting sign followed by hemolysis, thrombocytopenia, and renal failure. Patient already shows proteinuria, hematuria, and oliguria so his kidneys are already being damaged. Approximately 50% of these children will require dialysis. Azithromycin is not the appropriate antibiotic choice, GI is not the appropriate specialist, mom is not going to be able to correct this with PO fluids, but yes, she needs to stop with the unpasteurized milk

A 67 yo female presents to the clinic today for well woman. 1 year ago her Dual-energy x-ray absorptiometry (DXA) scan score was -2.1. When should this test be repeated? A. At this visit B. In 2 years C. In 3 years D. In 5 years

A Surveillance (DXA) is recommended for elderly men and postmenopausal women according to their T scores: every 5 years for T scores -1.0 to -1.5, every 3-5 years for scores -1.5 to -2.0 1-2 years for scores under -2.0

What labs need to be monitored in a transexual male using testosterone therapy? A. White Blood Cells B. Hemoglobin and Hematocrit C. Red Blood Cells D. Platelets

B 42-04, Hemoglobin and Hematocrit should be monitored. If elevated, testosterone needs to be decreased or changed to a patch or weekly injections.

A 3-year-old should be able to complete which of the following tasks correctly? a. Stand on 1 leg without losing balance b. Copy a circle c. Skip smoothly d. Copy a triangle

B A 3-year-old should be able to copy a circle. A 4- or 5-year-old should be able to stand on 1 leg without losing balance. A 5- or 6-year-old should be able to skip smoothly and copy a triangle.

A 16-year-old female presents for a wellness exam. Her mother has prepared her to undergo her first pelvic exam with Pap smear and she is very nervous. She denies any abdominal pain, vaginal discharge, sexual contact, and her periods are regular and do not bother her. The NP should: a. Ask the teen to remove her clothes and provide a drape in preparation for a pelvic exam. b. Allay the teen's anxiety as early as possible in the visit by explaining that a pelvic exam is not a part of her visit today as she does not have any complaints and does not need Pap screening until age 21. c. Explain to the teen that the pelvic exam with Pap smear and HPV testing is an important part of screening for women. d. She needs an exam for wellness purposes despite absence of genitourinary and menstrual concerns

B A pelvic exam in the teen is indicated with any concerns about pelvic or abdominal pain/mass, menstrual concerns, or vaginal discharge. Papanicolaou screening begins at age 21 regardless of sexual activity as the risk of adverse events related to screening follow up outweighs the risk of cancer in this age group. HPV testing begins at age 30 according to the American College of Obstetrics and Gynecology (ACOG). The only exception is for the HIV positive teen who should be screened for HPV within one year of starting sexual activity.

An 11-year-old male comes to the clinic for a wellness visit. According to AAP, which of the following screening guidelines is not indicated for this child? A: Non-fasting lipid screening B. Depression screening C. Substance abuse screening D. Tobacco use screening

B According to AAP, depression screening is recommended starting at 12 years old. The PHQ2 tool is used for screening. Universal non-fasting lipid screening is indicated between ages 9 to 11 years old. Fasting lipid screening would occur between ages 12-17 if there was a new family history, a parent with dyslipidemia, or other high-risk factors/high risk condition was present. Substance abuse screening is first utilized for 11-year old's using the CRAFFT tool. Tobacco use screening begins at age 11.

A 21-year-old female patient comes to your clinic for an acute visit. She has a history of asthma and is prescribed an albuterol rescue inhaler as needed. Her chief complaint is increased shortness of breath and wheezing requiring her to use her albuterol inhaler 3-4 days out of a week for a few months. She admits that the shortness of breath wakes her from sleep once or twice a month. She is not in distress in the clinic and her lungs are clear to auscultation. Which of the following is the next best course of treatment for this patient? A. No change; tell her to continue using her albuterol as needed B. Add a low dose inhaled corticosteroid like Budesonide to use once daily C. Prescribe oral corticosteroids and a leukotriene modifier like Montelukast D: Refer to pulmonology

B Adding a low dose inhaled corticosteroid is the best treatment plan because of the patient's complaints. She now has mild persistent asthma as evident from her waking at night a few days a month and using her albuterol inhaler 3-4 days a week. A is wrong because she needs a change in treatment as her current course is not effective. C is wrong as guidelines dictate stepping up one treatment regime at a time based on her symptoms. D may be right but is not the most correct as she can be treated in the family practice setting. She may require referral if symptoms continue or worsen.

For a patient with pre-hypertension, all of the following are appropriate lifestyle modifications except: A.) Increasing dietary potassium B.) Limiting alcohol consumption to three equivalent drinks per day C.) Decreasing dietary sodium D.) Tobacco cessation

B Alcohol consumption should be limited to two drinks per day for men and one drink per day for women. The DASH diet recommends decreasing dietary sodium and increasing dietary potassium. Tobacco cessation decreases risk for cardiovascular events.

A 17-year-old female presents to the clinic for a wellness exam. After excusing the mother from the room the teen discloses that she has been experiencing vaginal pain and greenish discharge after recently becoming sexually active. She does not want her mother to know. The NP understands that in relation to STI (sexually transmitted infection) testing and treatment the teen: a. Cannot keep this information from her parents as she is a minor b. Has the legal right in every state to consent to STI related care without parental consent c. Cannot be treated in the clinic and must be referred to an OB/GYN d. Should not be sexually active as abstinence is the best method to prevent pregnancy and STI's

B All states have variation in the regulations that govern the teen and reproductive care but all allow for STI care with teen consent. Some states allow the provider, but do not require, notification of a parent. Some states have a minimum age of consent. It is important for the NP know the regulations that affect their practice environment. Data is accessible through the Guttmacher Institute, cited in the text.

A healthy 51-year-old male presents to your clinic for his annual wellness exam. He has no concerns or complaints. Upon examination, you auscultate a systolic murmur in the 2nd right intercostal space preceded by an ejection click. It is harsh-sounding and you are also able to hear it radiate into the carotid artery. What valvular disorder do you suspect? a. Mitral regurgitation b. Aortic Stenosis c. Aortic Reguritation d. Mitral Valve Prolapse

B Aortic stenosis is defined as narrowing of the aortic valve. This murmur is rough/harsh-sounding and occurs after s1 but stops before s2, classifying it a systolic murmur. It commonly is transmitted to the carotid arteries. The murmur heard with mitral regurgitation is systolic but has more of a blowing, highpitched sound and does not have the ejection click. It commonly radiates to the left axilla. The Aortic regurgitation mumur is a faint diastolic murmur heard best at the left sternal border. MVP is uncommon in this age group and midsystolic click is usually what is heard on auscultation

Which is an example of primary prevention in women's health? A. DEXA Scan B. Gardasil 9 C. PAP smear D. Lumpectomy (partial mastectomy) after a cancerous mass found in the right breasT

B B Gardasil 9 vaccine. There are three levels of preventative health: primary, secondary, and tertiary. Primary prevention focuses on preventing disease before it occurs and evaluating your patient for risk factors, including routine immunizations. Secondary prevention focuses on identifying disease in its earlier states through screening such as the DEXA scan, mammogram, colonoscopy, PAP smears, low-dose CT, CVD, DM, etc. The goal of tertiary prevention is to focus on the difficulties of the disease process and minimize the effects of the established disease. Examples of tertiary prevention include cardiac and stroke rehabilitation and managing chronic disease (diabetes mellitus, depression, congestive heart failure, etc.).

In the absence of conditions such as congenital heart disease, at what age does routine preventative blood pressure screening begin during a well child visit? A. 5 years B. 3 years C. 4 years D. 2 years

B Blood pressure screening at well child visits start at age 3 years old unless child presents with conditions such as: congenital heart disease that may need earlier monitoring.

Which statement by the FNP demonstrates understanding of blood pressure screening in the pediatric patient? A) It's appropriate to begin BP screenings at the 2 year well-child visit. B) A child who presents at his 3 year well-child visit will begin to have BP screenings. C) Blood pressure screenings are started at puberty. D) The FNP will start blood pressure screenings at the 5 year well-child visit

B Blood pressure screening starts at age 3 in well-child visits. Blood pressure monitoring may be done at a earlier age for certain conditions such as prematurity, congenital heart disease, recurrent UTIs, renal disease, organ and bone marrow transplant, neurofibromatosis and increase intracranial pressure.

A 72-year-old male is scheduled to follow up at your Family Clinic to discuss his lipid panel results. Upon review, the lipid panel revealed a total cholesterol of 180 and a LDL level of 98. The patient is already taking Atorvastatin 80mg daily and has maintained a low-fat diet. He has a past medical history of hypertension, hyperlipidemia, stable angina, and osteoporosis. Which action is the most appropriate for this patient? A. Continue low-fat diet and recheck Lipid Panel in 1 month B. Prescribe Ezetimibe (Zetia) 10mg by mouth daily C. Nothing, these results are normal D. Prescribe Fenofibrate (Tricor) 145mg by mouth daily

B Ezetimibe (Zetia) is recommended as next step therapy for patients already on high intensity statins, diagnosed with clinical ASCVD, in order to obtain a LDL level of <70. As indicated in the question, the patient has already maintained a low-fat diet and has been unable to reach target LDL of <70 with this intervention. The lipid results listed above in this question may be acceptable for some patients but not in those with clinical ASCVD, the goal is to have LDL of <70. Fenofibrate should not be the first choice for this patient due to its sparse effects on LDL (Blaha & Baron, 2020, p.1284).

In treating asthma, which statement about the use of inhaled corticosteroids (ICSs) is true? a) ICSs are contraindicated if a patient already uses long acting beta agonists (LABAs) b) ICSs are considered first line therapy for patients with persistent asthma c) The maximum response to ICSs is normally observed right away d) If a patient is complaint with mouth rinsing after ICSs for prevention of local and systemic effects, the use of an inhalation chamber is no necessary

B ICSs are not contraindicated if a patient uses LABAs. Moreover, many inhalers combine ICS and LABA agents for convenient control of persistent asthma. It usually takes several months to observe the maximum response to ICSs. The best protection against local side effects, such as oral candidiasis and cough, and systemic side effects, such as osteoporosis and skin thinning, is mouth washing after using ICSs and the use of an inhalation chamber.

A 65-year-old male comes in coughing, and you notice his thick, tan sputum. His nailbeds are cyanotic with clubbing, he has 2+ edema bilaterally, and he's rhonchus on auscultation. On chart review, his BMI is 48, HGB 18, and paCO2 is 55. What pulmonary disorder and ventilation-perfusion results would you suspect? a. Bronchitis (Blue Bloater); Increase V/Q areas to low perfusion b. Bronchitis (Blue Bloater); Increase perfusion to low V/Q areas c. Emphysema (Pink Puffer); Low V/Q perfusion to low ventilation d. Emphysema (Pink Puffer); High ventilation to high V/Q areas

B In the advanced stages of COPD; patients often suffer from bronchitis and/or emphysema. Based on the above signs, symptoms and labs, this patient has bronchitis. In bronchitis, patients tend to have a chronic productive cough, higher concentrated hemoglobin, elevated CO2 levels, and are often overweight. On diagnostic testing, these patients have increase perfusion to low V/Q area in comparison to those with emphysema who have increased ventilation to high V/Q area due to dead space.

A 52-year-old male presents to the clinic with complaint of increased shortness of breath the past couple of months. He reports a smoke history of 30 years with a ½ pack per day. He says that the dyspnea is now with minimal exertion. He must sleep in his recliner in order to rest. CXR in clinic shows flattening of the diaphragm. Oxygen saturation at rest is 96% on room air with post exertion dropping to 92%. Which of the following should be a priority in his treatment plan for COPD? a. Exercise regimen b. Smoking cessation c. Oxygen therapy d. Theophylline

B Papadakis and McPhee explain that COPD is a progressive disease that starts out with exertional dyspnea that progresses to dyspnea at rest. Smoking cessation in an ambulatory patient is key in treating COPD. The book also includes oxygen therapy for a patient that has resting hypoxemia. Bronchodilators are also first line in treatment of COPD. Corticosteroids are helpful but are not considered first line. Theophylline is used as a fourth line treatment when bronchodilators have failed.

A 23-year-old female presents to the clinic with complaints of severe lower quadrant abdominal pain that started suddenly two days ago that does not radiate anywhere. She states her last menstrual cycle was about two weeks ago but was shorter than usual and had only spotting for a few days. She has taken a home pregnancy test that was positive yesterday. She was seen in urgent care recently for the pain and was told her serum HCG was lower than expected for her estimated gestation. What is the expected clinical diagnosis for this patient? a. Missed abortion b. Ectopic pregnancy c. Urinary tract infection d. Pelvic inflammatory disease

B Patients with ectopic pregnancies have a tendency to present with adnexal pelvic pain that has sudden onset and does not radiate anywhere. Patients also experience abnormal menstrual cycles with amenorrhea, irregular bleeding or spotting. The serum HCG levels are commonly lower than expected in comparison of pregnancies within the same duration. The serum levels do not double as expected every 48 hours. Page 823.

A 32-year-old female patient is 28 weeks pregnant and presenting with persistent headaches not relieved with over the counter medications such as Tylenol, and episodes of blurred vision. Her blood pressure in the office today is 164/112. Her recent blood work showed a platelet count of 90,000. What stage of preeclampsia/eclampsia would be appropriate to diagnose this patient with? a. Preeclampsia without severe features b. Preeclampsia with severe features c. Eclampsia d. HELLP syndrome

B Preeclampsia without severe features presents with a diastolic pressure less than 110, and a platelet count above 100,000 with no visual changes. Preeclampsia with severe features presents with headache and vision changes, blood pressures above 160/110, and thrombocytopenia. Eclampsia is defined by the occurrence of seizures with other findings of preeclampsia. HELLP syndrome presents with hemolysis, elevated LFTs, and low platelets. Page 826.

A 13-year-old female presents to your office with her mother with complaints of painful periods. She reports menarche 1 year ago with new onset of the pain. She reports mild lower abdominal cramps that radiate to her lower back and thighs with associated nausea and diarrhea. She denies ever being sexually active. She is diagnosed with primary dysmenorrhea. What should be your next course of action? A. Begin an oral contraceptive B. Start menstrual calendar and NSAIDs 1-2 days before menses or at the onset of menses if unpredictable C. Start a 7 day course of Flagyl for probable infection D. Order a pelvic ultrasound for evaluation

B Primary dysmenorrhea or pain with menses is the most common gynecological complaint with adolescent females. It is from excessive amounts of prostaglandin that cause uterine contractions, hypoxia, and ischemia. Primary dysmenorrhea does not start until 1-2 years after menarche when cycles are more regular. For mild, you want to keep a menstrual calendar and NSAIDs. For moderate to severe, NSAIDs and oral contraceptives are treatment to suppress ovulation. Start with NSAIDs with this patient, then potentially oral contraceptives. Antibiotics are inappropriate, and pelvic ultrasound would not be warranted at this time

Patient with triglyceride levels above 1000 mg/dL are at risk for which of the following? A) Diverticulitis B) Pancreatitis C) Esophagitis D) Early Death

B The reason for this is unclear, however the risk may be related to levels following a fatty meal. These levels do not necessarily cause early death but they may contribute, neither esophagitis nor diverticulitis are closely related.

A 75 year old female presents today to establish care at your Internal Medicine clinic. She has a history of hypercholesterolemia and has taken Ezetimibe 10 mg po daily for many years due to statin intolerance. Which of the following is the most common symptom associated with statin intolerance? A. Headache B. Muscle aches C. Diarrhea D. Depressed Mood

B Statins are usually well tolerated but up to 10% of patients report muscle aches which often leads to non-compliance. Muscle Aches are more likely when the patient also takes anti-fungals or erythromycin. Other risks of statins include a 10% increase risk for development of diabetes mellitus.

You have prescribed Amlodipine to your male patient with hypertension. What common side effect should you be mindful of? A- Cough B- Peripheral edema C- Hypokalemia D- Gynecomastia

B The most common side effects of calcium channel blockers include peripheral edema, constipation, headache & bradycardia. Cough is a side effect related to ace inhibitors. Hypokalemia is a side effect of loop diuretics. Gynecomastia can be caused by spironolactone.

Jeff, a 65-year-old male, presents to the clinic for evaluation of a productive cough, and shortness of breath with exertion increasing over the last 2 weeks. VS are 140/89, 99, 20, O2 sats 95%. PMHX is HTN, Obesity, and a 1 pack a day smoker for over 25 years. What is the most likely diagnosis that a novice NP would anticipate? A: CHF B: COPD C: Pneumonia D: Covid

B The most important factor contributing to COPD is the patient's history of cigarette smoking. Pneumonia and covid may present with the same symptoms but also include fever and malaise. CHF would also present with orthopnea and peripheral edema.

You are seeing a 35-year-old female patient in clinic who is wanting to be started on oral contraception. ShE tells you that she is a current tobacco smoker (2 packs/day) and has been diagnosed with high blood pressure in the past and is currently being treated. What is your response to this patient? a. "I would be glad to start you on some oral contraception pills. Do you have a certain medication in mind?" b. "Based on your age and current use of tobacco, it is contraindicated to start you on oral contraception at this time. We can look into other methods of birth control that are better suited for you."* c. "Because of your history of high blood pressure and cigarette use, we can't start you on any pills today." d. "I think it is a great idea to get you started on some oral contraception, but you are at an increased risk for stroke and blood clots based on your age and history. It would be best to use a monophasic option."

B The patients age and current tobacco use are absolute contraindications to starting oral contraception. Her current history of high blood pressure, which is currently controlled is a relative contraindication. Other absolute contraindications include: pregnancy, hx of stroke, undiagnosed vaginal bleeding, uncontrolled HTN, estrogen-dependent cancers, migraines with aura, surgery with prolonged immobilization, and known thrombophilia.

A 23-year-old male patient comes to the clinic for his annual wellness exam. You note he has a history of asthma and ask how often he uses his Albuterol inhaler and how asthma effects his everyday life. He reports having symptoms once a week that require him to use his inhaler but denies asthma interfering with any normal daily activities or causing him any sleep disturbances. As an NP, you know these findings would indicate the severity of his asthma is? A. Persistent Mild B. Intermittent C. Persistent Severe D. Persistent Moderate

B The step-wise approach is used to assist the advance practice provider in diagnosing the severity of a patients asthma. This approach assesses both impairment and risk by having the patient recall symptomatic prevalence within the last 2-4 weeks. An asthma patient with symptoms less than or equal to 2 days/week, SABA use less than or equal to 2 days/week, sleep disturbances less than or equal to 2 nights a month, with no interference to normal daily activities would be diagnosed as having intermittent severity.

Which of the following medications should be avoided in a patient with heart failure? a. Amlodipine b. Pioglitazone c. Felodipine d. Acetaminophen

B Thiazolidinediones, nonsteroidal anti-inflammatory, cyclooxygenase-2 inhibitors, and calcium channel blockers except for amlodipine and felodipine can cause heart failure to worsen. NSAIDS and cyclooxygenase-2 inhibitors both can cause sodium and water retention and renal impairment

2. A 51-year-old female, current smoker with: • a 30-pack year history • a family history of breast cancer • and well controlled type 2 diabetes mellitus is seeking advice from her NP regarding her healthcare. The NP counsels that the single most important primary prevention step this woman can take is: A. an annual mammogram as she has a family history of breast cancer B. smoking cessation as smoking contributes to cardiovascular disease, pulmonary disease, and cancer C. an annual low dose CT as lung cancer is the leading cause of cancer death in women D. an evaluation of her A1C every six months as uncontrolled DM can cause heart disease, kidney damage, and vision loss

B This question asks for counseling regarding primary prevention. The only answer that is appropriate is (b.) smoking cessation. It is true that this patient needs annual mammograms, annual low dose CT screening, and an A1C check every six months, however these answers are secondary prevention screenings.

A 3-day old infant presents with his mother to the clinic after hospital discharge. You notice a visible jaundice appearance on initial presentation. The mother states he was under phototherapy for 24 hours while in the hospital. You as the FNP have the infant's total serum bilirubin drawn, which results at 12 mg/dL. Which level of risk zone does this infant fall into? A. Low-risk zone B. Low-intermediate-risk zone C. High-intermediate-risk zone D. High-risk zone

B Visible jaundice is a common occurrence that develops in over 65% of newborns within the first week of life. Common factors related to development of physiologic jaundice include breastfeeding, lack of post discharge follow up, failure in recognizing hemolysis, and delayed measurement of total serum bilirubin. Peak bilirubin levels occur between days 3-5 of age, normally no higher than 15 mg/dL. Hyperbilirubinemia outside of these ranges is not physiologic and should prompt further workup.

An African American Male comes into the clinic for a yearly wellness exam. His blood pressure this visit is 150/95. The patient states that he takes his blood pressure daily at home and it has been elevated recently. When considering medications for treating hypertension in this patient, the NP knows that which medication may not be as effective for this patient? A. Metoprolol 25mg BID B. Amlodipine 10mg Daily C. Lisinopril 10mg Daily D. Hydralazine 25mg BID

C ACE inhibitors are less effective in the African American population and in the elderly. Higher dosages are usually required to achieve blood pressure control.

A 16-year-old female presents to your clinic alone requesting birth control. She reports being sexually active with one partner. She denies a history of blood clots, cancer, migraines, or HTN. All the following are appropriate next course of action except: A. Urine pregnancy test B. Ask about the 5 Ps: partners, practices, protection from STIs, past history of STIs, and prevention of pregnancy C. Ask to call her mother for consent to be seen today D. Discuss contraceptive options and methods

C According to the CDC, nearly 40% of high schoolers have had sexual intercourse. Concern of confidentiality is a reason adolescents delay being seen for contraceptives. Contraceptive counseling should include discussions of confidentiality, STI prevention and testing, and methods. Absolute contraindications to combination oral contraceptives are pregnancy, HTN, migraines with aura, current breast cancer, history of blood clots.

A 5-day old newborn presents to your office with his parents. As first-time parents their concerns were addressed regarding breastfeeding, urinating, and bowel movements. The mother states he has been having 6-8 wet diapers with 3 yellow, seedy stools a day. As the FNP for the newborn infant you respond with what education? A. 5-day old infants should be having about 10 wet diapers daily at this age B. Baby is having too many wet diapers, let's cut back on our feeding schedule C. Baby is urinating and passing stool appropriately for this age D. Baby's stools should be brown and soft at this age

C At day 5 for the newborn infant, baby should have 6-8 wet diapers daily consisting of colorless or light-yellow urine. Baby should also be having 3-4 yellow seedy stools daily. At this stage in the feeding routine, baby should continue feeding at least 8-12 times a day either formula or breastmilk. Baby is on schedule for his age and parents should be reassured.

A 67yo Caucasian female presents for follow-up on her DEXA scan results. She brings her results in which reveal a T score of -1.2. What is your interpretation of these results? A. The results are expected and reveal an average bone mineral density in this population. B. The patient has severe osteoporosis and is at a higher of fractures C. The patient has osteopenia D. The results are indicative of severe osteoporosis and indicate further evaluation is necessary.

C C. A DEXA scan (secondary prevention) is a screening tool for calculating osteoporosis risk. The two most significant risk factors for developing a fracture related to osteoporotic changes are age and female gender. Screening recommendations are encouraged for women >= 65 and men >=70 yo with the option to screen between 50-59yo if risk factors are present. Patients with a T score between -1.0 and -2.5 indicate osteopenia. T-scores of -2.5 or lower indicate osteoporosis

A 55-year male comes in wheezing, with a dry cough, respiratory rate 35 bpm, and nasal flaring. He is alert and oriented but appears irritable. For 3 days, he has had chest tightness, shortness of breath at rest, and having to take pauses when using simple words. What type of pulmonary disorder and level of severity is this patient experiencing? a. Asthma exacerbation, Respiratory Arrest Imminent b. COPD, Severe Exacerbation c. *Asthma, Severe Exacerbation d. COPD, Moderate Exacerbation

C COPD and Asthma symptoms are often similar, however there are a few things that sets them apart. The pulmonary disorder this patient is experiencing is a Severe Asthma Exacerbation. COPD can be ruled out because the patient has a dry cough. Patients with COPD are more likely to have a productive cough. The level of severity is distinguishable (severe from imminent respiratory arrest) based on the fact that the patient is still awake, alert, and oriented, able to lie flat but being upright is better, and wheezing is still present. In an imminent arrest, there will be no wheezing, patient will be slightly confused, and probably won't be able to hold a conversation. Remember, this patient is still communicating with you!!

A thoughtful clinician would consider Euthyroid Sick Syndrome in which patient: A. low serum FT4 with a serum TSH that is elevated B. normal serum FT4 with a serum TSH that is not elevated C. low serum FT4 with a serum TSH that is not elevated D. high serum FT4 with a serum TSH that is not elevated

C Euthyroid sick syndrome have a low serum FT4 with a serum TSH that is not elevated. Seen in patients with major surgery, caloric deprivation, or severe illness.

A 24-year-old woman presents to the clinic for a yearly well-person exam. During the health history, the patient states she is bisexual. The NP knows this patient is at increased risk for all the following health disparities EXCEPT: a. Childhood physical and sexual abuse b. Cardiovascular disease c. Lower than average body mass index d. Depression

C Lesbian and bisexual women are at an increased risk for health disparities compared to heterosexual women. These health disparities include, but are not limited to, childhood physical and sexual abuse, substance abuse, depression, sexual assault, cardiovascular disease, high body mass index, chlamydial infections as a teen and young adult, disabilities, asthma, and other types of violence and threats outside the home.

A 16-year-old female comes to the clinic with a complaint of irregular menstrual cycles for the last four months. Upon assessment it is noted that the patients BMI is 30 and she has a dark, velvety skin patch noted to her neck. What diagnosis does the NP suspect is causing this patient's irregular menstrual cycle? A. Ovarian Cyst B. Premenstrual Dysphoric Disorder C. Polycystic Ovary Syndrome D. Abnormal Uterine Bleeding

C PCOS typically affects females who are overweight or obese. There is a strong relationship between PCOS and insulin resistance further increasing the risk of type 2 diabetes mellitus. The dark, velvety skin in the patient's neck region is also known as acanthosis nigricans which correlates with type 2 diabetes mellitus. PCOS patients can also present with hirsutism and moderate to severe acne. PCOS patients are also at risk for cardiovascular disease including dyslipidemia, obstructive sleep apnea, fatty liver disease, anxiety, depression, low self-esteem, infertility issues, and endometrial cancer. An ovarian cyst can cause an irregularity in menstrual cycles, pelvic pain, or a patient could be asymptomatic. Premenstrual dysphoric disorder is a severe form of premenstrual syndrome (PMS) and includes physical and psychological symptoms present in the final week before menses starts but does not include irregularities in the menstrual cycle. Abnormal uterine bleeding is excessive bleeding during the menstrual cycle for longer than 7 days and typically a history of bleeding disorders is present

The next step in confirmation of COPD, the NP would order which test? A: CXR B: PFTs C: High-resolution CT scan D: ABG

C The most definitive test for COPD would be a high-resolution CT scan. The CXR or plain films are insensitive to diagnosing. ABG's are more common in severe COPD exacerbations. PFTs are a useful tool to measure airflow limitations.

Melissa, a 17-year-old female, presents to clinic with complaints of a thick, white vaginal discharge, dysuria and dyspareunia. She reports having unprotected sex with her boyfriend 2 weeks ago. Upon a pelvic examination, you assess a thick white discharge along with bleeding with swabbing of her cervical os. Upon viewing wet prep slide, the smear is negative for clue cells or trichomonads, however, white blood cell count is 9+. You next best course of action should include; A) Discharge Melissa home as she has a yeast infection; encourage her to purchase OTC Monistat-7 for symptom relief B) Treat Melissa for Bacterial Vaginosis with Metronidazole 500 mg PO BID X 7 day C) Complete full STI panel including NAAT for N. gonorrhoeae and C. trachomatis and serological testing for HIV, RPR. Treat her empirically with Azithromycin 1 gm PO X 1 and Rocephin 250 mg IM X 1. D) Educate Melissa on proper hygiene and advise her to be sure to wipe from front to back as you believe she has a UTI and provide her prescription for Macrobid X 5 days

C Treatment for Chlamydia and Gonorrhea is recommended as patient is symptomatic; co-infection is likely with Cervicitis.

The nurse practitioner knows that the most effective approach to preventing mortality in the adolescent aged 15-19 includes: a. encouraging regular cancer screenings b. Monitoring lipid and glycosylated hemoglobin levels annually c. Ensuring the patient has access to resources that address mental health, making choices that contribute to physical safety, and substance abuse. d. Maintaining a healthy BMI

C The three leading causes of mortality in adolescents aged 15-19 include unintentional injury, homicide, and suicide

A three day old infant presents for her first newborn wellness visit. The infant was born at 39 weeks' gestation via vaginal delivery and was discharged from the hospital just after 24 hours of life. The vital signs on arrival are Temp 100.5, HR 155, RR 88. On assessment the infant is retracting and grunting. As the NP you tell the parents: A. This is transitional tachypnea, put the infant skin-to-skin and it will resolve B. The infant most likely aspirated breast milk and needs a chest x-ray C. The vital signs and assessment findings are signs of infection in the newborn, your baby needs to be taken to the children's hospital emergency room right away D. We need to check a blood sugar to see if your baby is hypoglycemic

C signs of late-onset sepsis include respiratory distress and fever. The infant should be admitted to the hospital for blood cultures and CSF and IV antibiotics

A 6-year-old female presents for a well child exam. She has been previously diagnosed with attention-deficit disorder, inattention type. As the nurse practitioner, you know what is an example of inattention? A. Unable to sit still in a seat B. Has difficulty waiting her turn in line C. Does not seem to listen when directly spoken to D. Runs around in inappropriate situations

C unable to sit still in a seat, having difficulty waiting for turn in line, and running around in inappropriate situations are examples of hyperactivity and impulsivity. Not seeming to listen when directly spoken to is an example of inattention.

A 66-year-old male is being seen for a wellness exam. He is new to your clinic and states he has been without a primary care provider for many years. He has a medical history of hypertension and is a 45 pack year smoker. During his history, he admits to intermittent coughing and some shortness of breath for "a long time." After educating on the importance and benefits of smoking cessation, what form of screening would be most effective for lung cancer screening? A. One view chest X-ray B. Lung sputum culture C. Bronchoscopy D. Low dose chest CT scan

D A one view x-ray does not provide the best lung cancer screening. Lung sputum culture is indicated for infectious etiology of respiratory illness. Bronchoscopy is an invasive procedure and is not first line screening. A low dose chest CT to screen for lung cancer has been recommended by the US Preventive Services Task Force since 2013 for high-risk individuals.

The strongest predisposing factor of asthma is? A. Obesity B. Smoking C. RSV during infancy D. Atopy

D Atopy is a genetic immune response that predisposes a patient to allergic diseases. This causes the body to produce immunoglobulin E (IgE), which responds to the environmental substances that may trigger an allergic response. Common conditions related to atopy include asthma, allergic rhinitis, and eczema.

An 11-year-old adolescent male presents to the clinic for a well-visit prior to school starting back. His BMI is at the 90th percentile for his age. He also has a family history of HTN and Type 2 DM. Which routine screenings should you perform? a. BMI, BP, anemia, lead b. Depression, substance use, tobacco use, testicular cancer, and HIV c. BMI, BP, lipid profile, diabetes, scoliosis d. BMI, BP, lipid profile, diabetes, substance use, tobacco use

D BMI and BP should be screened annually. BMI of 85th to 94th percentile is considered overweight. Risk factors for anemia should be assessed annually. Screen patients with risk factors for anemia with HgB or HCT. Lead screening should be done in children 1-2 years old and for older children who live in areas of high lead exposure. Screening for depression in youth should begin at 12 years old by using the PHQ2 or other screening tools. Screening for substance and tobacco use should begin at 11 years old. Testicular examination should be performed to assess for epididymitis, varicocele, or hernia. HIV screening should occur once between the ages of 15-18 years old. Universal lipid screening should be performed between 9-11 years old. Diabetes should be screened in children 10 years and older who have at least 2 risk factors. Diabetes screening should be continued every other year. Risk factors include: family history of type 2 DM, BMI greater than the 85th percentile, signs of insulin resistance, and high-risk ethnicity. Scoliosis screening in males should occur once between 13-14 years old. Scoliosis screening for females is at 10-12 years old (pg 108-110).

When performing a well-child examination in the office, the Nurse Practitioner knows all are components of a comprehensive pediatric history EXCEPT: A. Demographic data B. Allergies C. Sexual History D. Travel History

D Demographic data, allergies, and sexual history are some components of the comprehensive pediatric history not travel history. The data collected allows the physician to address problems in detail, while more quickly reviewing areas that are not of concern. The collected information ideally, should be collected in full at the first office visit with parent and patient subjective information. Elements of the history will be useful over time.

The NP knows which of the following patients is at the highest risk for developing HIV? a. A 19-year-old Caucasian male who has oral intercourse with men b. A 45-year-old Hispanic male who has receptive anal intercourse with men c. A 32-year-old African American male who has insertive intercourse with men d. A 27-year-old African American male who has receptive anal intercourse with men

D Despite representing less than 10% of the US male population, men who have sex with men (MSM) make up approximately 70% of new HIV infections. High HIV infection rates stem from the efficient transmission of HIV through receptive anal intercourse which poses a higher risk for HIV transmission than any other sexual activities. MSM of color are at in increased risk of HIV. African American MSM have the highest risk for HIV (1 in 2) followed by Hispanic MSM (1 in 4) then Caucasian MSM (1 in 11).

A 6-year-old presents to clinic with his mother with complaints of polyuria, polydipsia, enuresis that was fully potty trained at age 3. The mother is concerned that he may have a UTI because he has been complaining of pain with urination. He has a history of recurrent UTIs, and his paternal uncle had a kidney transplant at age 15. Which of the following results would prompt further testing? A. Serum creatinine of 0.6 mg/dL B. RBCs <5 on urine dipstick C. Urine dipstick negative for leukocytes D. First morning urine with specific gravity of <1.020

D First morning urine should have a specific gravity of ≥1.020. Inability to concentrated urine is often the first sign of chronic renal failure. This in addition to family history of renal transplant and recurrent UTIs should warrant further testing. All others are normal findings.

A 24-year-old sexually active female presents with the complaint of increased discharge with a "bad smell". Upon a speculum exam, the NP observes a gray, frothy discharge from the cervix. A subsequent wet prep result shows "clue cells". The NP prescribes: A. fluconazole 150mg PO once B. metronidazole 2g PO once for both partners C. nothing as this type of discharge is normal in the sexually active D. metronidazole 500mg PO BID x 7 days

D Fluconazole is the appropriate treatment for vulvovaginal candidiasis. The signs and symptoms of vulvovaginal candidiasis include itching, vulvovaginal redness, and white curd like discharge. Testing would reveal hyphae and spores. Therefore (a.) is not the correct answer. Metronidazole at 2g for both partners is a recognized treatment for Trichomonas vaginalis vaginitis where a "strawberry cervix", itching, frothy yellow-green, malodorous discharge would be expected. Testing would illustrate protozoal flagellates. Therefore (b.) is incorrect. This discharge is not normal in the sexually active, (c.) is incorrect. "Clue" cells are indicative of bacterial vaginosis, an overgrowth of Gardnerella and other bacterial species that is commonly associated with a "fishy" or amine odor. One correct treatment is metronidazole 500mg PO for seven days. Therefore (d.) is the correct answer.

Edward, a 68-year-old male who is one of your partner's patient's, is seeing you in the clinic for a routine follow up. He has a history of CAD with stent placement and DM Type 2. He is compliant with his Metoprolol, Plavix, Metformin, and Jardiance. You calculate his 10-yr ASCVD risk which is 8.9%. His recent LDL was 105. What is the top priority in your treatment plan? a. Ensure he is following up with his cardiologist regularly. b. Encourage him to exercise more. c. Discuss starting him on Atorvastatin 20 mg PO daily. d. Discuss starting him on Atorvastatin 40 mg PO daily.

D Given this patient's 10-yr ASCVD risk of >7.5% in addition to his diagnosis of DM Type 2 & history of CAD, he should be on a high-intensity statin (40-80 mg Atorvastatin or 20-40 mg Rosuvastatin) with goal LDL of <70. Though it is important to discuss and encourage lifestyle modification such as exercise and ensure follow up with his cardiologist, the top priority is statin therapy.

Your 50 year old male patient comes in for BP follow up with consistent home readings of SBP in the 150's for the past 3 weeks. His previous 2 office visits were 150/85 & 152/89 respectively. Today's office BP reading is 153/86. What is the most effective, first line diuretic best utilized in mild-moderate hypertensive patients? A- Furosemide B- Spironolactone C- Bumex D- Hydrochlorothiazide

D Hydrochlorothiazide (HCTZ)** thiazide diuretics have a solid research history which supports this class as the most reliable & effective diuretic to lower blood pressure. Blood pressure control can be achieved with single use diuretics in 50% of patients successfully with mild to moderate hypertension. Furosemide is best utilized in patients with chronic kidney disease due to volume & electrolyte loss- also a weak hypertensive. Spironolactone & Bumex are not first line diuretics.

A 60 year old male with a history of hypertension presents to the clinic for an annual check-up and labs. His fasting LDL result is 230 mg/dL. According to AHA/ACC/Multi-specialty guidelines, which of the following treatments should be initiated? A. Simvastatin 10 mg daily B. Pravastatin 80 mg daily C. Lovastatin 40 mg daily D. Rosuvastatin 20 mg daily

D In a patient without ASCVD and a primary elevated LDL >190 mg/dL, a high intensity -statin should be initiated. Of the choices above, only Rosuvastatin is considered "high intensity".

A 4 day old infant presents to the clinic for his first newborn wellness visit. The baby was born at 37 weeks gestation via vaginal delivery. The mother reports an uncomplicated pregnancy and delivery and breastfeeding is going well. As the NP, what assessment finding are you concerned about that requires further workup? A. The infant has lost 8% of his birth weight B. Three Blueish-black oval shaped marked over the infant's lumbosacral area C. The infant is voiding about 6 times per day and stooling twice per day D. The infant has a yellow skin tone and yellow sclera

D Jaundice in the newborn is a common disorder that requires a workup and possible intervention. A serum bilirubin level should be drawn to determine if intervention is needed. Common causes of newborn jaundice include ABO incompatibility, prematurity, infection, bruising from delivery, and RH-isoimmunization. 1, 2, and 3 are all normal findings in the newborn.

. A 90-year-old male is seen in the clinic for dry cough, shortness of breath, fever, and fatigue. He is a retired coal miner but denies having black lung. A CXR is performed and reveals a small, left lower lung infiltrate. The WBC is 18,000. What is the best response by the nurse practitioner? a. refer to a pulmonologist b. send to the hospital for IV antibiotics c. treat symptomatically for cough and fever d. prescribe levofloxacin 750mg PO daily x 5 days

D Most of these symptoms also correlate with common viral infections. However, this patient has evidence of an acute bacterial infection with possible LLL pneumonia. Due to his age and history, he is high risk and should be treated with an antibiotic. Options are fluoroquinolone or macrolide plus beta-lactam. (Chestnutt, p. 281)

First line treatment for patients with symptomatic HFrEF of <40% includes diuretic therapy in combination with an ACE inhibitors. Which of the following is best indicated for treatment with a diuretic such as hydrochlorothiazide? A. Carvedilol B. Valsartan C. Metoprolol D. Lisinopril

D Papadakis et al., 2020 states that ACE inhibitors used in conjunction with diuretics have shown effectiveness in treatment of HFrEF by stopping disease progress and hospitalizations

Ranolazine is contraindicated in all of the following except? a. a patient whose EKG shows current QT prolongation b. patient being treated for h. pylori with clarithromycin c. patient taking sotalol d. male patient taking tadalafil for erectile dysfunction

D Ranolazine is a medication prescribed to treat chronic angina. It differs from other nitrates, because it is safe to use with erectile dysfunction medications. However, it can cause QT prolongation, so it is contraindicated in patients with preexisting prolonged QT, medications that cause QT prolongation such as antiarrhythmics (ex: quinidine, dofetilide and sotalol); and in patients taking CYP450 3A inhibitors (ex: clarithromycin and rifampin).

During a presentation to a group of high school counselors, the NP identifies which of the following as a risk factor for an adolescent to develop an STI? A) Being from a single parent home B) Having a low IQ score C) Using condoms with every sexual encounter D) Having a partner who is 3 years older or more than the adolescent

D Risk factors for adolescents developing an STI include; having sex without a condom, having multiple partners, having sex at an early age, alcohol and/or drug use, having a history of an STI and having a partner who is older by 3 years or more.

You are completing an annual physical on a 5 year old who is going to be starting kindergarten. When doing his vision screen, which result would prompt you to refer him to an ophthalmologist? A. Left eye 20/20 and right eye 20/30 B. Left eye 20/30 and right eye 20/40 C. Left eye 20/40 and right eye 20/40 D. Left eye 20/40 and right eye 20/20

D The minimal acceptable range for the visual acuity screen in this age group is 20/40. However, if there is any two line discrepancy then they need to be referred to ophthalmologist. The person screening should make sure that the child is cooperating and if not then should reassess.

Which of the following answers is FALSE regarding coronary artery calcium score? A) It may help identify patients who will not benefit from cholesterol lowering therapy. B) It is the best test for risk stratification. C) It is a cardiac-gated CT scan D) This test is recommended by the USPSTF and is an annual requirement for lipid screening in all persons over the age of 50

D This test is not recommended by the USPSTF and is not recommended annually. This test is reserved for situations where additional information can change a therapeutic decision or will help to inform shared decision making.

Pregnancy-related urinary tract infections (UTIs) are most caused by this organism: A. Klebsiella pneumoniae B. Pseudomonas aeruginosa C. Group B streptococcus D. Escherichia coli

D UTIs in pregnant women are most commonly caused by Escherichia coli in two thirds of pregnancies. The other choices are incorrect.