FNP Test Questions

Patients taking warfarin (Coumadin) for atrial fibrillation should: A. Increase intake of vitamin K enriched foods B. Avoid intake of vitamin K enriched foods C. Maintain a consistent intake of vitamin K enriched foods D. Decreasing take a vitamin K enriched foods

C. Maintain a consistent intake of vitamin K enriched foods

A common side effect associated with sildenafil is: A. Arthralgia B. Myositis C. Nasal congestion D. Dysuria

C. Nasal congestion

The most commonly reported side effects of desvenlafaxine (Pristiq) is: A. Dizziness B. Gastroesophageal reflux C. Nausea D. Somnolence

C. Nausea

A patient has scabies. Which asymptomatic contacts do not need to be treated for scabies? A. Household contacts B. Sexual contacts C. Office mates D. Close personal contacts

C. Office mates

What symptoms might be present in a child with cystic fibrosis? A. Excessive sweating B. Frequent episodes of diarrhea C. Persistent productive cough D. Persistent watery eyes and tears

C. Persistent productive cough

What type of electrolyte should an individual with primary hypertension increase in their diet? A. Calcium B. Chloride C. Potassium D. Sodium

C. Potassium

A patient comes into the office after having dental work completed two days before. She's complaining of severe and burning mouth pain. She is finding it difficult to both eat and drink currently. On exam, you note a shallow ulcer on the inside of her cheek that is erythematous and tender. How should you treat this patient? A. Prescribed valacyclovir and prescribe extra in case this issue reoccurs in the future B. Instruct the patient that this is viral and will go away on its own C. Prescribe the patient "magic mouthwash" for symptom relief D. Educate the patient about proper oral hygiene before and after dental procedures

C. Prescribe the patient "magic mouthwash" for symptom relief (aphthous stomatitis)

Patients taking sildenafil should be advised to immediately report: A. Headache B. Flushing C. Priapism D. Nausea

C. Priapism

What is the gold standard treatment for gastroesophageal reflux disease? A. Antacids B. H2 receptor agonist (H2RAs) C. Proton pump inhibitors (PPIs) D. PPIs plus H2RAs

C. Proton pump inhibitors (PPIs)

A 17 year old boy presents with a sensation of heaviness in his scrotum. On exam, the nurse practitioner palpates a small nodule on the left testicle. How should the nurse practitioner proceed? A. Urethral swab B. Abdominal CT C. Scrotal ultrasound D. Evaluation of cremasteric reflex

C. Scrotal ultrasound

A 40 year old woman is diagnosed with a first episode of moderate depression. What medication would be a good initial choice for her? A. Aripiprazole (Abilify) B. Bupropion XR (Wellbutrin) 150 mg once a day C. Sertraline (Zoloft) D. Duloxetine (Cymbalta)

C. Sertraline (Zoloft)

A patient has a fundal height measurement of 32 cm. Which of the following is a correct statement about this patient? A. She is 14 to 18 weeks pregnant B. She is 18 to 22 weeks pregnant C. She is 32 weeks pregnant D. She is at term and ready to deliver

C. She is 32 weeks pregnant

In what position should a patient be examined to identify the presence of a hernia? A. Seated B. Lying supine C. Standing D. Squatting

C. Standing

Which one of the following actions is the least likely to improve G.I. symptoms in a patient who is taking iron by mouth? A. Switching to a lower elemental iron containing pill B. Taking the iron supplement in a liquid form C. Taking iron supplementation just before bed D. taking and supplementation with food

C. Taking iron supplementation just before bed

Where is Kiesselbach's plexus located? A. The posterior area of the pharynx B. The superior lateral area of the maxillary sinus C. The anterior inferior area of the nasal septum D. The submandibular area of the mouth

C. The anterior inferior area of the nasal septum

A patient newly diagnosed with diabetes reports severe hives and swollen lips after taking Bactrim for a bladder infection two months ago. Which of the following statements is correct? A. The patient cannot take any pills in the sulfonylurea class B. The patient can take some of the pills in the sulfonylurea class C. The patient can take any of the pills in the sulfonylurea class D. None of the above

C. The patient can take any of the pills in the sulfonylurea class

Differential diagnosis in a patient with spider angiomas does not include: A. Pregnancy B. Vitamin B deficiency C. Thrombocytopenia D. Liver disease

C. Thrombocytopenia

The Jarisch-Herxheimer reaction is a response to treatment of which of the following organisms? A. Neisseria gonorrhoeae B. Chlamydia trachomatis C. Treponema pallidum D. Rickettsia rickettsii

C. Treponema pallidum Coco

Which of the following benzodiazepines has the shortest half-life? A. Lorazepam B. Alprazolam C. Triazolam D. Clonazepam

C. Triazolam Triazolam 2 hours, alprazolam 12 hours, lorazepam 15 hours, clonazepam 34 hours

A 4 week old infant has suspected pyloric stenosis. What imaging study is most commonly used to diagnose this condition? A. Upper endoscopy B. Barium enema C. Ultrasound D. pH manometry

C. Ultrasound

A 36-year-old obese woman presents with abdominal pain. If the most likely differential diagnosis is cholecystitis, what is the diagnostic test of choice? A. CT of the abdomen B. MRI of the abdomen C. Ultrasound of the abdomen D. Kidney, ureter and bladder x-ray

C. Ultrasound of the abdomen

If a patient has erectile dysfunction, he's at the risk of having which type of disease?

Cardiovascular disease

An infant has physiologic hyperbilirubinemia. At what age does this usually appear? A. Within 24 hours of birth B. About 2-3 days after birth C. 3-5 days after birth D. Within the first week after birth

B. About 2-3 days after birth

Which medication is associated with Reyes syndrome? A. Acetaminophen B. Aspirin C. Guaifenesin D. Ibuprofen

B. Aspirin

The nurse practitioner has exam is Mr. Jones. He has mild dyspnea and bilateral lower extremity edema. What diagnostic test or finding is sensitive in identifying heart failure? A. Calcium score B. BNP >100 pg/mL C. Atrial fibrillation D. A three lead EKG

B. BNP >100 pg/mL

36 year old woman complaints of irritated, dry, itchy eyes. There is eyelid margin erythema. What is the likely diagnosis? A. Conjunctivitis B. Blepharitis C. Iritis D. Chalazion

B. Blepharitis

What is the most common cause of balanitis? A. Pseudomonas B. Candida albicans C. Bacteria D. Virus

B. Candida albicans

A 52-year-old man complains of left lower extremity swelling, erythema, fever, chills, and malaise. The nurse practitioner suspects: A. Deep vein thrombosis (DVT) B. Cellulitis C. Peripheral neuropathy D. Heart failure

B. Cellulitis

What is the most common cause of lateral epicondylitis? A. Osteoarthritis B. Overuse C. Deconditioning D. Aging

B. Overuse

Which findings are characteristic of Osgood-Schlatter disease? Select all that apply. A. Erythema, warmth of the tibial tuberosity B. Pain reproduce by extending the knee against resistance C. Pain over the patellar tendon D. Straight leg raise is painless

B. Pain reproduce by extending the knee against resistance D. Straight leg raise is painless

Which of the following medication increases the risk of erectile dysfunction? A. Amoxicillin B. Paroxetine C. Levothyroxine D. Aspirin

B. Paroxetine

Patient with recent history of breast cancer presents with sudden severe low back pain. What is a likely etiology? A. Bone metastasis B. Pathologic fracture C. Soft tissue infection D. Osteomyelitis

B. Pathologic fracture

Which of the following is considered an extrinsic risk factor for falls in the older adults? A. Postural hypotension B. Psychoactive medications C. Previous falls D. Fear of falling

B. Psychoactive medications

What effect does finasteride have on PSA levels in patients with prostate cancer? A. Finasteride does not have an acute effect on the PSA B. The chronic effect of finasteride is the stabilization of PSA C. When using finasteride for long-term management, the PSA will be doubled D. An increase in PSA within the normal range may occur with the use of finasteride

B. The chronic effect of finasteride is the stabilization of PSA

Which one of the following is commonly associated with carpal tunnel syndrome? A. The Obturator nerve B. The median nerve C. The brachial plexus D. The sural nerve

B. The median nerve

Which of the following pharmacological agents is the best choice for an elderly patient with insomnia? A. Diazepam B. Zolpidem C. Temazepam D. Diphenhydramine

B. Zolpidem Quick onset of action (15 minutes) and short half life (two hours)

An 80-year-old man complains of chest pressure when walking up a flight of stairs at his home. The nurse practitioner auscultates a 2/6 systolic murmur near the second intercostal space to the right of the store now. Which murmur is likely present? A. Aortic regurgitation B. Mitral valve prolapse C. Aortic stenosis D. Mitral stenosis

C. Aortic stenosis

A pregnant mother is Rh negative. When should she receive RhoGAM (anti-D immunoglobulin)? Select all that apply. A. At the time pregnancy is diagnosed B. At 12 to 14 weeks gestation C. At about 28 weeks gestation D. During each trimester E. Within 72 hours of delivery

C. At about 28 weeks gestation E. Within 72 hours of delivery

What is the preferred means of rehydration for a child who has a viral gastroenteritis? A. Beverage of choice B. IV rehydration C. Commercially prepared electrolyte solution D. Chicken broth or other salty beverage

C. Commercially prepared electrolyte solution

Radioactive iodine treatment for the permanent treatment of hyperthyroidism is usually administered: A. Subcutaneously daily for 14 days B. Intravenously over a period of weeks C. Via laser treatments D. Orally in a single dose

D. Orally in a single dose

A 6 week old infant has visible peristaltic waves in the upper abdomen just before emesis. Which of the following is likely to be included in the differential diagnosis? A. Gastroesophageal reflux B. Milk protein intolerance C. Intestinal obstruction D. Pyloric stenosis

D. Pyloric stenosis

A 13 year old male patient is brought to an outpatient clinic by his father with a complaint of a sudden onset of severe left testicular pain. The patient is very nauseous and has already vomited a few times. Physical exam reveals a red, swollen, and tender left scrotum. There is no cremasteric reflex. The abdomen is soft, with no rebound or localized tenderness. Ball sounds are positive. Which of the following is recommended for this patient? A. Recommend increase fluid intake and BRAT diet (bananas, rice, applesauce, and dry toast) B. Order an ultrasound of the left scrotum C. Refer the patient with urologist; give the patient's father the contact information D. Refer the patient to the ED as soon as possible

D. Refer the patient to the ED as soon as possible

What is the recommendation from the American Cancer Society for assessment of the prostate gland in a man who is 45 years old and of average risk for development of prostate cancer? A. Prostate specific antigen (PSA) now and again in five years B. PSA and digital rectal exam now and again in five years C. Digital rectal exam yearly D. Share decision making based on risk factors

D. Share decision making based on risk factors

Examples of social determinants of health: A. Age B. Sex C. Disabilities D. Social support

D. Social support

A diuretic that does not promote the secretion of potassium into the urine is: A. Furosemide (Lasix) B. Hydrochlorothiazide (Microzide) C. Bumenatide (Bumex) D. Triamterene (Dyrenium)

D. Triamterene (Dyrenium)

Prior to prescribing metformin for a 32 year old patient with a BMI of 30, what labs should be checked? Select all that apply. A. CBC B. Vitamin B12 level C. Vitamin D level D. eGFR E. ALT, AST

D. eGFR E. ALT, AST

What is the first line treatment for trigeminal neuralgia? What is the second line treatment?

First line treatment: Tegretol Backup option: tricyclic antidepressants

Which of the following are common asthma triggers? Select all that apply. A. Exercise B. Changes in weather C. Respiratory infection D. Irritant exposure

A. Exercise B. Changes in weather C. Respiratory infection D. Irritant exposure

All of the following are true statements regarding tetanus and diphtheria vaccine, except: A. Fever occurs in up to 80% of the patients B. A possible side effect is induration on the injection site C. A tetanus and diphtheria toxoid vaccine is given every 10 years D. The DPT and DT should not be given beyond the seventh birthday

A. Fever occurs in up to 80% of the patients

Long term or repeated use of polymyxin B/trimethoprim ophthalmic drops may cause: A. Fungal infections B. Trichiasis C. Photosensitivity D. Depigmentation

A. Fungal infections

A black adult male presents with new onset of jaundice, dark urine, fatigue, and anorexia. He was seen a few days previously and treated for a possible urinary tract infection. He is on the third day of nitrofurantoin 100 mg PO BID 7 days. The hemoglobin is 11 g/dL, and hematocrit is 34%. The MCV is 84 fL. The serum indirect bilirubin is elevated. Which of the following conditions is most likely? A. G6PD anemia B. Sickle cell anemia C. Iron deficiency anemia D. Pernicious anemia

A. G6PD anemia

Which of the following should the nurse practitioner recognize as close to domestic violence in a pregnant patient? A. Missed prenatal visit without notification B. A partner who refuses to allow the patient to be examined in private C. Bipolar disorder in the patient's partner D. Poor eye contact by patient E. Improbable injury or injuries in the pregnant patient

A. Missed prenatal visit without notification B. A partner who refuses to allow the patient to be examined in private E. Improbable injury or injuries in the pregnant patient

If a patient has a positive screen for bipolar disorder, what do choices should be part of the nurse practitioner's initial plan of care? A. Referral to a mental healthcare provider B. Prescribe an SSRI C. Avoid SSRIs D. Prescribe a benzodiazepine E. Prescribe an atypical antipsychotic medication

A. Referral to a mental healthcare provider C. Avoid SSRIs

According to the Centers for Disease Control and Prevention, HIV screening should be: A. Routine in patients ages 13 to 64 B. Recommended for pregnant women in the third trimester C. Performed after a blood transfusion D. Only advised if the patient is seeking STI treatment

A. Routine in patients ages 13 to 64

A 30 year old woman with type two diabetes uses regular and intermediate acting insulin in the morning and evening. She denies changes in her diet or any illness, but she recently started attending aerobic classes in the afternoon. Our fasting blood glucose level before breakfast is now elevated. Which of the following is best described? A. Somogyi phenomenon B. Dawn phenomenon C. Raynaud's phenomenon D. Insulin resistance

A. Somogyi phenomenon

Common etiology of cellulitis includes (select all that apply): A. Staph aureus B. MRSA C. Group A strep D. H. influenza E. E. coli

A. Staph aureus B. MRSA

During a well child exam, a 1 year old boy is found to have a hydrocele. What is most important for the nurse practitioner to include in the assessment of this patient? A. A rectal exam B. Assessment for inguinal hernia C. Assessment for hypospadias D. Assessment of testicle placement

B. Assessment for inguinal hernia

A 54 year old African-American female patient presents today with new fatigue as well as numbness and tingling in her hands and feet. Her past medical history is significant for a gastric bypass approximately three years ago, and since losing weight she has been able to discontinue her diabetes and hypertension medication's. What type of anemia is this patient likely presenting with? A. Folate B. B12 C. Iron D. Sickle cell anemia

B. B12

A 24 year old woman tells the nurse practitioner that since she began treatment with S citalopram, she has been experiencing episodes of racing thoughts and inability to sleep. The patient should be screened for: A. Anxiety B. Bipolar disorder C. PTSD D. Suicide potential

B. Bipolar disorder

Which of the following best describes Cullen's sign? A. Cessation of inspiration upon deep palpation of the RUQ of the abdomen B. Bruising around the periumbilical area of the abdomen C. Deep palpation of the LLQ of the abdomen that causes pain to radiate to the RLQ D. Blue-black discoloration that is located on the right flank of the trunk

B. Bruising around the periumbilical area of the abdomen

A 52-year-old woman states that for the last three mornings, she has seen pink drops of "blood" in the toilet water after she has a bowel movement. She had a normal colonoscopy at age 50 and has no family history of colorectal cancer. What should be done first? A. Abdominal CT B. CBC with ferritin level C. Stool for occult blood D. Refer to G.I. for a repeat colonoscopy

B. CBC with ferritin level

A sexually active 16 year old which cervicitis is tested for gonorrhea and chlamydia. The NAAT test results shows that the patient is positive for gonorrhea. Which of the following is appropriate treatment for this patient? A. Cephalosporin B. Cephalosporin and macrolide C. Tetracycline D. Tetracycline and sulfonamide

B. Cephalosporin and macrolide

A 44 year old obese woman presents with abdominal pain. She is afebrile. What is the most likely etiology? A. Appendicitis B. Cholecystitis C. Diverticulitis D. Pancreatitis

B. Cholecystitis

A new patient, who is a 54 year old athlete with a history of hyperlipidemia, is seen for new onset of generalized myalgia, muscle weakness, oliguria, and tea-colored urine for the past 24 hours. He recently completed running a marathon. He's on a statin and reports taking ibuprofen several times to treat the muscle pain. Which diagnosis is most likely? A. Hyperthyroidism B. Rhabdomyolysis C. Pyelonephritis D. Viral influenza

B. Rhabdomyolysis

Skin lesions that appear hypo or hyperpigmented with slightly scaly macules on the trunk, neck, and upper arms are likely: A. Vitiligo B. Tinea versicolor C. Actinic keratosis D. Ichthyosis vulgaris

B. Tinea versicolor

Which effect will the nurse practitioner take into consideration when prescribing oral pharmacologic treatment for a two week old infant with omphalitis? A. Increased renal excretion B. Undeveloped blood brain barrier C. Increased gastric emptying time D. Increased ability of protein drugs to bind

B. Undeveloped blood brain barrier

If Mr. Boudreaux's finding/symptoms include microscopic hematuria and urinary frequency, what might be included in the differential diagnosis? A. Undiagnosed diabetes B. Urinary tract infection C. Acute prostatitis D. Prostate cancer

B. Urinary tract infection

A 57 year old African-American male patient presents for a follow up visit today. At his last visit, his BP was 135/77. He was asked to implement several lifestyle modifications and keep a BP log at home. Today, his BP is 142/79. Which of the following medication's is considered first line for this patient? A. Lisinopril B. Losartan C. Amlodipine D. Metoprolol

C. Amlodipine

A 45-year-old patient has suspected B12 deficiency. What symptoms might warrant a serum B12 and folate level? A. Increased appetite B. Abdominal pain C. Burning in the hands or feet D. Joint aches and lower extremity swelling

C. Burning in the hands or feet

A 60 year old patient reports chronic cough and sputum production. He has a long history of exposure to secondhand cigarette smoke from his wife. What diagnosis is most likely? A. Lung cancer B. Emphysema C. COPD D. Allergic cough

C. COPD

A 3 year old girl has a urine dipstick result that indicates UTI. She is afebrile. Based on the most likely pathogen, which antibiotic is a good first choice? A. TMP-SMX (Bactrim) B. Cephalexin (Keflex) C. Cefuroxime (Ceftin) D. Amoxicillin (Amoxil)

C. Cefuroxime (Ceftin)

A nurse practitioner student is seeing a client who was recently diagnosed with hyperlipidemia. His labs were: LDL 150, HDL 38, triglycerides 554, Total cholesterol 388. Which exam findings with the student need to tell her preceptor about immediately? A. Xanthelasma B. Arcus senilis C. Cullen's sign D. Murphy's sign

C. Cullen's sign Cullen's sign = pancreatitis, especially possible pancreatic necrosis which has led to intra-abdominal bleeding. Murphy's sign indicates cholecystitis

Which of the following individuals is at the highest risk for suicide? A. Obese teenager who fails an exam in high school B. Black middle-aged female who is newly diagnosed with type 2 diabetes C. Elderly white male whose wife of 40 years recently died D. Asian adult who is mother has a chronic illness

C. Elderly white male whose wife of 40 years recently died

Which of the following works by indirectly inhibiting thrombin and is considered a low molecular weight heparin used in the prevention of deep vein thrombosis? A. Rivaroxaban B. Clopidogrel C. Enoxaparin D. Aggrenox

C. Enoxaparin

What is the most common causative agent in mononucleosis? A. Adenovirus B. Coxsackie B virus C. Epstein-Barr virus D. Herpes simplex virus

C. Epstein-Barr virus

An 85-year-old patient has been diagnosed with moderate depressive disorder. Which medication would be a good initial choice to treat her? A. Aripiprazole (Abilify) B. Desipramine C. Escitalopram (Lexapro) D. Duloxetine (Cymbalta)

C. Escitalopram (Lexapro)

Depo-Provera used to provide contraception and manage abnormal uterine bleeding in an 18 year old, does not have: A. Androgenic effects B. Anabolic effects C. Estrogenic activity D. Progesterone activity

C. Estrogenic activity

A 20 year old man has suspected acute HIV infection. Which lab test should be ordered? A. HIV IgM antibodies B. Antigen/antibody immunoassay (ELISA/EIA) C. HIV1/HIV2 antibody differentiation immunoassay D. HIV-1 RNA assay (NAT)

C. HIV1/HIV2 antibody differentiation immunoassay

Butalbital, one of the components of Fioricet, medication used to abort tension type headaches: A. Is habit forming and potentially abusable B. Does not impair mental and/or physical abilities C. Is a barbiturate that acts on the central nervous system D. Can be purchased over-the-counter

C. Is a barbiturate that acts on the central nervous system

A 55-year-old man with a history of MI and chronic hypertension presents with complaints of dyspnea and fatigue. Right heart failure is suspected. The nurse practitioner knows that the most common cause of right heart failure is: A. Cardiomyopathy B. Hypertension C. Left ventricular heart failure D. Aortic regurgitation

C. Left ventricular heart failure

A 36 year old woman has a BMI of 30, a family history of T2DM, and hypothyroidism. She takes no medications and had a normal menstrual period two weeks ago. Her blood pressure is 135/82, her heart rate is 78, and her respiratory rate is 16. Her fasting glucose is 135. What should be the initial pharmacologic intervention for this patient elevated blood glucose? A. Sitagliptin (Januvia) B. Glipizide (Glucotrol) C. Metformin (Glucophage) D. Rosiglitazone (Avandia)

C. Metformin (Glucophage)

A three week old infant has white pinpoint papules on his face and cheeks. What is this? A. Mongolian spots B. Eczema C. Milia D. Hemangioma

C. Milia

In a patient diagnosed with lead toxicity removal from the source of exposure in the initial plan, in addition, the nurse practitioner should evaluate for factors that affect the biokinetics of lead (e.g. elimination) which would not include: A. Gastrointestinal transit time B. Nutritional status C. Neurologic status D. Renal insufficiency

C. Neurologic status

A 76 year old male patient comes into the clinic today for sudden vision loss in his left eye. When questioned further, the patient notes that it feels like "a curtain was pulled over my eye." Of the following, which is the likely diagnosis and treatment? A. Open angle glaucoma; refer to the ED stat B. Open angle glaucoma; refer to ophthalmology for a consult C. Retinal detachment; refer to the ED stat D. Retinal detachment; refer to ophthalmology for a consult

C. Retinal detachment; refer to the ED stat

A 75-year-old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The nurse practitioner replies: A. Palpitations and weakness B. Ventricular arrhythmias C. Shortness of breath and syncope D. Fatigue and exercise intolerance

C. Shortness of breath and syncope

What lab value do we need to monitor when a patient is on lithium?

Sodium level

What is ginkgo used for?

Some people use it for memory and sometimes you can see it used after menopause as well

What heart sound is benign if it disappears during expiration?

Split S2

What is coenzyme 10 used for?

The heart

What is kava kava used for?

Stress, anxiety and sleep

With which comorbidity do we not prescribe beta-blockers?

Those with COPD and asthma

Which two calcium channel blockers would be inappropriate to prescribe to a patient with heart failure and hypertension

Verapamil and Diltiazem

A multigravitable who is at 28 weeks gestation has a funnel height of 29 cm. Which of the following is the best recommendation for this patient? A. Advise mother that her pregnancy is progressing well B. Order an ultrasound of the uterus C. Refer her to an obstetrician for an amniocentesis D. Recommend bed rest with bathroom privileges

A. Advise mother that her pregnancy is progressing well

An older adult has lost his spouse of 55 years. If the nurse practitioner suspects alcohol abuse, how could he be screened? A. CAGE questionnaire B. GAGE screening tool C. AAA screen D. Geriatric alcohol tool

A. CAGE questionnaire

To assess the function of the parathyroid gland, the nurse practitioner would check: A. Calcium levels B. Sodium levels C. Potassium levels D. Magnesium levels

A. Calcium levels

Your patient comes in complaining of unilateral muffled hearing. When you do the weber test, the test lateral lyses to the bad ear. Which of the following could be a potential cause of the patient's muffled hearing? A. Cerumen impaction B. Age C. Ménière's disease D. Head trauma

A. Cerumen impaction

Measles is characterized by what clinical findings? Select all that apply. A. Cough B. Runny nose C. Conjunctivitis D. Anemia

A. Cough B. Runny nose C. Conjunctivitis

What history or actions are expected for a presentation of primary dysmenorrhea in a 28 year old woman? A. Dysmenorrhea since menarche B. OB-GYN referral C. Worsening dysmenorrhea over time D. NSAIDs and/or oral contraceptives for symptom relief

A. Dysmenorrhea since menarche D. NSAIDs and/or oral contraceptives for symptom relief

The nurse practitioner student knows that when testing the cranial nerves, which of the following are only sensory in nature? A. I B. II C. III D. IV E. V F. VI

A. I B. II Some say marry money but my brother says big brains matter more

Which of the following is true regarding a screening test with high sensitivity? A. It is the ability of the test to correctly identify an individual who has the disease B. It is the ability of the test to correctly identify an individual who does not have the disease C. It is the probability that subjects with a positive screening test truly have the disease D. It is the probability that subjects who have a negative screening test truly do not have the disease

A. It is the ability of the test to correctly identify an individual who has the disease

Steroid selection should be based on which of the following? Select all that apply. A. Site of involvement B. Steroid potency C. Severity of condition D. Gender of patient E. Cost of medication

A. Site of involvement B. Steroid potency C. Severity of condition

A 23 year old female who is homeless presents to the free clinic. She should be screened for: A. TB, HIV, and hepatitis B. Pregnancy, headaches, and STDs C. Urinary tract infection and STDs D. Diabetes, HIV, and neuropathy

A. TB, HIV, and hepatitis

A 77 year old male patient presents to the clinic with a new sudden onset of a bilateral tremor. Upon exam, the patient is able to reproduce his symptoms. Which finding would probe further investigation by the nurse practitioner? A. The tremor only occurs at rest B. The tremor is dampened when the patient drinks alcohol C. The tremor is present in the head, which affects the patient's voice D. The patient's handwriting has recently increased in size

A. The tremor only occurs at rest Most concerning differential is Parkinson's which is why choice A warrants further investigation Choices B & C are indicative of essential tremors in Parkinson's patients handwriting gets smaller. Thus, choice D is incorrect

What two tests might be used to assess for carpal tunnel syndrome? A. Tinel's sign B. Snuffbox tenderness test C. Phalen's sign D. McMurray test

A. Tinel's sign C. Phalen's sign

A 4-month-old infant will be traveling with his parents to South Africa. What should the nurse practitioner do to learn which vaccines this child requires? A. Visit the CDC vaccines and immunizations webpage B. Call the CDC to ask for guidance C. Consult an infectious disease specialist D. Refer the patient to a travel medicine clinic

A. Visit the CDC vaccines and immunizations webpage

An elderly male patient comes into the clinic complaining of hearing loss in his right ear. The nurse practitioner decides to test his hearing using both the Rinne and Weber tests. Which of the following findings would indicate that the patient has an abnormal response to the Rinne test? A. Lateralization to the bad ear B. No lateralization is present C. AC > BC D. BC > AC

D. BC > AC

A 12 year old girl in tanner stage 3 presents to your office today for a routine physical examination. What clinical finding would you expect to see in this patient? A. Breast budding B. Straight pubic hairs C. No breast development D. Bilateral small breast mounds

D. Bilateral small breast mounds

Which of the following factors will not increase a woman's risk of developing breast cancer? A. Moderate to high intake of alcohol B. Onset of menstruation at 10 years of age C. First pregnancy at age 30 years or older D. Body mass index of 23

D. Body mass index of 23

Which cranial nerve is responsible for tongue movement? A. CN VIII B. CN IX & CN X C. CN XI D. CN XII

D. CN XII

A 22 year old woman is taking her third those of triptan such as sumatriptan this month. The headache started 1.5 hours ago and has been unresponsive to NSAIDs. Taking the triptan at this time will not: A. Improve the likelihood of complete pain relief B. Lower the chance of rebound headache C. Lower the overall treatment costs D. Cause medication overuse syndrome

D. Cause medication overuse syndrome

Tourette's syndrome: A. May be diagnosed at any age B. Is a result of psychosocial trauma C. Is a result of the psychological effects of substance such as stimulants D. Causes motor and vocal tics

D. Causes motor and vocal tics

A patient who has been taking a proton pump inhibitor for the last six months reports persistent diarrhea for the past three weeks. The nurse practitioner should consider: A. Colitis B. Gastro paresis C. Bacterial gastroenteritis D. Clostridium difficile

D. Clostridium difficile

Which condition is a core disorder on the recommended uniform screening panel (RUSP) for newborns? A. Hypermethioninemia B. Tyrosinemia type II C. Galactokinase deficiency D. Congenital adrenal hyperplasia

D. Congenital adrenal hyperplasia

A patient cannot stick his tongue out of his mouth and move it from side to side. Which cranial nerve is responsible for movement of the tongue? A. Cranial nerve III B. Cranial nerve VII C. Cranial nerve X D. Cranial nerve XII

D. Cranial nerve XII

What common overuse syndrome produces dorsal thumb pain? A. Carpal tunnel syndrome B. Osteoarthritis C. Trigger finger D. DeQuervain's tenosynovitis

D. DeQuervain's tenosynovitis

A pediatric patient has sickle cell disease. Which of the following should not be performed or provided at the 1 year well child check? A. Assessment of growth and development B. Review of immunization status C. Caregiver education about the importance of adequate hydration D. Discontinuation of daily penicillin for prophylaxis

D. Discontinuation of daily penicillin for prophylaxis

The LEAST important goal of pharmacologic therapy in the treatment of epilepsy is to: A. Achieve the best possible control of seizures B. Minimize the amount of side effects C. Achieve seizure free status D. Minimize polypharmacy

C. Achieve seizure free status

A young adult male patient presents to the clinic with mild jaundice and abdominal discomfort. A hepatitis panel is drawn and the results are: +HBsAg, -Anti-HBs, and +Anti-HBc IgM. which of the following is the correct diagnosis for the patient? A. Chronic hepatitis B infection B. Possible hepatitis B infection C. Acute hepatitis B infection D. Past hepatitis B infection

C. Acute hepatitis B infection

A 50-year-old man presents with fevers, chills, tenderness on digital rectal exam, and pelvic pain. What should be included in the differential diagnosis? A. Urinary tract infection B. Benign prostatic hypertrophy C. Acute prostatitis D. Epididymitis

C. Acute prostatitis

The most well documented risk factor for down syndrome is: A. Alcohol use during pregnancy B. Inadequate folic acid intake during pregnancy C. Advanced maternal age D. Genetics

C. Advanced maternal age

Which antidepressant is most lethal if consumed in quantity? A. Escitalopram B. Sertraline C. Amitriptyline D. Fluoxetine

C. Amitriptyline

What are the other 2 A's that are associated with allergies?

Asthma and atopic dermatitis

You have diagnosed a 28 year old woman with primary hypothyroidism. Her calculated thyroid hormone replacement is 108 mcg daily. How much should she be given initially? A. 25 mcg daily B. 50 mcg daily C. 100 mcg daily D. 112 mcg daily

C. 100 mcg daily

An adolescent male patient presents to the office with diffused hives and pruritus that began suddenly this morning. His mother brings him into the clinic as it appears to be getting worse. What would be the next most appropriate action by the nurse practitioner? A. Administer Epinephrine IM in the office B. Prescribe Benadryl 50 mg PO BID until symptoms resolve C. Educate the patient about avoiding triggers in the future D. Assess the patient further

D. Assess the patient further

A newborn has visual deficits that gradual develops along with cognitive development. At what age would you expect the visual acuity to be 20/20: A. 2 years B. 3 years C. 4 years D. 5-6 years

D. 5-6 years

Topical permethrin in the treatment of scabies should be left in place for a minimum of: A. 30 minutes B. 2 hours C. 6 hours D. 8 hours

D. 8 hours

What type of ear drops do we prescribe for otitis external?

Ofloxacin ear drops (fluoroquinolone)

What are the three main symptoms of Parkinson's disease?

Tremor, bradykinesia, and rigidity

Acute tension type headaches refractory to simple analgesics me respond to a combination of analgesics and: A. Butalbital B. Corticosteroids C. Opioids D. Triptan d

A. Butalbital

What is the instrument used to measure interocular pressure? A. Dermatoscope B. Ophthalmoscope C. Tonometer D. Pachymeter

C. Tonometer

What would an accurate Pap smear sample contain?

Cells from the squamocolumnar junction also known as the transformation zone. That is where the endo cervix and the vaginal cervix meet.

A patient has allergic rhinosinusitis. What would be unusual to find in him? A. Infraorbital edema B. Accentuated lower eyelid folds C. Transverse nasal crease D. Erythematous sclera

D. Erythematous sclera

The mother of a newborn is HBsAg positive. How should immunization for this infant proceed? A. Do not immunized the infant hepatitis B B. Call the CDC for recommendations on how to proceed C. Immunized the newborn against hepatitis B within 24 hours of birth D. Immunized a newborn against hepatitis B and administer hepatitis B immune globulin within 12 hours of birth

D. Immunized a newborn against hepatitis B and administer hepatitis B immune globulin within 12 hours of birth

Migraine without aura is characterized by: A. Bilateral frontal head pain caused by fatigue B. Headache lasting <2 hours with nausea C. On site within 60 minutes and subsides after rest D. Unilateral pain lasting 4-72 hours

D. Unilateral pain lasting 4-72 hours

Azithromycin used in the treatment of N. gonorrhea because serious adverse effects including: A. Essential tremors B. Pancytopenia C. Renal failure D. QT prolongation

D. QT prolongation

A 10 year old presents with a severe sore throat and headache at the urgent care clinic today. On examination, the nurse practitioner notes cervical adenopathy and splenomegaly. What is the most appropriate treatment for this child? A. Amoxicillin B. Azithromycin C. Doxycycline D. Symptomatic treatment

D. Symptomatic treatment Strep throat can be differentiated from mononucleosis by the presence of splenomegaly, which is only present in patients with mono. Giving antibiotics to patients with mono can cause them to have morbilliform rash!

Which of the following patients would be at the risk for lactic acidosis secondary to Metformin use? A. A 50-year-old man with asthma B. A 32 year old pregnant woman C. A 40 year old woman with a 60% ejection fraction D. A 65-year-old man who is a binge drinker

D. A 65-year-old man who is a binge drinker

A side effect of beta blockers that is more common in children than adults is: A. Decreased appetite B. Muscle weakness C. Vivid dreams D. A cough that produces mucus

D. A cough that produces mucus

Which one of the following statements related to hypertension in older adults is correct: A. Increase vascular relaxation in older adults leads to decreased cardiac output B. Vascular vasoconstriction in older adults leads to decreased peripheral vascular resistance C. In older adults, arterial pressure decreases vascular relaxation D. Aging leads to increased peripheral vascular resistance and arterial pressure

D. Aging leads to increased peripheral vascular resistance and arterial pressure

An obese Asian patient with a BMI of 33 complaints of fatigue and excessive thirst and hunger. You suspect type two diabetes mellitus. Initial testing to confirm diagnosis can include: A. Fasting plasma glucose level B. Glycated hemoglobin level (A1C) C. Oral glucose tolerance testing D. All of the above

D. All of the above

B12 deficiency is a side effect of all of the following medication's except: A. Proton pump inhibitors B. Metformin (Glucophage) C. Colchicine D. Aspirin

D. Aspirin

A 42 year old patient is being treated with 40 mg of famotidine daily for the treatment of reflux. The best time for the patient to take this medication is: A. On an empty stomach, one hour prior to breakfast B. With breakfast C. Prior to the largest meal of the day D. At bedtime

D. At bedtime

A 48-year-old man presents with complaint of erectile dysfunction. Upon palpation of the prostate gland it is found to be nontender, firm, and modular. This finding is most consistent with: A. A normal prostate gland B. Acute bacterial prostatitis C. Benign prostatic hyperplasia D. Carcinoma of the prostate

D. Carcinoma of the prostate

A patient comes in complaining of green yellow halos in their vision and feeling extremely weak. Their heart rate is 42. They likely have toxic levels of which cardiac drug?

Digoxin

After anti-hypertensive therapy is initiated, when should a patient's blood pressure be rechecked? A. 1 month B. 2 months C. 3 months D. 4 months

A. 1 month

Which one of the following medication should be avoided during pregnancy? A. Bismuth subsalicylate (Pepto-Bismol), an anti-diarrheal B. Colace (docusate), a stool softener C. Polyethylene glycol (MiraLAX), a laxative D. Simethicone (Gas-X), an anti-flatulent

A. Bismuth subsalicylate (Pepto-Bismol), an anti-diarrheal

A 39 year old male patient is being seen in the office today for schizophrenia. The nurse practitioner decides to place the patient on olanzapine (Zyprexa) for further management of his disorder. The nurse practitioner knows which of the following should be monitored at the next visit? Select all that apply: A. Blood glucose level B. Lipid profile C. GFR/BUN/Cr D. Sodium level E. EKG

A. Blood glucose levels B. Lipid profile There is a risk of gaining weight on antipsychotics. Therefore it is imperative to monitor the glucose and lipid profile.

All of the following findings are associated with the secondary stage of an infection by the organism treponema pallidum, except: A. Condylomata acuminata B. Maculopapular rash of the palms and soles C. Lymphadenopathy D. Condylomata lata

A. Condylomata acuminata

Your patient has been newly diagnosed with type 2 diabetes, and is requiring lots of education as they do not know anyone with diabetes personally. Who should you refer this patient to? Select all that apply: A. Dietitian B. Podiatrist C. Ophthalmologist D. Diabetes educator

A. Dietitian B. Podiatrist C. Ophthalmologist D. Diabetes educator Also check for urine micro albumin and renal function panel

Which of the following laxatives should be avoided in patients who have renal impairment? A. Magnesium hydroxide (milk of magnesia) B. Psyllium (Metamucil) C. Sodium docusate (Colace) D. Methylcellulose (Citrucel)

A. Magnesium hydroxide (milk of magnesia)

A 25-year-old male patient presents today for right knee pain that began yesterday when he was playing football. When the patient was tackled, he heard a pop in his right knee and has been having pain ever since. Which diagnostic tool would be appropriate to use based off of this patient's history? A. McMurray test B. Lachman test C. Valgus test D. Hook/drop arm test

A. McMurray test "Pop" + contact sport = meniscus tear Meniscus = McMurray (M=M)

Routine bloodwork in 48 year old patient identifies elevation in his liver function test (LFTs). He states that he feels well and has no physical complaints. What are common etiologies of elevated LFTs? A. Medications B. Alcohol use C. Fatty liver disease D. Hemachromatosis E. Infiltration from malignancy

A. Medications B. Alcohol use C. Fatty liver disease

A 34 year old pregnant patient has mitral valve prolapse. Where is this best auscultated? A. Mitral listening point B. Aortic listening point C. Tricuspid listening point D. Pulmonic listening point

A. Mitral listening point

An adolescent high school athlete who is on the wrestling team complains of multiple bumps on his lower left arm. The patient denies pruritus, pain, or discomfort from the lesions. During the skin exam, the nurse practitioner notices multiple smooth domed papules that are 2 to 5 mm in diameter with central umbilication. Which diagnosis is most likely? A. Molluscum contagiosum B. Acne vulgaris C. Verruca vulgaris D. Basal cell carcinoma

A. Molluscum contagiosum

An elderly male patient presents to the clinic with periumbilical abdominal pain. Initially he states he was having issues with diarrhea but it has now changed to constipation. Upon exam, there is obvious abdominal distention. What should be the nurse practitioners priority action? A. Order a KUB B. Order an EGD C. Order a stool study for ova and parasites D. Refer the patient for a colonoscopy

A. Order a KUB This patient needs to be referred out to the ER for possible surgery depending on the severity of the bowel obstruction

Which of the following conditions is classified as sensory neuro hearing loss? A. Presbycusis B. Otitis media C. Ceruminosis D. Otitis externa

A. Presbycusis

A 48-year-old female patient comes into the office with a complaint of heartburn after eating heavy meals. She said that initially it happened every once in a while but now seems to be happening more frequently and would like to start medication. She is unable to sleep and is struggling to eat. What should the nurse practitioner initially prescribe for treatment of severe GERD? A. Prilosec (omeprazole) B. Tums (calcium carbonate) C. Reglan (metoclopramide) D. Pepcid (famotidine)

A. Prilosec (omeprazole) H2 blockers and PPIs are both first-line treatments for GERD. But H2 blockers are used for milder disease and PPIs are used for severe disease

Which of the following are effective approaches to the management of moderate depression? Select all that apply. A. Psychotherapy B. Medication C. Lifestyle changes D. Combination of therapy and medications E. Combination of therapy, medication, and lifestyle

A. Psychotherapy B. Medication C. Lifestyle changes D. Combination of therapy and medications E. Combination of therapy, medication, and lifestyle

A two month old patient has suspected hip dysplasia. What might be present on assessment? A. Unequal gluteal folds B. Inability to lie prone on hips C. Pain with straightening of the legs D. Difficulty externally rotating the hips

A. Unequal gluteal folds

An elderly male visits the nurse practitioner in November for an annual physical exam and laboratory tests. The CBC results are hemoglobin of 12 g/dL, Hematocrit of 36%, and MCV of 76 fL. The patient has a history of benign prostatic hyperplasia, hypertension, hyperlipidemia. Which off the following laboratory tests is the next step in this patient's evaluation? A. TIBC, ferritin level, iron B. Homocysteine, folate level C. Vitamin B12 level, folate level D. Hemoglobin electrophoresis

A. TIBC, ferritin level, iron

The nurse practitioner is assessing a 6 month old boy and identifies a single palpable testicle in the scrotum. This increases the infant's risk for: A. Testicular cancer B. Penile cancer C. Epididymitis D. Hydrocele

A. Testicular cancer

A 19 year old patient is in the urgent care center with a complaint of scrotal pain 9/10. He has an absent cremasteric reflex. Which of the following should the nurse practitioners differential diagnosis include? A. Testicular torsion B. Epididymitis C. Testicular cancer D. Possible sexually transmitted infection

A. Testicular torsion

Which of the following statements is true regarding a threatened abortion? A. Vaginal bleeding and cramping are present, but the cervix remains closed B. Vaginal bleeding and cramping are present along with a dilated cervix C. The fetus and placenta are both expelled D. The products of conception and the placenta remain inside the uterus along with a dilated cervix

A. Vaginal bleeding and cramping are present, but the cervix remains closed

A well-controlled asthma patient presents to your office as they are experiencing "white patches" in their mouth. The nurse practitioner diagnoses the patient with oral candidiasis. What education should the nurse practitioner provide to this patient? A. You need to rinse your mouth out after using your fluticasone as this is the medication that led to your developing thrush. B. Do you need to be sure to wait at least an hour before eating or drinking after administering your fluticasone. C. This is an adverse side effect of salmeterol, so I will switch you to another long acting beta agonist. D. This is a very rare occurrence. After we treat you for thrush, you do not need to make any changes because this will likely not happen again.

A. You need to rinse your mouth out after using your fluticasone as this is the medication that led to your developing thrush.

A 35-year-old woman tries to donate blood but was unable due to a "low blood count." Which lab tests should the nurse practitioner order today to evaluate this patient? A. Hgb B. CBC C. CBC, peripheral smear D. CBC, iron studies

B. CBC

An older adult male with alcohol use disorder is scheduled for a physical exam and laboratory testing. The patient's laboratory blood test results may show: A. Increase serum creatinine levels and eGFR B. Decreased number of platelets and increased MCV C. Increased serum potassium and increased triglycerides D. Decreased AST and ALT levels

B. Decreased number of platelets and increased MCV

A 54 year old woman complains of "being stressed out" at her new job. She complains about daily headaches for several months and takes acetaminophen to self-treat twice a day. She describes the headache as being band-like and dull accompanied by tight neck muscles bilaterally. She denies nausea, vomiting, visual changes, and photophobia. Which of the following is appropriate management of this patient? A. Stop the acetaminophen and start her on ketorolac B. Discontinue the acetaminophen and encourage stress reduction measures as exercise and yoga C. Advised patient to start taking ibuprofen 1 to 2 tablets daily D. Start patient on butalbital and discontinue acetaminophen

B. Discontinue the acetaminophen and encourage stress reduction measures as exercise and yoga

Regarding the previous case, which of the following tests will help diagnose this patient? A. Lachman B. Dix-Hallpike C. Obturator D. Finklestein

B. Dix-Hallpike

A 37-year-old male high school teacher complains of an acute onset of pain and tenderness of his left wrist. He denies trauma to the wrist. He reports that the condition occurred on the same wrist before. The symptoms started that morning after he went to a birthday party the previous evening. He reports that he drank a few glasses of white wine. During the physical exam, the left wrist is red, swollen, and tender to palpation. The skin is intact but feels warm to touch. What is the most likely diagnosis? A. Wrist sprain B. Gout C. Osteoarthritis D. Septic joint

B. Gout

Which of the following is a contra indication for prescribing the "triptan" drug class? A. Peptic ulcer disease B. Heart disease C. Kidney infection D. Psoriasis

B. Heart disease

A 36-year-old female patient today comes in requesting birth control as she is recently divorced and started dating again. She has no known past medical history and has used the birth control pill Loestrin [norethindrone acetate/ethinyl estradiol) in the past. She is requesting to be placed back on Loestrin. Her vital signs at today's visit are: temp 98.7, heart rate 85, blood pressure 152/89, and O2 sat 99%. How should you respond to this patient? A. We will start you on the Loestrin today. Be sure to follow up if you have any new side effects. B. I can start you on birth control today, but I prefer to either start to an a progesterone only method or a non-hormonal method due to your elevated BP. C. I cannot start you on any birth control methods until your blood pressure has been evaluated. D. Loestrin is no longer FDA approved. I could start you on another combined oral contraceptive method such as Ortho-Tricyclen.

B. I can start you on birth control today, but I prefer to either start to an a progesterone only method or a non-hormonal method due to your elevated BP.

Due to safety concerns, scopolamine to reduce nausea secondary to motion sickness, should be used with caution: A. In adolescents B. In older adults C. As an adjunct to anesthesia D. In patients with diabetes

B. In older adults

The nurse practitioner is following up with a patient who started taking Zoloft (sertraline) 50 mg five weeks ago for new depressive symptoms. The patient reports that she now has had some relief in her symptoms but he's still having symptoms. What should the nurse practitioner do next? A. Discontinue the Zoloft, and start a medication from another drug class such as Elavil B. Increase the Zoloft dose to 75 mg PO daily, and instruct the patient to follow up in approximately one month C. Keep the Zoloft dosing the same as it has not been long enough for the patient to see the medication's full affect D. Discontinue the Zoloft, and encourage the patient to try counseling instead

B. Increase the Zoloft dose to 75 mg PO daily, and instruct the patient to follow up in approximately one month Extra tips: if patient has relief of symptoms and wishes to discontinue the med, it can be done after 4 to 6 months. Extra, extra tip: if the patient has G.I. symptoms in the first 4 to 6 weeks of starting Zoloft, such as nausea, vomiting, diarrhea, do not discontinue medication as these symptoms are self limiting.

A 45-year-old male patient reports to her office today for routine physical examination. Upon auscultation of heart sounds, you note a diastolic murmur - mitral stenosis. What should we do next for this patient? A. Educate the patient this is a normal variation and not a cause for concern B. Instruct the patient to follow up with a cardiologist C. Reassure the patient because when you ask auscultated the murmur, it disappeared during expiration D. Ask the patient to follow up with the nurse practitioner in one month for a recheck to see if the murmur is still occurring

B. Instruct the patient to follow up with a cardiologist

You are referring a patient who was diagnosed with actinic keratosis at today's visit in a primary care clinic to the dermatologist for removal. He states that he is about to go on a vacation abroad and would like to delay seeing the dermatologist until after he gets back from his vacation in two months. What guidance should you provide for this patient? A. It is no issue to delay your dermatology visit until after your return. Just make sure that you make an appointment for the week you return. B. It would be ill advised to delay your dermatology appointment as this has the potential to turn into squamous cell carcinoma. C. It would be you advised to delay your dermatology appointment as this has the potential to turn into basal cell carcinoma. D. On your trip, I would advise you to call the clinic if it becomes also rated or bleeds easier than normal.

B. It would be ill advised to delay your dermatology appointment as this has the potential to turn into squamous cell carcinoma.

A 60 year old woman with a 30 pack year smoking history visits the nurse practitioner clinic for an initial visit. How should she be screened for lung cancer? A. Chest x-ray B. Low-dose CT of chest C. MRI of chest D. No screening as indicated in this patient

B. Low-dose CT of chest

A 28-year-old woman at 20 weeks gestation is worried about possible down syndrome. Which of the following would the nurse practitioner expect to see when assessing her alpha-fetoprotein levels if this were the case? A. Normal B. Lower than normal C. Higher than normal D. Slightly above normal

B. Lower than normal

Ingestion of large seagoing fish, such as tuna, swordfish and shark should be avoided in pregnant women, because they contain large amounts of: A. Vitamin A B. Mercury C. Iron D. Toxoplasmosis

B. Mercury

An eight year old girl has been having episodes of abdominal pain mixed with nausea and vomiting over the last several months. There is a link between when the patient takes tests at school and her symptoms. She is diagnosed with abdominal migraines. What should a nurse practitioner educate the patient's father about? A. I can start her on Imitrex (sumatriptan) today to take when she has these episodes B. Most children with abdominal migraines later go on to develop migraines as adults C. Prophylactic medications will not be helpful with this particular type of migraine D. Children with abdominal migraines typically outgrow them altogether by age 12 and go on to live healthy lives

B. Most children with abdominal migraines later go on to develop migraines as adults Sumatriptan cannot be given to children under the age of 12 Prophylactic medication such as beta blockers can help symptoms

A 55-year-old woman with rheumatoid arthritis sees the nurse practitioner for an episodic visit. She has been taking ibuprofen twice daily for many years. All of the following organ systems are at risk for damage from chronic nonsteroidal anti-inflammatory drugs (NSAID) use, except: A. Cardiovascular system B. Musculoskeletal system C. Hematopoietic system D. Integumentary system

B. Musculoskeletal system Hematopoietic because aspirin affects platelets. Integumentary example Stevens-Johnson syndrome

A 30 year old patient with allergic rhinitis has been using OTC oxymetazoline for the past three months. She has developed rhinitis medicamentosa. What symptom is associated with this? A. Rhinorrhea B. Nasal congestion C. Cough D. Epistaxis

B. Nasal congestion

During the early stages of iron deficiency anemia, the red blood cells are: A. Microcytic B. Normocytic C. Macrocytic D. Hyperchromic

B. Normocytic

A young adult patient comes in with diffused generalized abdominal pain. Which of the following signs would support a diagnosis of appendicitis? Select all that apply: A. Murphy's sign B. Obturator sign C. Turner's sign D. Blumberg sign E. Rovsing sign

B. Obturator sign D. Blumberg sign E. Rovsing sign

A 29-year-old female patient presents to the office for a Pap smear. Previously, she has had a history of normal Pap results. On today's Pap smear, the results indicate that AS-CUS (atypical squamous cells of undetermined significance) is present. What should the nurse practitioner initiate next? A. Educate the patient this is a benign finding, and no further intervention is necessary B. Order HPV testing C. Refer the patient for a colposcopy D. Repeat the Pap smear to ensure an accurate sample was taken

B. Order HPV testing AS-CUS Is the most common abnormal finding on a pap smear. It is usually not serious, but further investigation is warranted. Therefore, HPV testing needs to be ordered. And if that is positive, colposcopy is needed.

A middle-aged woman presents with new increasing fatigue and chest congestion. Upon exam, it is noted that the patient's AP diameter is 2:2, and there is hyper resonance on percussion of the chest. Her past medical history is significant for hypertension and a 15 pack a year smoking history. What should the nurse practitioner do next? A. Prescribe albuterol for symptom relief B. Perform spirometry C. Educate the patient about the importance of quitting smoking to limit disease severity D. Refer the patient to a pulmonologist

B. Perform spirometry If we suspect COPD, the diagnostic tool is spirometry. To confirm the diagnosis of COPD we have to have an FEV1 over FVC ratio less than 0.70

A 28 year old multipara who is at 32 weeks gestation presents to your office complaining of a sudden onset of small amount of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft about patient. Which of the following is most likely? A. Placenta abruptio B. Placenta previa C. Acute cervicitis D. Molar pregnancy (hydatidiform mole)

B. Placenta previa

Molluscum contagiosum is caused by: A. Herpesvirus B. Poxvirus C. Staphylococcus aureus D. Haemophilus influenzae

B. Poxvirus

Do notice the following results on a routine urinalysis of a 37-year-old primagravida who is at 30 weeks gestation: Leukocytes = trace, nitrite = negative, protein = 2+, blood = negative. Her weight has increased by 5 pounds during the past week. Which of the following is most likely? A. HELLP syndrome B. Pregnancy induced hypertension (preeclampsia) C. Eclampsia of pregnancy D. Primary hypertension

B. Pregnancy induced hypertension (preeclampsia)

A 22-year-old presents for her annual gynecology goal exam and testing. The Pap smear results shows ASC - US. Which of the following is the best management for this patient? A. Check for high-risk HPV B. Repeat Pap in 12 months C. Refer patient to colposcopy D. Refer patient for endometrial biopsy

B. Repeat Pap in 12 months

Folic acid is recommended prior to and during the first three months of pregnancy to prevent neural tube defects. Which of the following answer choices are examples of neural tube defects? Select all that apply. A. Cleft palate B. Spina bifida C. Anencephaly D. Encephalocele

B. Spina bifida C. Anencephaly D. Encephalocele

A middle aged patient presents to the clinic with increased urination. She states that she is also more thirsty than normal. The nurse practitioner suspects possible diabetes and orders an Hgb A1cThe patient Hgb A1c today is 6.9%. Which would be appropriate for the nurse practitioner to prescribe? A. Instruct the patient to begin lifestyle modifications and return in three months for a follow up B. Start the patient on Metformin, and encourage the patient to also do additional lifestyle modifications C. Educate the patient that they are now considered "pre-diabetic" and will have to start Metformin D. Start the patient on a long acting insulin such as Lantus as their Hgb A1c is so elevated

B. Start the patient on Metformin, and encourage the patient to also do additional lifestyle modifications

What is the most common bacterial cause of pharyngitis? A. Mycoplasma pneumoniae B. Streptococcus Group A C. Streptococcus Group C D. Haemophilus influenzae

B. Streptococcus Group A

Which statements about cervical cancer are correct? Select all that apply. A. Women between ages 21 and 29 years should be screened every 5 years with Pap testing only. B. The cervical cancer screening intervals recommended by the American Cancer Society and the ASCCP are safe and were developed according to evidence-based guidelines. C. Immunization against HPV is most effective when administered before age 26 years. D. Two HPV vaccines doses are recommended for patients who are younger than 15 years and not sexually active.

B. The cervical cancer screening intervals recommended by the American Cancer Society and the ASCCP are safe and were developed according to evidence-based guidelines. D. Two HPV vaccines doses are recommended for patients who are younger than 15 years and not sexually active.

A 34 year old woman presents with a complaint of lower right quadrant pain. Her last menstrual period was 45 days ago. What should be in the differential diagnoses? Select all that apply. A. Cholecystitis B. Urinary tract infection C. Ectopic pregnancy D. Gastroenteritis E. Ovarian cyst

B. Urinary tract infection C. Ectopic pregnancy D. Gastroenteritis E. Ovarian cyst

A middle-aged man presents with a sharp severe stabbing pain on the right side of his face whenever he's trying to eat. The nurse practitioner suspects possible trigeminal neuralgia due to the severity of the patient's symptoms. Which cranial nerve is affected in this patient? A. III B. V C. VII D. VIII

B. V

You have a 10 year old patient that you are doing a diagnostic work up on for possible asthma. The nurse practitioner knows which of the following does not impact peak flow reading results? A. Height B. Weight C. Age D. Gender

B. Weight Mnemonic: HAG

An elderly patient with a history of severe mitral regurgitation has surgery for placement of a prosthetic mitral valve. Which of the following is the correct INR value? A. 1.5 to 2.5 B. 2.0 to 3.0 C. 2.5 to 3.5 D. 3.0 to 4.0

C. 2.5 to 3.5 Higher INR is recommended for patients with prosthetic valves because of a higher risk of blood clots

A six year old is started on amoxicillin to treat tonsillitis. A side effect of amoxicillin common in children is: A. Nausea B. Joint pain C. Abdominal pain D. Headache

C. Abdominal pain

A 42 year old obese female patient comes in with RUQ pain after eating fried chicken last night from a local restaurant. She states that pain started about an hour after eating and radiated between her shoulder blades. What should you order for the patient? A. EGD B. HIDA scan C. Abdominal ultrasound D. Baseline CMP

C. Abdominal ultrasound

When are symptoms of groin hernias most evident? Select all that apply. A. After eating B. Before a bowel movement C. After sitting for an extended period of time D. With heavy lifting E. After prolonged standing

C. After sitting for an extended period of time D. With heavy lifting E. After prolonged standing

A 25-year-old female patient comes into the clinic with a large dog bite. The patient has no known drug allergies. Which antibiotic would be most appropriate to prescribe for this patient prophylactically? A. Keflex B. Ciprofloxacin C. Augmentin D. Ceftriaxone

C. Augmentin

A 46 year old sales clerk has been diagnosed with mitral stenosis. What choice best describes this murmur? A. A late systolic click near the apex B. Radiation of soft diastolic sounds into the neck and carotid arteries C. Diastolic sounds heard loudest near the apex D. Soft diastolic sounds in the left midclavicular area

C. Diastolic sounds heard loudest near the apex

Among patients with nephrolithiasis, which is the most common type of kidney stone? A. Struvite B. Cystine C. Calcium oxalate D. Uric acid

C. Calcium oxalate

Which condition may be associated with gout? A. Peptic ulcer disease B. Nonalcoholic fatty liver disease C. Chronic renal disease D. Gastric ulcer disease

C. Chronic renal disease

A 35 year old woman smokes approximately 10 cigarettes per day. She started smoking at the age of 18 years. She has a new male sexual partner and is interested in contraception. She was recently treated for gonorrhea and chlamydia. She is using condoms in consistently. The urine pregnancy test is negative. She denies a history of hypertension, blood clots, liver disease, heart disease, and diabetes. Her last menstrual period was five days ago. Which of the following contraceptive methods is recommended? A. Oral contraceptive pills B. Copper IUD C. Etonogestrel implant (Nexplanon) D. Vaginal ring (NuvaRing)

C. Etonogestrel implant (Nexplanon)

An 18 year old woman is complaining of right ankle pain. She reports twisting her ankle while jogging the previous day. She states that she "rolled inward" on her ankle. During the physical exam, the nurse practitioner finds a markedly swollen ankle with several areas of ecchymosis. There is tenderness on the tip of the lateral malleolus. The joint is tender on palpation. The patient has problems with weight-bearing and walking. What type of sprain does this patient have? A. Grade I B. Grade II C. Grade III D. Grade IV

C. Grade III

A mother comes in with her 14 month old son concerned about whether he's progressing like other children his age. Which finding would indicate the child needs further evaluation? A. He is able to walk to steps, but then falls B. He says "mama/dada" with meaning C. He grasps tightly around whatever is placed in his hand when the palm is stroked D. He consistently reaches up to be held when upset

C. He grasps tightly around whatever is placed in his hand when the palm is stroked

What is the most common cause of death for people with DM? A. Unintentional injuries or accidents B. Pancreatic cancer C. Heart disease D. Hypoglycemia

C. Heart disease

A 23 year old woman is receiving spironolactone (Aldactone) for polycystic ovarian syndrome. Follow up, she has a serum potassium of 5.8 mEq/L. The nurse practitioner should: A. Discontinue spironolactone B. Discontinue the spironolactone and administer Kayexalate C. Hold spironolactone until hyperkalemia is resolved D. Discontinue spironolactone and begin a thiazide diuretics

C. Hold spironolactone until hyperkalemia is resolved

A 40-year-old African-American patient has blood pressure readings of 175/10 and 170/102. What is a reasonable plan of care for this patient today? A. Start 12.5 mg hydrochlorothiazide daily (usual dose 12.5 to 50 mg daily) B. Start 10 mg lisinopril daily (usual dose is 10 to 40 mg daily) C. Initiate 5 mg amlodipine daily (usual dose is 5 to 10 mg daily) D. Initiate 5 mg amlodipine and 10 mg lisinopril daily

C. Initiate 5 mg amlodipine daily (usual dose is 5 to 10 mg daily)

A mother reports that her 1-year old child has an allergy to eggs that produces a nonpruritic rash. The nurse practitioner knows that this: A. Contraindicates most immunizations B. Requires careful monitoring and follow up C. Is not IgE mediated D. Contraindicates influenza immunization

C. Is not IgE mediated

A 55-year-old female patient experience menopause approximately two years ago. Due to issues with hot flashes, she was prescribed Paxil which has controlled her symptoms. Today, the patient reports noting some new drops of blood when going to the bathroom and is asking if her period is restarting. What should the nurse practitioner tell the patient? A. Long-term use of Paxil can lead to vaginal bleeding. We will discontinue your Paxil and start you on another SSRI for symptom control. B. It is important that we run some diagnostic lab work today to evaluate you for possible anemia. C. It is abnormal to have vaginal bleeding after menopause. I will refer you to a gynecologist for further evaluation and possible biopsy. D. It is normal to have post menopausal vaginal bleeding for up to 5 years after the start of menopause.

C. It is abnormal to have vaginal bleeding after menopause. I will refer you to a gynecologist for further evaluation and possible biopsy.

Which of the following is the recommended treatment for hereditary hemochromatosis? A. Genetic counseling B. Ferrous sulfate supplementation C. Phlebotomy D. Dialysis

C. Phlebotomy

An adolescent has acne. The nurse practitioner prescribe a benzoyl peroxide product for him. What important teaching points should be given to this adolescents regarding the benzoyl peroxide? A. Don't apply this product more than once daily B. This often causes peeling of the skin C. Photosensitivity of the skin can occur D. Hypersensitivity can occur with repeated use

C. Photosensitivity of the skin can occur

What is the most common cause of secondary amenorrhea? A. Turner syndrome B. Polycystic ovary syndrome C. Pregnancy D. Anorexia nervosa

C. Pregnancy

An actinic keratosis lesion is not likely to: A. Have a sandpaper-like texture B. Progress to squamous cell carcinoma C. Present as an erythematous, smooth lesion D. Who larger than 6 mm in diameter

C. Present as an erythematous, smooth lesion

A nurse practitioner student has severe test anxiety. Which medication could it take to relieve his anxiety prior to taking his certification exam? A. 50 mg sertraline for 6-8 weeks before exam B. Low dose alprazolam 45 minutes before the exam C. Propranolol 60 minutes before the exam D. Buspirone 60 minutes before the exam

C. Propranolol 60 minutes before the exam

A 30 year old woman who is 11 weeks pregnant comes into your office for a follow up on recent lab work. Her lab work shows a decreased TSH and an elevated T3/T4. Which of the following would be most appropriate to prescribe to this patient? A. Synthroid B. Methimazole (Tapazole) C. Propylthiouracil (PTU) D. Radioactive iodine

C. Propylthiouracil (PTU)

A patient presents with complaints of double vision. Upon neurologic exam, the nurse practitioner discovers abnormalities to cranial nerve III resulting in: A. Decrease corneal reflex B. Extropia C. Ptosis D. Anisocoria

C. Ptosis

Which diagnosis cannot be determined by a chest x-ray? A. Pneumonia B. Heart failure C. Pulmonary embolism D. Pulmonary edema

C. Pulmonary embolism

Elevated uric acid levels associated with gout is an end stage byproduct of the metabolism of: A. Tyrosine B. Alanine C. Purine D. Glycine

C. Purine

Which lab value will the nurse practitioner monitor in a patient taking theophylline? A. Liver function test B. Complete blood count C. Serum concentration D. Complete metabolic panel

C. Serum concentration

A three year old child with a history of asthma presents with symptoms of croup. The nurse practitioner notes mild intercostal retractions in the patient. How should this be managed? A. Nebulized albuterol for cough B. Guaifenesin/dextromethorphan PRN for cough C. Single dose of oral dexamethasone (0.6 mg/kg) D. Oral prednisone for three days

C. Single dose of oral dexamethasone (0.6 mg/kg)

A 13 year old female patient was recently diagnosed at an outside facility with pharyngitis and prescribe amoxicillin. A week after starting the antibiotics, the patient develops an erythematous maculopapular rash with healthy skin intervening throughout. What should you educate the mother about? A. This is likely scarlatina and we need to start Keflex instead B. This is a typical side effect of taking amoxicillin, and it will result with use of OTC steroids C. Sometimes this rash occurs when patients are given antibiotics for viral etiologies of strep throat. It will resolve on its own D. This rash is known as scarlatina so I am going to refer you to the ED for further treatment

C. Sometimes this rash occurs when patients are given antibiotics for viral etiologies of strep throat. It will resolve on its own

A 73-year-old male who is a smoker has a BMI of 28 and his newly diagnosed with primary hypertension. He has a history of emphysema and second-degree AV block. His blood pressure from the previous visit is 145/80 mmHg. During the current visit, his blood pressure is 155/80 mmHg. What is the next step? A. Start patient on atenolol 50 mg once a day and reassess in three months B. Start patient on felodipine 2.5 mg once a day and reassess in two months C. Start patient on chlorthalidone 12.5 mg daily and reassess in one month D. No medication is needed at this time

C. Start patient on chlorthalidone 12.5 mg daily and reassess in one month

A young adult female patient presents to the urgent care clinic with thin and foamy vaginal discharge. On the physical exam of this patient, there is a positive whiff test and clue cells are present. The client is diagnosed with bacterial vaginosis. What should the nurse practitioner educate her client about the treatment? A. Until you complete your course of antibiotics, you need to abstain from having sex as you might infect your partner B. Tell your partner to also come to the clinic because he needs to be tested and treated as well C. The antibiotics that I will prescribe you for this issue will make you very sick if you drink alcohol D. This will likely go away on its own shortly so there is no need to treat you with antibiotics

C. The antibiotics that I will prescribe you for this issue will make you very sick if you drink alcohol Flagyl (disulfiram-like reaction w/ ETOH)

A 14 year old male patient comes into the clinic. He is on his high school wrestling team and recently developed a new skin rash near his groin. Upon examination, there is an erythematous annular lesion present with central clearing on his right inner thigh. What diagnosis should the nurse practitioner document in her note? A. Tinea pedis B. Tinea barbae C. Tinea cruris D. Tinea capitis

C. Tinea cruris Jock itch

A 10 year old male patient comes in with intense pruritis of the back of his knees. His mother states this seems to happen every year during the summer months. On exam, you note that the skin is erythematous and very rough to the touch. What treatment should the nurse practitioner prescribe for this patient? A. Topical coal tar B. Phototherapy C. Topical steroids D. Tetracycline D. Nothing, the patient should be educated about avoiding triggers

C. Topical steroids

And independent 82-year-old male patient is very active but retired last year. His total cholesterol and LDLs are moderately elevated. How should the nurse practitioner approach his lipid elevation? A. He has reached an age where treatment holds little benefit B. Treatment is age dependent, he should receive a statin today C. Treatment is based on expected length of life D. He should receive a statin today until he is 85 years

C. Treatment is based on expected length of life

Which of the following is not a symptom of heart failure? A. Peripheral edema B. Shortness of breath C. Urinary retention D. Hypertension

C. Urinary retention

All of the following increase the risk of urinary tract infection in women, except: A. Frequent sexual intercourse B. Pregnancy C. Vaginal douching D. Spermicide used with diaphragms

C. Vaginal douching

An elderly patient has a positive PCR for varicella zoster virus and has a recent history of breast cancer. All of the following interventions should be included in the treatment plan, except: A. Acyclovir five times daily x10 days B. Lidocaine 5% patch C. Zostavax vaccine D. Gabapentin TID

C. Zostavax vaccine This patient is immuno compromised and should not receive a live vaccine

A 49-year-old male patient comes into the office with a chief complaint of right leg pain. Upon exam, it is noted that there is localized erythema on the patient's right lower leg with multiple areas producing purulent drainage. The area is edematous and tender to palpation. Which of the following antibiotics would not be appropriate for treating this condition? A. Bactrim B. Clindamycin C. Doxycycline D. Keflex

D. Keflex This is purulent cellulitis. Remember BCD - Bactrim, Clindamycin, Doxycycline

Anemia and certain chronic diseases is likely a result of decreased red blood cell productions which is triggered by the release of erythropoietin from them A. Liver B. Spleen C. Bone marrow D. Kidneys

D. Kidneys

You recently saw a 57 year old woman two months ago for treatment of a sinus infection. Today, she is complaining of a cough, fever and chills over the last three days. On exam, you note audible expiratory wheezes on auscultation and there is increased tactile fremitus. What should you prescribe for this patient? A. Ciprofloxacin B. High dose amoxicillin C. Doxycycline D. Levofloxacin

D. Levofloxacin

Which vehicle is least appropriate for treating a steroid-responsive condition on thickened skin of the elbows and knees of an adult? A. Gel B. Cream C. Ointment D. Lotion

D. Lotion

A previously well-controlled moderate persistent asthma patient is now having recurrence of daily symptoms. The patient's FEV1today is 56%. According to the 2019 GINA guidelines, what medication should the nurse practitioner prescribe for this patient? A. Levalbuterol B. Fluticasone C. Salmeterol D. None of the above

D. None of the above FEV1 <60% = severe asthma = REFER TO PULMONOLOGY!!!

A 13 year old patient presents to you with left ear pain after spending a week at summer camp where he swam every day. Upon exam, it is noted that the ear canal is erythematous and edematous. The patient is diagnosed with otitis externa. What bacteria is likely responsible for this issue? A. Staphylococcus aureus B. Aspergillus C. Candida species D. Pseudomonas aeruginosa

D. Pseudomonas aeruginosa

A 12 month old girl received the varicella vaccine three weeks ago. How long must she wait before receiving the MMR vaccine? A. 1 week B. 2 weeks C. 3 weeks D. She may receive it today

A. 1 week

A 55-year-old female patient presents with symptoms of urinary tract infection. A clean catch midstream urine specimen is obtained and sent to the laboratory for culture and sensitivity testing. Which of the following results is indicative of an uncomplicated urinary tract infection? A. 10^5 CFU/mL of one organism B. 10^5 CFU/mL of one or more organism C. 10^3 CFU/mL of Enterobacteriacae D. 10^3 CFU/mL of gram-negative Enterobacteriacae

A. 10^5 CFU/mL of one organism

The CDC recommends monitoring a child after immunization for: A. 15 minutes B. 30 minutes C. 45 minutes D. 60 minutes

A. 15 minutes

Patient at the highest risk of developing suicidal thoughts with the initiation of SSRIs fall within the age range of: A. 18-24 B. 25-30 C. 31-65 D. >65

A. 18-24

At what age should dyslipidemia risk assessment begin? A. 2 years B. 5 years C. 6 years D. 10 years

A. 2 years

A 67-year-old female patient is being seen today for a follow up on recent lab work related to fatigue. Her lab results showed that her TSH is elevated and her T3/T4 are decreased. What starting dose of Synthroid should be prescribed to this patient? A. 25 mcg B. 37.5 mcg C. 50 mcg D. 75 mcg

A. 25 mcg

A 75 year old woman that was diagnosed with depression and started on sertraline (usual dose 50-200 mg daily). which dosage would be a good starting dose for her? A. 25 mg once daily B. 25 mg twice daily C. 50 mg once daily D. 100 mg once daily

A. 25 mg once daily

At what age are symptoms of pyloric stenosis most likely to develop? A. 3-6 weeks B. 3 months C. 6 months D. 12 months

A. 3-6 weeks

A 63 year old woman with type 2 diabetes mellitus is diagnosed with hypertension and has microalbuminuria. She is started on an ACE inhibitor. How soon can the antiproteinuric effect of the ACE inhibitor be realized in this patient? A. 6 weeks B. 3 months C. 6 months D. 3-5 years

A. 6 weeks

A patient was exposed to HIV through sexual intercourse last night. He was screamed and found to be negative for HIV. When should he be screened again? A. 6 weeks B. 8 weeks C. 3 months D. 6 months

A. 6 weeks

A nurse practitioner has diagnosed a child with roseola. How old is this child likely to be? A. 7-13 months old B. 2-4 years old C. 3-6 years old D. 6-12 years old

A. 7-13 months old

Which scenario is most concerning for scoliosis? A. A 13 year old girl with a 10° curve in the spine B. A 17 year-old girl with a 10° curve in the spine C. A 12 year old boy with a 5° curve in the spine D. An 18 year old boy with a 5° curve in the spine

A. A 13 year old girl with a 10° curve in the spine

Each of the following children has received the PCV 13 vaccine. Which of them needs the PPSV 23 immunization? Select all that apply. A. A 5-year old patient who has cyanotic heart disease B. A 3-year old patient with functional asplenia C. A 7-year old patient with a cochlear implant D. A 4-year old patient will be traveling internationally

A. A 5-year old patient who has cyanotic heart disease B. A 3-year old patient with functional asplenia C. A 7-year old patient with a cochlear implant

What are USPSTF recommended guidelines for breast cancer screening? A. A baseline mammogram should start at age 50 and repeat every two years until age 74 B. A baseline mammogram should start at age 40 and repeat every three years until age 74 C. A baseline mammogram should start at age 50 and repeat every year until age 74 D. A baseline mammogram should start at age 55 and repeat every three years

A. A baseline mammogram should start at age 50 and repeat every two years until age 74

The appropriate pharmacology management choice for a patient with symptomatic hyperthyroidism is: A. A beta blocker B. An ACE inhibitor C. Thyroid hormone D. Aspirin

A. A beta blocker

Which of the following assessment findings warrants an urgent referral of the patient to the emergency department? A. A fiery red epiglottis B. Sudden onset of hoarseness C. Purulent drainage from the external canal D. Tragal tenderness

A. A fiery red epiglottis

Thickened, hyperpigmented skin with a velvet like texture found in flexural areas (i.e.. axillae, skinfolds) are most likely: A. Acanthosis nigricans B. Seborrheic keratosis C. Dysplastic nevi D. Lentigo

A. Acanthosis nigricans

A 35-year-old woman with type two diabetes mellitus has taken 1000 mg Metformin twice daily for the past three months. Today's hemoglobin A1c has decreased to 7.8%. An appropriate action today is to: A. Add glimepiride because this patient does not have health insurance and she is unable to afford a different medication. B. Continue the current dose of Metformin for another three months before adding another agent. C. Discontinue her metformin and consider a once daily insulin in the evening. D. Encourage lifestyle modifications (diet and exercise) for another three months before adding a second agent.

A. Add glimepiride because this patient does not have health insurance and she is unable to afford a different medication.

Which of the following could be the cause of an elevated alkaline phosphatase level? A. Age B. Pregnancy C. Recent healing fracture D. Hyperthyroidism E. Bone metastasis

A. Age B. Pregnancy C. Recent healing fracture D. Hyperthyroidism E. Bone metastasis

When should routine blood pressure screening begin in children? A. Age 3 years B. Age 5 years C. Age 6 years D. Age 10 years

A. Age 3 years

Which antibiotic(s) is/are not contraindicated in pregnancy? A. Amoxicillin B. Levofloxacin C. Trimethoprim sulfamethoxazole D. Cefalexin

A. Amoxicillin D. Cefalexin

Polycystic ovarian syndrome (PCOS) reflects an excess of which hormone? A. Androgen B. Estrogen C. Testosterone D. Progestin

A. Androgen

Which of the following is the screening test for hepatitis C virus (HCV)? A. Anti-HCV B. HBsAg C. Anti-HAV D. HCV RNA polymerase chain reaction (PCR)

A. Anti-HCV

A 24-year-old woman calls the office stating that she thinks she has a vaginal yeast infection again. She requests that her provider called in a prescription. Which statements are correct? Select all that apply. A. Ask her to come in for an exam as soon as possible. B. Take a brief history before deciding if she should be seen in the office. C. Call in a prescription for an anti-fungal; this patient is known to you. D. Recommend an OTC external cream for symptom relief until she can be seen in the office.

A. Ask her to come in for an exam as soon as possible. D. Recommend an OTC external cream for symptom relief until she can be seen in the office.

A patient has type two diabetes and takes NPH insulin. If his blood glucose values are elevated before the evening meal, when should additional NPH insulin be given? A. At breakfast B. One hour after breakfast C. One hour before lunch D. With lunch

A. At breakfast

The uterine fundus should be palpable at 20 weeks gestation: A. At the level of the umbilicus B. Just above the level of the symphysis pubis C. Midway between the symphysis pubis and the umbilicus D. Below the symphysis pubis

A. At the level of the umbilicus

The nurse practitioner is treating the patient of a 22 year old patient with a positive nucleic acid amplification test for chlamydia trachomatis. Which of the following is the preferred treatment for the patient's partner? A. Azithromycin 1 g PO in a single dose B. Benzathine penicillin 2.4 million units IM in a single dose C. Clindamycin 300 mg BID X7 days D. Doxycycline 100 mg PO BID x7 days

A. Azithromycin 1 g PO in a single dose

A middle-aged adult presents as a "walk-in" patient. He is anxious and wants to be seen today. He complains that when he woke up and got out of bed that morning, he had severe dizziness and almost fell on the floor because "the room was spinning so much." His gait is unstable with some swaying noted. He reports that if he moves his head quickly, he gets very dizzy and has problems with balance. He denies trauma, hypertension, tinnitus, hearing loss, and fever. The Romberg test is positive. Which of the following conditions is most likely? A. BPPV (Benign proximal positional vertigo) B. Ménière's disease C. Acoustic neuroma D. Cerebrovascular accident (CVA)

A. BPPV (Benign proximal positional vertigo)

Which neurological assessment will evaluate cerebellar function in a patient who reports experiencing left facial numbness that occurred for 10 minutes, then subsided? A. Balance B. Coordination C. Movement D. Cerebral reflexes E. Sensation

A. Balance B. Coordination C. Movement D. Cerebral reflexes E. Sensation

A 45-year-old woman arrived with sudden complaint of facial drooping and numbness on the right side. She is unable to close the right eye or lift the right paper. The nurse practitioner assessment findings show no other neurological deficits. The nurse practitioner suspects: A. Bell's palsy B. A transient ischemic attack (TIA) C. A cerebral vascular accident (CVA) D. Trigeminal neuralgia

A. Bell's palsy

A 14 year old male patient is brought into the clinic for new issues with acne. Upon exam, it is noted that they are erythematous, pus filled pimples across the patient's chin and hairline. What would be the most appropriate treatment for this patient? A. Benzoyl peroxide B. Topical erythromycin C. PO doxycycline D. Accutane

A. Benzoyl peroxide

Which findings are typically associated with leukemia? A. Bruising B. Bleeding C. Frequent nosebleeds D. Fatigue E. Swollen lymph nodes

A. Bruising B. Bleeding C. Frequent nosebleeds D. Fatigue E. Swollen lymph nodes

A 35 year old woman was diagnosed today with iron deficiency anemia (IDA). The nurse practitioner has prescribed once daily ferrous sulfate for the patient. What labs should be ordered when she returns in 4 weeks for a clinic follow up? A. CBC B. CBC, serum iron C. CBC, serum ferritin D. CBC, serum ferritin, red cell distribution width (RDW)

A. CBC

A 46 year old woman with abdominal pain in the right lower quadrant has suspected diverticulitis. What should be part of the initial workout? Choose all that apply. A. CBC B. Electrolytes C. Pregnancy test D. Urinalysis E. CT scan with and without contrast

A. CBC B. Electrolytes C. Pregnancy test D. Urinalysis E. CT scan with and without contrast

A 33-year-old woman presents with complaints of constipation. The antacid that is most likely to cause constipation is: A. Calcium carbonate (Tums) B. Aluminum magnesium (Maalox) C. Magnesium hydroxide (milk of magnesia) D. Sodium bicarbonate (Alka-Seltzer)

A. Calcium carbonate (Tums)

A febrile child is in the exam room with his mother and your office nurse. Assessment findings include a croupy cough, intercostal retractions, stridor and drooling. How should this patient be managed right now? Select all that apply. A. Call 911 B. Administer nebulized epinephrine C. Administer a steroid injection D. Instruct the mother to drive the child to the nearest emergency department E. Administer nebulized coolmist until EMS arrives

A. Call 911 B. Administer nebulized epinephrine

A 25 year old woman with hirsutism, obesity, and oligomenorrhea is diagnosed with PCOS. A woman with PCOS is at higher risk for all of the following except? A. Cervical cancer and atrophic vaginitis B. Endometrial cancer and infertility C. Type two diabetes and heart disease D. Obesity and nonalcoholic fatty liver disease

A. Cervical cancer and atrophic vaginitis

A patient has taken 100 mg sertraline for the past seven months. She abruptly stopped taking it five days ago. What symptoms today may be attributed to abrupt discontinuation of this SSRI? Select all that apply. A. Chills B. Dizziness C. Fatigue D. Myalgia E. Dysphoria

A. Chills B. Dizziness C. Fatigue D. Myalgia E. Dysphoria

A 35-year-old woman presents with moderate depression. She refuses to take a medication but is willing to try psychotherapy. What is an example of psychotherapy? Select all that apply. A. Cognitive behavioral therapy B. Social skills training C. Interpersonal psychotherapy D. Behavioral activation E. Problem-solving therapy

A. Cognitive behavioral therapy B. Social skills training C. Interpersonal psychotherapy D. Behavioral activation E. Problem-solving therapy

A patient has been diagnosed with anemia of chronic disease. What might be part of the reason for this diagnosis? Select all that apply. A. Colorectal cancer B. Iron deficiency anemia C. Poorly controlled lupus D. Metastatic breast cancer E. Severe ulcerative colitis

A. Colorectal cancer C. Poorly controlled lupus D. Metastatic breast cancer E. Severe ulcerative colitis

On ophthalmoscopic examination of a 70 year old, a thin grayish white arc is noted on the lower end of the cornea this is referred to as a: A. Corneal arcus B. Corneal scar C. Pterygium D. Cataract

A. Corneal arcus

A 24-year-old man presents with complaints of episodes of intermittent weight loss over the last three months. He denies hematochezia. His ESR and CRP are elevated. The most likely diagnosis is: A. Crohn's disease B. Ulcerative colitis C. Irritable bowel syndrome D. Peptic ulcer disease

A. Crohn's disease

Common side effects of selective serotonin reuptake inhibitors (SSRIs) include: A. Diarrhea B. Nausea C. Sexual dysfunction D. Somnolence E. Weight loss

A. Diarrhea B. Nausea C. Sexual dysfunction D. Somnolence

A 10-year-old patient is brought to the urgent care clinic after a tick bite. On the right lower leg where the tick was attached, there is a red rash with central clearing present. What medication should be used to treat this condition? A. Doxycycline B. Erythromycin C. Amoxicillin D. Keflex

A. Doxycycline (Lyme disease - erythema migrans)

A 36-year-old presents with erythema migrans after a hunting trip to the mountains one week ago. The medication that is recommended for this is: A. Doxycycline (Doryx) B. Amoxicillin clavulanate (Augmentin) C. Trimethoprim sulfamethoxazole (Bactrim) D. Cephalexin (Keflex)

A. Doxycycline (Doryx)

A middle-aged female patient with a history of osteoarthritis and asthma reports to the nurse practitioner that she has been taking ibuprofen twice daily for many years. All of the following organ systems are at risk of damage from chronic NSAID use exceptM A. Endocrine system B. Respiratory system C. Gastrointestinal system D. Renal system

A. Endocrine system

Quinolones are not recommended for patients with community acquired pneumonia who have a comorbidity of: A. Epilepsy B. Diabetes C. Heart failure D. Depression

A. Epilepsy

A young adult with myasthenia gravis is diagnosed with pertussis. Which antibiotic is contraindicated in a patient with this condition? A. Erythromycin B. Doxycycline C. Clarithromycin D. Azithromycin

A. Erythromycin Erythromycin and telithromycin are contraindicated in patients with myasthenia gravis because of potential respiratory collapse

A 22 year old patient witnessed the brutal murder of her friend. She has been diagnosed with PTSD. Which medication could be tried initially to manage her symptoms? Select all that apply. A. Escitalopram B. Bupropion C. Lorazepam D. Hydroxyzine E. Sertraline

A. Escitalopram E. Sertraline

A mother brings her adolescent son in for a routine physical examination. During the exam, you mentioned that it is recommended that her son received the Gardasil vaccine. The mother responds, "Doesn't Gardasil just prevent cervical cancer in women?" How would you respond to the mother? A. Gardasil protects against the hide risk forms of HPV virus, which can lead to cancer in men as well. B. Gardasil protect women from cervical cancer, and men from prostate cancer. C. The Gardasil vaccine will prevent your child from ever being able to get our spread the HPV virus to anyone else. D. The Gardasil vaccine protect against the HPV virus and the majority of sexually transmitted diseases

A. Gardasil protects against the hide risk forms of HPV virus, which can lead to cancer in men as well.

An adolescent athlete reports a sudden onset of posterior right thigh pain. The injury occurred while she was running during a soccer game. She denies falling. She is limping and walking slowly. On physical examination, the middle portion of the right hamstring muscle is tender to palpation with some bruising noted. Which of the following conditions is most likely in this patient? A. Hamstring muscle strain B. Baker's cyst C. Quadriceps muscle strain D. Piriformis syndrome

A. Hamstring muscle strain

A 67-year-old man complains of pain in his left calf when he walks. The pain is relieved by rest. The patient's ankle brachial index (ABI) is 0.75. He probably: A. Has peripheral vascular disease B. Does not have peripheral vascular disease C. Has atypical leg symptoms D. Has normal pedal pulses

A. Has peripheral vascular disease

Which conditions make NSAID use for osteoarthritis riskier? Select all that apply. A. Heart failure B. Chronic renal disease C. History of myocardial infarction D. Gastric ulcer disease E. Nonalcoholic fatty acid disease

A. Heart failure B. Chronic renal disease D. Gastric ulcer disease

A 55-year-old male patient comes into the clinic who has worked as a carpenter throughout his life. He is complaining of joint stiffness and pain upon awakening in the morning in his hands. The pain starts to dissipate once he gets up from bed and starts working. What clinical findings would the nurse practitioner suspect to find in this client upon further examination? Select all that apply: A. Heberden's nodes B. Joint space narrowing on an x-ray C. Boutonniere deformity D. Swan neck deformity E. Bouchard's nodes

A. Heberden's nodes B. Joint space narrowing on an x-ray E. Bouchard's nodes Boutonniere deformity and swan neck deformity are indicative of rheumatoid arthritis

Which of the following health conditions may be associated with constipation? Select all that apply. A. Hemorrhoids B. Anal fissure C. Anorexia nervosa D. Parkinson's disease E. Hypothyroidism

A. Hemorrhoids B. Anal fissure C. Anorexia nervosa D. Parkinson's disease E. Hypothyroidism

All of the following have been classified as nationally notifiable diseases by the Centers for Disease Control and Prevention, except: A. Herpes simplex infections B. Pertussis C. Anthrax D. Lyme disease

A. Herpes simplex infections

A patient with a prosthetic heart valve is taking warfarin (Coumadin) therapy. The appropriate action prior to dental surgery is to: A. Hold the warfarin five days prior to surgery and begin a low molecular weight heparin B. Hold the warfarin two days before surgery and resume immediately afterwards C. Decrease the dose of Coumadin by 50% for the week prior to surgery D. Hold warfarin three days prior to surgery and administer vitamin K about two hours prior to surgery

A. Hold the warfarin five days prior to surgery and begin a low molecular weight heparin

Amsel's criteria for bacterial vaginosis diagnosis include: A. Homogeneous white discharge coating the vulva/vagina B. Vaginal pH of >4.7 C. Fishy odor of vaginal discharge before or after adding of KOH ("whiff test") D. Clue cells on microscopic exam

A. Homogeneous white discharge coating the vulva/vagina B. Vaginal pH of >4.7 C. Fishy odor of vaginal discharge before or after adding of KOH ("whiff test") D. Clue cells on microscopic exam

Which cranial nerves are associated with eye movement? Select all that apply. A. III B. IV C. VI D. V

A. III B. IV C. VI

Which medication will the nurse practitioner include in the treatment plan for a patient with a positive Finkelstein's test? A. Ibuprofen B. Oral prednisone C. Lidocaine injection D. corticosteroid injection

A. Ibuprofen De Quervain's tenosynovitis - First line treatment for this condition includes applying ice packs for a prescribed amount of time daily and taking nonsteroidal anti-inflammatory drugs such as ibuprofen for discomfort.

Which symptoms are associated with depression in older adults? Select all that apply. A. Impaired memory B. Tremors C. Low energy (anergy) D. Inability to concentrate E. Social withdrawal

A. Impaired memory C. Low energy (anergy) D. Inability to concentrate E. Social withdrawal

A test of cure to assure resolution of gonococcal infection is not needed: A. In a 33-year-old man with uncomplicated rectal gonorrhea treated with first line medications B. A 24 year old pregnant woman treated with first line medications C. A 28 year old woman with pharyngeal gonorrhea with a macrolide allergy D. An 18 year old man treated one month ago and who now has urethritis

A. In a 33-year-old man with uncomplicated rectal gonorrhea treated with first line medications

Which of the following statements indicates that the nurse practitioner understands probable pregnancy with a urine hCG test? A. In a normal pregnancy, urine and blood test are about equally accurate. B. If an ectopic pregnancy is suspected, a qualitative hCG serum test should be ordered. C. If a home urine test is positive, and in office test is not needed. D. Urine testing can be done as soon as a missed period occurs.

A. In a normal pregnancy, urine and blood test are about equally accurate.

What is the first-line treatment for asthma? A. Inhaled corticosteroids B. Long-acting beta2-agonists C. Leukotriene inhibitors D. Short-acting beta2-agonists

A. Inhaled corticosteroids

The mechanism of action of venlafaxine (Effexor), the treatment of depression, is to: A. Inhibit the uptake of serotonin and norepinephrine B. Increase norepinephrine and serotonin levels and block the action of acetylcholine C. Decrease serotonin availability in the synaptic space, causing an upregulation of 5HT1A receptors D. Increase serotonin availability in the synaptic space, causing an downregulation of 5HT1A receptors

A. Inhibit the uptake of serotonin and norepinephrine

A three year old girl is diagnosed with fifth disease. Her mother is in the first trimester of pregnancy and has had significant exposure to the sick child. If her mother has a positive IgM test (Parvo B 19), what is the risk to the fetus? A. Intrauterine fetal death B. Significant fetal neurologic delay C. Congenital heart defects D. Significant orthopedic anomalies

A. Intrauterine fetal death

The nurse practitioner observes abdominal guarding in an 18 month old patient. And abdominal ultrasound reveals a "coiled spring appearance" in the mid upper abdomen. What is the most likely diagnosis? A. Intussusception B. Intestinal obstruction C. Constipation D. Pathologic reflux

A. Intussusception

Which statements are true about placenta previa? Select all that apply. A. It causes painless vaginal bleeding. B. It usually occurs in the second trimester. C. Obstetric referral is not needed unless the symptoms worsen. D. Give me progress to placenta abruptio.

A. It causes painless vaginal bleeding. B. It usually occurs in the second trimester. D. Give me progress to placenta abruptio.

What is the value of vitamin D supplementation in the diet of older adults? A. It decreases the risk for falls B. It decreases the severity of hip fractures C. There is no clear value unless a vitamin D deficiency is identified D. It helps to prevent fractures

A. It decreases the risk for falls

A nurse practitioner is examining an eight year old patient and identifies raised, red papillae on the tongue. What might be the cause of this? Select all that apply. A. Kawasaki disease B. Streptococcal pharyngitis C. Hand, foot and mouth disease D. Thrush

A. Kawasaki disease B. Streptococcal pharyngitis

A 57-year-old woman was diagnosed with Crohn's disease about five years ago. You are her primary care provider. Which findings today might be related to her Crohn's disease? Select all that apply. A. Likely deep vein thrombosis in her right calf B. Elevated platelet count C. Iritis D. Arthritis

A. Likely deep vein thrombosis in her right calf C. Iritis D. Arthritis

Which statements about contraception are correct? Select all that apply. A. Long-acting reversible contraceptives (LARCs) may be safely used by nulliparous women. B. For patients with PCOS, combined oral contraceptives are generally safe and effective, and can be helpful with PCOS symptoms. C. LARCs should not be inserted by primary care providers. D. The management of heavy menses required low-dose estrogen - and progesterone - containing combined hormonal contraceptives.

A. Long-acting reversible contraceptives (LARCs) may be safely used by nulliparous women. B. For patients with PCOS, combined oral contraceptives are generally safe and effective, and can be helpful with PCOS symptoms.

Which of the following are signs of preterm labor? Select all that apply. A. Low or dull backache B. Increased uterine activity C. Menstruation-like cramps D. Constipation E. Vaginal spotting or bleeding

A. Low or dull backache B. Increased uterine activity C. Menstruation-like cramps E. Vaginal spotting or bleeding

What is the preferred reliever medication for asthmatics according to the Global Initiative for Asthma (GINA, 2020) treatment guidelines? A. Low-dose ICS with formoterol B. SABA C. LABA D. Leukotriene receptor agonists

A. Low-dose ICS with formoterol

The nurse practitioner is instructing the patient to flex both wrists at 90° for one minute. This test is associated with: A. Median nerve inflammation B. Navicular fracture C. Colle's fracture D. Scaphoid bone fracture

A. Median nerve inflammation

Which conditions can mimic a stroke? Select all that apply. A. Migraine headache B. Atrial fibrillation C. Seizure D. Hypoglycemia E. Dementia

A. Migraine headache C. Seizure D. Hypoglycemia

A malnourished older adult is in your exam room today. What common symptoms might warrant a serum potassium and magnesium level? Select all that apply. A. Muscle cramping B. Jaundice C. Visual disturbances D. Lower extremity numbness and tingling E. Anorexia

A. Muscle cramping D. Lower extremity numbness and tingling

A 66 year old man awakened with a painful right shoulder this morning. He has had intermittent right shoulder pain for several months. The three likely differential diagnoses are: A. Muscle strain B. Bursitis C. Tendinitis D. Rotator cuff dislocation

A. Muscle strain B. Bursitis C. Tendinitis

When prescribing a macrolide such as erythromycin for a patient with bronchitis, the patient should be informed that they may experience: A. Nausea and vomiting B. Urticaria and exanthem C. Itching and jaundice D. Abdominal cramps and diarrhea

A. Nausea and vomiting

Which of the following are symptoms of mild dehydration in pediatric patients? Select all that apply. A. Normal pulse B. Normal systolic blood pressure C. Normal respirations D. Normal anterior fontanel E. Normal skin turgor

A. Normal pulse B. Normal systolic blood pressure C. Normal respirations D. Normal anterior fontanel E. Normal skin turgor

A 6 month old boy has one palpable testicle. When should the nurse practitioner refer this patient to urology? A. Now B. At age 3 months C. At age 6 months D. At age 1 year

A. Now

A nurse practitioner has filed a report of suspected child abuse based on her findings in a child she has just examined. Which statement is correct? A. Nurse practitioners are mandatory reporters in all states B. Suspected child abuse requires concrete evidence of abuse C. Child neglect does not constitute child abuse D. The parents should be informed that the report is being made

A. Nurse practitioners are mandatory reporters in all states

Which of the following conditions would contribute to diastasis recti? Select all that apply. A. Obesity B. Pregnancy C. Prior abdominal surgery D. Constipation

A. Obesity B. Pregnancy C. Prior abdominal surgery

To perform Ortolani's test, where should the examiners second through fifth fingers be placed? A. On the greater trochanter B. On the buttocks C. The medial aspect of the knee D. The lower abdomen

A. On the greater trochanter

A pregnant patient has a routine visit that includes a urinalysis. The urinalysis shows bacteriuria, but the patient denies any urinary complaints. Which choice below demonstrates an appropriate action on the part of the nurse practitioner? A. Order a urine culture and begin prophylactic antibiotics B. Advise the patient to notify you if she develops urinary symptoms C. Have the patient return in three days for a repeat urinalysis D. Send urine for culture and reevaluate once results are received

A. Order a urine culture and begin prophylactic antibiotics

A 65-year-old female patient presents to the nurse practitioner with complaints of pain in the right knee, occasional stiffness (especially in the morning) with minimal tenderness to touch. Examination reveals moderate swelling in the knee with a tender bony ridge along the joint margin. These findings are consistent with: A. Osteoarthritis B. Rheumatoid arthritis C. Gouty arthritis D. Polymyalgia rheumatica

A. Osteoarthritis

A patient presents to the clinic numerous times width of a complaints. She seems to respond poorly to medical treatments that is given to her. What should be considered when obtaining a history from her? A. Physical abuse or depression B. Depression or HIV C. Hepatitis or HIV D. Anemia or depression

A. Physical abuse or depression

All of the organisms listed can produce pruritus. Which one is treated with an oral agent? A. Pinworms B. Bed bugs C. Pubic louse D. Scabies

A. Pinworms

A common health condition related to the aging process is: A. Presbycusis B. Depression C. Hypertension D. Diabetes

A. Presbycusis

Based on his clinical complaints, you suspect that a patient has gastroesophageal reflux disease. What is the first step in diagnosis and treatment? A. Prescribe a PPI B. Order a CT of the abdomen C. Advise the patient to avoid recumbence after meals D. Refer the patient to a gastroenterologist

A. Prescribe a PPI

A 63-year-old male patient comes into the clinic with a chief complaint of hoarseness. He states that he has been horse for approximately six weeks, and it does not seem to be getting better. He has not seen any other providers for this issue. His only past medical history is COPD and a 30 year pack history. What should the nurse practitioner do next? A. Refer the patient to an ENT for direct laryngeal visualization. B. Educate the patient to quit smoking as this likely contributed to his hoarseness C. Instructed patient to do warm salt water gargles every 4 to 6 hours. If there is no relief of symptoms, then follow up in one week. D. Investigate further about what the client has done at home for this issue.

A. Refer the patient to an ENT for direct laryngeal visualization. Any hoarseness greater than three weeks is a major red flag! Evaluate for cancer!

A patient presents to the primary care clinic for a lesion his wife noticed on the back of his scalp. Upon further examination, the lesion is pearly in appearance with visible blood vessels across the lesion. What should the nurse practitioner do next? A. Refer the patient to dermatology as this is basal cell carcinoma and needs to be removed B. Perform a punch biopsy while the patient is in the office today and instruct the patient that this is likely just actinic keratosis, which is benign C. Educate the patient that this is likely actinic keratosis, and they do not need to follow up unless it starts to ulcerate and bleed as that would indicate progression to squamous cell carcinoma D. Refer the patient to dermatology as soon as possible as it is likely malignant melanoma, so they need to be seen immediately

A. Refer the patient to dermatology as this is basal cell carcinoma and needs to be removed Basal cell carcinoma = sun exposed areas, pearly in appearance AND telangiectasias (visible blood vessels)

A 65-year-old female patient presents to the clinic today with a chief complaint of sudden eye pain for the last 3 hours. She states that her vision is blurred, and she is seeing halos around lights. Upon exam, her eyeball is firm and tender to the touch. What should the nurse practitioner initiate next for this patient? A. Refer the patient to the ER for further evaluation B. Conduct florescein staining to evaluate intraocular pressure C. Irrigate the eye with normal saline, as this will likely resolve the issue D. Prescribe the patient corticosteroid eyedrops, as well as an eye lubricant

A. Refer the patient to the ER for further evaluation Firm and tender eyeball = acute closed-angle glaucoma = EMERGENCY! FLORESCEIN STAINING = for foreign bodies in the eye/corneal abrasions

Which statements about gestational diabetes are correct? Select all that apply. A. Screening for gestational diabetes should be conducted in the second trimester. B. One abnormal reading on the 3-hour oral glucose tolerance test (OGTT) is considered diagnostic for gestational diabetes. C. Gestational diabetes affects about 18% of pregnant women. D. Gestational diabetes is associated with maternal and fetal abnormalities.

A. Screening for gestational diabetes should be conducted in the second trimester. C. Gestational diabetes affects about 18% of pregnant women. D. Gestational diabetes is associated with maternal and fetal abnormalities.

Mr. Boudreaux has been diagnosed with benign prostatic hyperplasia (BPH). His daily symptoms include frequency, urgency, and weakened urinary stream. What might help to manage his symptoms quickly? Select all that apply. A. Tamsulosin (Flomax) B. Dutasteride (Avodart) C. HCTZ D. Tadalafil (Cialis)

A. Tamsulosin (Flomax) D. Tadalafil (Cialis)

Which of the following vaccines are safe to administer to a pregnant patient? Select all that apply. A. Tetanus and diphtheria B. Measles, mumps and rubella C. 9-valent HPV D. Influenza E. Pneumococcal

A. Tetanus and diphtheria D. Influenza

A patient who has been prescribed warfarin is advised to avoid eating large amounts of leafy green vegetables for which of the following reasons? A. The high vitamin K levels will decrease the INR B. The vegetables have too much ascorbic acid, which can interact with the medicine C. The high fiber content will decrease the absorption of the warfarin D. The vitamins in the vegetables will bind with, and inactivate, the warfarin

A. The high vitamin K levels will decrease the INR

A 13 year old middle school student reports that he does not feel like eating and that his stomach has bothered him for the past 24 hours. He states that last night, the middle of his stomach around the umbilicus hurt and then the pain moved to the right lower side of his abdomen. His temperature is 100.8°F, Pulse is 90 bpm, respiratory rate is 20 breaths per minute, and blood pressure is 110/60 4 mmHg. During abdominal exam, the patient has RLQ abdominal tenderness without rebound. Rovsing's sign is negative. Which of the following is the most helpful clue in the patient's diagnosis? A. The manner in which the pain involved B. The patient's vital signs C. The patient poor appetite D. The abdominal exam

A. The manner in which the pain involved

A 45 year old man comes to the ER with increasing jaw pain accompanied by temple pain. He is also complaining of blurred vision. An ESR is drawn which is elevated, and the nurse practitioner diagnoses the patient with temporal arteritis. If left untreated, what may happen to this patient? A. The patient will experience permanent vision loss and will become blind B. The patient's temporal artery may burst, leading to death C. The patient may experience a hemorrhagic stroke from pressure buildup D. The patient will likely never be able to walk again

A. The patient will experience permanent vision loss and will become blind

Which statements are true about depression in adolescence? A. They attempt suicide more often than older adults. B. Impulsivity is a common finding in these patients. C. Depressed mood is a predominant symptom. D. Patients should be screened for substance abuse as a potential co-occurring disease. E. These patients may experience difficulty thinking or concentrating.

A. They attempt suicide more often than older adults. B. Impulsivity is a common finding in these patients. C. Depressed mood is a predominant symptom. D. Patients should be screened for substance abuse as a potential co-occurring disease. E. These patients may experience difficulty thinking or concentrating.

A 19 year old patient has been diagnosed with bacterial vaginosis. Which choices are appropriate diagnostic or management considerations? Select all that apply. A. This patient should be treated with oral or vaginal metronidazole or an alternative antibiotic. B. While this patient is undergoing treatment, her partner should wear a condom for sexual intercourse. C. This patient should douche for symptom relief. D. This patient should be informed that she has a sexually transmitted infection (STI). E. This patient should be screened for the most common STI's.

A. This patient should be treated with oral or vaginal metronidazole or an alternative antibiotic. B. While this patient is undergoing treatment, her partner should wear a condom for sexual intercourse. E. This patient should be screened for the most common STI's.

A patient who has been diagnosed with otitis external should be taught: A. To avoid swimming while OE is present B. That hearing will be diminished for about one week after OE resolution C. That tinnitus is common with OE D. That the infection rarely occurs unilaterally

A. To avoid swimming while OE is present

37 year old adult male complains of swelling on the right scrotum that is mildly tender for a few weeks. There is a pressure-like sensation. The right scrotum is larger than the left scrotum. Which of the following tests is appropriate for this patient? A. Transillumination B. CBC with differential C. Ultrasound of the scrotum D. Urinalysis

A. Transillumination

Which of the following can be a secondary cause of osteoporosis? Select all that apply. A. Type 1 diabetes B. Long-standing hyperthyroidism C. Oral glucocorticoid use for greater than three months D. Chronic malnutrition E. Chronic kidney disease

A. Type 1 diabetes B. Long-standing hyperthyroidism C. Oral glucocorticoid use for greater than three months D. Chronic malnutrition E. Chronic kidney disease

Mr. Boudreaux's only symptom is urinary frequency. What might be in the differential diagnosis? Select all that apply. A. Undiagnosed diabetes B. Urinary tract infection C. Acute prostatitis D. Prostate cancer

A. Undiagnosed diabetes B. Urinary tract infection

A patient with a complaint of acute low back pain has a positive straight leg raise test. When he's distracted, the straight leg raise improves. He is observed to move easily when getting dressed. These can be documented as: A. Waddell's sign B. Organic disease C. Nondermatomal pain D. Nonspecific back pain

A. Waddell's sign

A 70 year old woman has daily complaints of fatigue and pain for the past few months. The nurse practitioner suspects depression. How should she be evaluated initially? A. With a geriatric specific depression screen B. With TSH and B12/folate levels C. With a screen for anxiety D. CBC, CMP, TSH today

A. With a geriatric specific depression screen

A patient who is 11 weeks pregnant is taking fluoxetine (Prozac) for depression. Should any adjustments be made to this therapy? A. Yes. Discontinue fluoxetine and consider sertraline (Zoloft). B. Yes. Discontinue fluoxetine and start a tricyclic antidepressant. C. No. Continue the fluoxetine at the same dose. D. Yes. Continue the fluoxetine but reduce the dose.

A. Yes. Discontinue fluoxetine and consider sertraline (Zoloft).

Which of the following antigens is a component of the HIV 1/2 combination antibody/antigen testing? A. p24 B. p20 C. p18 D. p14

A. p24

An elderly patient presents with unilateral weakness and facial drooping for approximately 45 minutes. When the patient reports to the clinic, the symptoms are not able to be reproduced. The nurse practitioner suspects a TIA has occurred. What should you educate this patient about? A. It is common for patients with transient ischemic attacks to develop symptoms again within 24 hours. B. 1/3 of patients who have transient ischemic attacks go on to later have a stroke. C. Since you do not have any residual effects, we do not need to do any further interventions at this time. D. We will start you on anticoagulant therapy such as warfarin to prevent these from occurring in the future.

B. 1/3 of patients who have transient ischemic attacks go on to later have a stroke.

According to the CDC, what is the recommended daily dose of folic acid for pregnant women? A. 0.5 mcg (500 mg) per day B. 1000 mcg (1 mg) per day C. 0.4 mcg (400 mg) per day D. 2000 mcg (2 mg) per day

B. 1000 mcg (1 mg) per day

At what age are symptoms of colic most likely to occur? A. 1-2 weeks B. 4-6 weeks C. 3 months D. 6 months

B. 4-6 weeks

Which patient will derive the most benefit from prostate screening? A. A 40 year old white man B. A 60 year old black man C. A 70 year old men of Japanese descent D. A 75 year old Native American man

B. A 60 year old black man

Which older adult patient is at the lowest risk for falls? A. A patient who visits a primary care provider after an acute fall B. A patient who has experienced one fall in the past 12 months C. A patient who has experienced two falls in the past 12 months D. A patient with a slowed gait speed

B. A patient who has experienced one fall in the past 12 months

Which condition will the nurse practitioner monitor for in a geriatric patient taking hydrochlorothiazide and nifedipine? A. Macrocytosis B. Acquired neutropenia C. Primary polycythemia D. Secondary thrombocythemia

B. Acquired neutropenia

Which of the following is considered as a precursor lesion of squamous cell skin cancer? A. Atopic dermatitis B. Actinic keratosis C. Seborrheic keratosis D. Nevi

B. Actinic keratosis

A patient with COPD has been using albuterol with good relief for shortness of breath. He is using it 3 to 4 times daily over the past four weeks. How should the nurse practitioner manage this? A. Encourage its use B. Add a long acting beta agonist C. Tell him to use it once daily only D. Add an oral steroid

B. Add a long acting beta agonist

A patient has been diagnosed with general anxiety disorder (GAD). What medication might be helpful in relieving acute symptoms? A. Propranolol (Inderal) B. Alprazolam (Xanax) C. Bupropion (Wellbutrin) D. Escitalopram (Lexapro)

B. Alprazolam (Xanax)

A good first choice of anti-depressants in an older adult is: A. A tricyclic antidepressant (TCA) B. An SSRI C. An MAO inhibitor D. Any agent is a good first choice

B. An SSRI

Which assessment question will the nurse practitioner ask for 68 year old patient who has been receiving ongoing treatment with gabapentin after a shingles outbreak? A. Have you noticed any new blisters? B. Are you experiencing pain anywhere? C. Have you had a rash over the past month? D. Are you experiencing problems falling asleep?

B. Are you experiencing pain anywhere? Gabapentin is prescribed in patients after a shingles outbreak to treat post herpetic neuralgia

A woman brings her elderly father into the clinic. The woman is distraught, and demanding you take her father's drivers license away due to his inability to think clearly. What should be the nurse practitioner's initial action? A. Educate the patient that this is a common part of the aging process, and you will start the process to revoke his license today B. Assess the client further with a mini mental status exam C. Probe further into what is occurring when the patient is driving so you can determine whether it is reckless D. Educate the patient's daughter that her father needs an immediate referral to a neurologist

B. Assess the client further with a mini mental status exam

Which of the following is indicative of changes that occur in the second trimester of pregnancy? A. BP unchanged, HR unchanged B. BP decreases, HR increases C. BP increases, HR decreases D. BP decreases, HR unchanged

B. BP decreases, HR increases

In children between the ages of 5-11, the long-term use of which asthma medication because a transient slowing of growth? A. Albuterol sulfate (Proventil) inhaled B. Budesonide (Pulmicort Flexhaler) inhaled C. Levalbuterol (Xopenex) inhaled D. Montelukast (Singulair) oral

B. Budesonide (Pulmicort Flexhaler) inhaled

A man who is being treated with sertraline for depression has complaints of erectile dysfunction. Which medication could be tried in lieu of sertraline? A. Paroxetine (Paxil) B. Bupropion (Wellbutrin) C. Duloxetine (Cymbalta) D. Venlafaxine (Effexor)

B. Bupropion (Wellbutrin)

The vitamin deficiency that will most likely result in neurologic symptoms is: A. Biotin (vitamin B7) B. Cyanocobalamin (vitamin B12) C. Riboflavin (vitamin B2) D. Thiamine (vitamin B1)

B. Cyanocobalamin (vitamin B12)

A 62 year old truck driver has aortic regurgitation. What would you expect to hear when auscultating the murmur? A. A late diastolic click near the apex B. Diastolic sounds heard loudest near the 2ICS right sternal border C. Diastolic sounds heard in the midsternal area D. Intermittent diastolic murmur heard near the left sternal border

B. Diastolic sounds heard loudest near the 2ICS right sternal border

When prescribing tamsulosin, the nurse practitioner should educate the patient about common side effects, such as: A. Abdominal pain B. Dizziness C. Urinary hesitancy D. Fatigue

B. Dizziness

An elderly diabetic female with peripheral neuropathy and corner artery disease is recently diagnosed with major depression. The patient refuses psychotherapy and wants medication. She denies suicidal and homicidal ideation. Which of the following pharmacologic agents is the best choice for this patient? A. Quetiapine (Seroquel) B. Duloxetine (Cymbalta) C. Escitalopram (Lexapro) D. Amitriptyline (Elavil)

B. Duloxetine (Cymbalta)

Do you have a woman who is 30 weeks pregnant that presents in the office for an ultrasound today. Which of the following vaccines would be appropriate for her to receive during today's visit? A. Flumist B. Hepatitis B C. Varicella D. MMR

B. Hepatitis B

Which one of the following is not a symptom of ectopic pregnancy? A. Lower abdominal pain B. High fever C. Vaginal bleeding D. Missed menses

B. High fever

What history finding contra indicates the use of bupropion in a patient who has depressive disorder? A. Intolerance of SSRIs B. History of seizures C. Hypothyroidism D. Cholecystectomy

B. History of seizures

A three year old child with a respiratory virus was given aspirin for an elevated temperature. The child subsequently became lethargic and developed severe vomiting and diarrhea. The nurse practitioner assesses for all of the following findings, except: A. Elevated ALT B. Hyporeflexia C. Confusion D. Cerebral edema

B. Hyporeflexia

A 65-year-old male patient comes into your office today for a medication reconciliation after recent discharge for a new diagnosis of heart failure. The patient's current medications include metoprolol, furosemide, potassium supplements, allopurinol, ibuprofen as needed, and Tylenol as needed. Which does the nurse practitioner need to advise the patient to discontinue taking? A. Tylenol B. Ibuprofen C. Allopurinol D. Metoprolol

B. Ibuprofen

A first time mother comes into the office frantic as she is worried her baby is not receiving enough breastmilk. What education and guidance should be provided to the mother? A. If there is a notable clicking sound when the baby is breast-feeding, then we know the infant has a good latch and is adequately breast-feeding. B. If your baby has 6 to 8 wet diapers a day and is gaining weight appropriately, then we know they are receiving enough breastmilk. C. The baby should only need to eat up to four times per day, so if they eat at all for times we know they are receiving enough. D. There is no need to worry about your baby not breast-feeding enough, they have gained a pound in their first month of life.

B. If your baby has 6 to 8 wet diapers a day and he's gaining weight appropriately, then we know they are receiving enough breastmilk.

A 75 year old alcoholic male patient presents today with right foot pain. On further examination, the pain is localized to his greater on the right foot. He states that "It hurts so bad I can't even let the bed sheets rub against it". Which would be appropriate to prescribe to this patient? A. Allopurinol B. Indomethacin C. Acetaminophen D. Symptomatic treatment with alternating heat and ice

B. Indomethacin

A 46-year-old female patient with a history significant for anxiety comes to the clinic today to discuss possible herbal treatments with the nurse practitioner. The patient states that she understands there is minimal evidence to support herbal supplements for anxiety, but would like to try an herbal anyway. Which of the following is typically indicated for anxiety? A. Saw palmetto B. Kava kava C. Ginkgo D. Valerian root E. Ginseng

B. Kava kava Saw palmetto: BPH Ginkgo: memory Valerian root: insomnia Ginseng: boost immunity

A type of leader that has minimal involvement in decision making, allowing people to make their own decisions are known as: A. Democratic B. Laissez-faire C. Autocratic D. Absence

B. Laissez-faire

Which class of antibiotics is first line treatment for an unvaccinated infant diagnosed with pertussis? A. Penicillins B. Macrolides C. Cephalosporins D. Quinolones

B. Macrolides

A 70 year old woman complains of restless sleep and insomnia. After ruling out potential common physiological causes, the nurse practitioner recommends a sleep aid. Which is most appropriate? A. Diphenhydramine B. Melatonin C. Zolpidem D. Chamomile tea

B. Melatonin

A 34-year-old woman presents to the clinic with chest pain you suspect that she's having a myocardial infarction induced by cocaine use based on her history. You have called EMS and are waiting for them to arrive. Considering the effects of cocaine on the cardiovascular system, which medication should be avoided in this patient? A. Morphine B. Metoprolol C. Nitroglycerin D. Aspirin

B. Metoprolol

Iron deficiency anemia is: A. Macrocytic, normochromic B. Microcytic, hypochromic C. Microcytic, normochromic D. Macrocytic, hypochromic

B. Microcytic, hypochromic

This same patient comes back into the clinic 4 weeks later with increasing fatigue and muscle weakness. He complains that his urine has become tea colored. What is your priority action as the NP? A. Order LFTs B. Order a CK level C. Educate the patient that this is an expected findings after starting rosuvastatin D. Order a urinalysis

B. Order a CK level

The nurse practitioner is seeing a 35-year-old patient with HIV for follow-up of initial antiretroviral treatment regimen of 600 mg dolutegravir/50 mg abacavir/300 mg lamivudine. His plasma viral load (PVL) is 25,000 copies/mL, a decrease from 35,000 copies/mL; CD4 is 400 cells/mm3, up from 250 cells/mm3; an assessment reveals that the patient is in no acute distress. All of the following interventions are indicated for this patient, except: A. Order liver enzyme testing B. Order a follow up PVL in two weeks C. Refer the patient to a nutritionist for low fat diet counseling D. Order a follow up CD4 in three months

B. Order a follow up PVL in two weeks This drug regimen has a black box warning for severe hepatomegaly and hepatitis B exacerbation, so monitoring liver enzymes is crucial. Likewise, steatosis is common with hepatomegaly, so monitoring cholesterol levels and introducing a low fat diet are important as well. Follow up PVL should be completed in 4 to 8 weeks and CD4 in three months

Your patient reports to you that over the last several months they have had a crampy leg pain while walking around the neighborhood. They state that there is a park bench they frequently sit on as sitting relieves their pain. There is no edema of the bilateral lower extremities. There only past medical history includes smoking one pack per day over the last 20 years. What should your next step be? A. Order a d-dimer B. Order an ABI C. Order a Venus Doppler D. Obtain a more thorough history

B. Order an ABI

Isoniazid therapy is associated with some possible adverse events. Which of the following events can be minimized or prevented with simultaneous intake of pyridoxin? A. Hepatic toxicity B. Peripheral neuropathy C. Urticaria D. Nausea and vomiting

B. Peripheral neuropathy

A four day old term infant who is being breast-fed has hyper bilirubinemia (18 mg/dL). This is most often treated with: A. Cessation of breast feeding B. Photo therapy C. Hydration D. Blood transfusion

B. Photo therapy

Topical corticosteroids, used to treat various skin conditions: A. Do not suppress the immune system B. Possess anti-inflammatory properties C. Do not call systemic side effects D. Are safe to use during pregnancy

B. Possess anti-inflammatory properties

A patient who is 14 days postpartum has a positive screen for depression. What is the patient's most likely diagnosis? A. Postpartum "blues" B. Postpartum depression C. Major depressive disorder D. Postpartum psychosis

B. Postpartum depression

A 15 year old girl has a viral upper respiratory infection. She has experienced symptoms for three days. She is wheezing but is in no distress. How should the nurse practitioner handle this? A. Monitor her status B. Prescribe nebulized albuterol C. Prescribe an oral steroid D. Prescribe an inhaled steroid

B. Prescribe nebulized albuterol

The nurse practitioner knows that a positive hCG pregnancy test is which of the following signs of pregnancy? A. Presumptive B. Probable C. Positive

B. Probable

Hegar's sign is considered a: A. Positive sign of pregnancy B. Probable sign of pregnancy C. Presumptive sign of pregnancy D. Problem in pregnancy

B. Probable sign of pregnancy

Etonogestrel (Nexplanon) implant for contraception: A. Is effective for five years B. Produces a quicker return to fertility than medroxyprogesterone (Depo-Provera) C. Is not safe for women with moderate to severe obesity D. Does not affect libido

B. Produces a quicker return to fertility than medroxyprogesterone (Depo-Provera)

A middle-aged male patient presents with a chief complaint of issues with recent impotence. Upon further questioning, the patient states that he sometimes wakes up with an erection in the middle of the night. Based on this finding, we know that the patient impotence is likely due to which etiology? A. Organic B. Psychogenic C. Mixed D. Reflexogenic

B. Psychogenic

A 56-year-old man has relocated to your area from another state. You will be his primary care provider. He is a past smoker, and he has an elevated BMI and a history of Barrett's esophagus. He takes OTC proton pump inhibitor and is asymptomatic. What should be part of his plan of care? A. Use of OTC PPIs B. Referral to a gastroenterologist due to the history of Barrett's esophagus C. Weaning of PPIs and using H2 blockers D. Prescribing regular usage of prescription strength PPIs

B. Referral to a gastroenterologist due to the history of Barrett's esophagus

Which condition involves the bacteria Rickettsia ricketsii? A. Yellow fever B. Rocky mountain spotted fever C. Scarlet fever D. Typhoid fever

B. Rocky mountain spotted fever

A 55-year-old male patient presents to the clinic with a history of hypertension and diabetes. You draw a fasting lipid profile and note the following labs: LDL 191, triglycerides 142, HDL 439, and total cholesterol 276. What medication do you anticipate starting him on? A. Fenofibrate B. Rosuvastatin C. Lovastatin D. Niacin

B. Rosuvastatin

A nine month old infant is brought into the clinic by his mother for watery/irritated eyes, nasal congestion and cough. Upon exam, the nurse practitioner notes that there are white papules across an erythematous base on the child's buccal mucosa. What do these findings suggest? A. Rubella B. Rubeola C. Roseola D. Scarlet fever

B. Rubeola

A patient who is 32 weeks pregnant comes to your office today for treatment of heartburn. You decide to evaluate the patient further prior to deciding your treatment plan. During your examination of this patient, you note an additional heart sound when auscultating the chest. Which additional heart sound would be normal to hear in this patient? A. Split S2 B. S3 C. S4 D. S5

B. S3 S3 = fluid overload (common in pregnancy and HF patients) S4 = uncontrolled HTN and LV hypertrophy

A 75-year-old male patient with a new diagnosis of BPH is looking for possible herbal supplements that he can use to treat his condition. Which might he use for his new diagnosis? A. Coenzyme 10 B. Saw palmetto C. Ginkgo D. Kava kava

B. Saw palmetto

A 50 year old female patient presents to the clinic today looking to get a referral for a mammogram. Her friend was recently diagnosed with breast cancer and now she would like to be screened herself. The nurse practitioner understands that receiving a mammogram is what level of prevention? A. Primary B. Secondary C. Tertiary D. Quarternary

B. Secondary Screening = Secondary Treatment = Tertiary (recent MI pt going for cardiac rehab) Prevention before it even happens = Primary (seatbelt education to teenagers)

A pregnant mother who is Rh negative experienced a suspected miscarriage earlier this morning. Her last menstrual period was eight weeks ago. How should this patient be managed today? A. She does not require RhoGAM. B. She should receive RhoGAM now. C. She does not need RhoGAM because the miscarriage did not occur in the second trimester. D. She does not need RhoGAM because the miscarriage did not occur in the third trimester.

B. She should receive RhoGAM now.

A 48 year old patient who works in a daycare setting asked which immunizations she should receive based on CDC guidance. The nurse practitioner response by advising that: A. She should receive the shingles immunization to prevent chickenpox B. She should receive a Tdap vaccine if she has not had one within the past 10 years C. She should get the pneumococcal vaccine D. The CDC has no specific immunizations for her

B. She should receive a Tdap vaccine if she has not had one within the past 10 years

A nurse practitioner is working in a minor care area of an emergency department. An illegal immigrant has a bunch of wound caused by an unknown sharp object in a trash container. A dirty needle is suspected. The nurse practitioner: A. Should administer a tetanus injection only since the patient has no medical insurance. B. Should prescribe appropriate medication's for HIV exposure even though the nurse practitioner knows the patient can't afford them. C. Should not mentioned the possibility of HIV exposure from a dirty needle to the patient. D. Can I offer to buy the HIV medication's for $50 with the professional discount at the pharmacy next door.

B. Should prescribe appropriate medication's for HIV exposure even though the nurse practitioner knows the patient can't afford them.

Which of the following is the most useful to a clinician in making a correct diagnosis of asthma? A. Chest x-ray B. Spirometry C. Peak flow monitoring D. History

B. Spirometry

An 80-year-old female with a history of hypertension, atrial fibrillation, and type 2 diabetes presents to the clinic with a complaint of painless bright-red blood on the right eye that she noticed on awakening. She denies falling, visual changes, visual loss, eye pain, headache, coryza, and fever. The visual exam is normal, and both pupils are equal and reactive to light and accommodation. The funduscopic exam does not show bleeding. Which of the following conditions is most likely? A. Hyphema B. Subconjunctival hemorrhage C. Ectropion D. Blepharitis

B. Subconjunctival hemorrhage

Prior to the initiation of paroxetine (Paxil) to treat mood disorder related to premenstrual dysphoric disorder in an 18 year old woman, the nurse practitioner should check for: A. Altered liver function tests B. Suicidal ideations C. Obsessive compulsive disorder D. Decreased bone mineral density

B. Suicidal ideations

A 60 year old patient who is otherwise healthy presents with acute onset of right knee pain. She denies injury but reports that she walked up a lot of steps yesterday. She is diagnosed with prepatellar bursitis. What is a common finding? A. Limping and erythema about the anterior knee B. Swelling and pain to touch of the anterior knee C. Posterior knee pain, anterior knee edema, and redness D. Tenderness to touch of the tibial tubercle

B. Swelling and pain to touch of the anterior knee

You are examining a 72-year-old man with aortic stenosis. What would you expect to auscultate when listening to the murmur? A. A late diastolic click near the apex B. Systolic sounds heard loudest near the 2 ICS right sternal border C. Diastolic sounds heard in the midsternal area D. Intermittent diastolic murmur heard near the left sternal border

B. Systolic sounds heard loudest near the 2 ICS right sternal border

A 30 year old male with a history of HIV infection has been an anti-retroviral therapy (ART) since diagnosis at age 28 years. Which of the following indicates that the patient immune system is responding to ART? A. The HIV viral load is higher compared with the previous test B. The CD4 count is higher than the previous test C. The CBC shows an increase in the leukocyte count D. HIV genetic testing of the patient's HIV strain shows that it is sensitive to current HIV regimen

B. The CD4 count is higher than the previous test

The most commonly prescribed and tested medication's for attention deficit disorder are on schedule II. What does this mean? Select all that apply. A. The medications are highly effective B. The medications have a high potential for abuse C. Use of the medications may lead to physical and psychological dependence D. The medications are highly abused

B. The medications have a high potential for abuse C. Use of the medications may lead to physical and psychological dependence

A 36-year-old man presents with a silvery, scaly, pruritic rash. Which statement is not true about this presentation? A. These symptoms may be associated with inflammatory bowel disease B. The patient is at high risk for cataracts C. Monoclonal antibodies may be used to treat this presentation D. This patient may have an associated arthritis

B. The patient is at high risk for cataracts

The following statements are true regarding herpes zoster, except: A. It occurs secondary to reactivation of the varicella zoster virus B. The typical lesions are bullae C. It is usually more severe in immunocompromised individuals D. Infection of the trigeminal nerve ophthalmic branch can cause corneal blindness

B. The typical lesions are bullae A typical shingles rash is groups of papules and vesicles (not bullae) on a red base that rupture and become crusted

Which of the following is not an absolute contraindication for use of oral contraceptive pills? A. Active hepatitis A infection B. Thrombosis related to an intravenous needle C. Undiagnosed vaginal bleeding D. Transient ischemic attack

B. Thrombosis related to an intravenous needle

The best screening test for both hyperthyroidism and hypothyroidism is: A. Free T4 (thyroxine) B. Thyroid stimulating hormone C. Thyroid profile D. Palpation of the thyroid gland

B. Thyroid stimulating hormone

A 56-year-old female patient presents today with increasing wrist pain over the last several months. She has worked as an office secretary over the last 15 years and does not have any significant past medical history. You evaluate her for possible carpal tunnel syndrome by tapping over the median nerve on the inside of the wrist. The test is positive. Which test have you just performed? A. Phalen's test B. Tinel's sign C. Chvostek's sign D. Trousseau's sign

B. Tinel's sign

Regarding the previous case, all of the following can be used to treat his condition, except: A. Oral glucocorticoids B. Topical glucocorticoids C. NSAIDs D. Colchicine

B. Topical glucocorticoids

After receiving the inactivated influenza injection, how much time does it take for antibodies to develop in the body? A. One week B. Two weeks C. Three weeks D. Four weeks

B. Two weeks

40-year-old male who is building a house presents with a two day history of foreign body sensation and excessive tearing of the right eye. What type of exam is recommended initially? A. Cardiac exam B. Visual exam C. Neurologic exam D. Cerebellar exam

B. Visual exam

A patient with a history of HIV comes into the clinic today for increasing symptoms of fatigue. Upon exam, it is noted that the patient has new oral candidiasis. The nurse practitioner orders labs and the patient CD4 count is 150. What education should be provided to the patient? A. We occasionally expect dips in your CD4 count, and that explains why you develop the oral thrush. I will prescribe you some nystatin. B. We need to discuss your new treatment plan, as you have now progressed to AIDS criteria C. CD4 count of >100 is normal, and therefore we do not need to do anything further today. The thrush will resolve on its own. D. When your CD4 count drops below 200, I need to prescribe you additional medication such as Rocephin and dapsone.

B. We need to discuss your new treatment plan, as you have now progressed to AIDS criteria Normal CD4 count >500 Diagnosis of AIDS CD4 <200

Mr. Boudreaux has suspected benign prostatic hyperplasia (BPH). Which urinary symptoms would you expect him to report? Select all that apply. A. Erectile dysfunction B. Weak urinary stream C. Burning D. Urgency E. Hesitancy

B. Weak urinary stream D. Urgency E. Hesitancy

Which statements about folic acid are correct? Select all that apply. A. All pregnant women should take 1 mcg folic acid daily B. When planning to become pregnant, women should take 0.4 mg folic acid daily C. Maternal folic acid use can prevent cleft palate in the developing fetus D. Maternal folic acid use can prevent neural tube defects in the developing fetus

B. When planning to become pregnant, women should take 0.4 mg folic acid daily D. Maternal folic acid use can prevent neural tube defects in the developing fetus

How many weeks should a patient with GERD be treated with a proton pump in a better (PPI)? A. 2 weeks B. 4 weeks C. 8 weeks D. 12 weeks

C. 8 weeks

Osgood Schlatter disease occurs in conjunction with: A. Closure of the bone apophysis B. Development of secondary sexual characteristics C. A rapid growth spurt D. Increasing bone and muscle density

C. A rapid growth spurt

The nurse practitioner is evaluating a patient who has subclinical hypothyroidism (TSH 6.2). What are the major risks of prescribing levothyroxine? A. The risks are very few B. Hyperlipidemia and atrial fibrillation are risks C. Accelerated bone loss and atrial fibrillation are risks D. The patient may develop hypertension and tachycardia

C. Accelerated bone loss and atrial fibrillation are risks

The drug of choice for analgesic and antipyretics use during pregnancy is: A. Aspirin B. Ibuprofen C. Acetaminophen D. Naproxen

C. Acetaminophen

What is the preferred treatment for the above patient's condition? A. Amoxicillin B. Doxycycline C. Amoxicillin-clavulanate plus a macrolide D. Azithromycin plus a fluoroquinolone

C. Amoxicillin-clavulanate plus a macrolide

A new mother reports to you that her six month old infant has a cold and a fever of 99.8°F. The infant is not irritable and is feeding well without problems. The mother wants to know whether it is OK for him to be immunized at this time. Which of the following statements is true? A. The infant should not be immunized until he is afebrile B. An infant with a cold can be immunized at any time C. An infant with a cold can be immunized as long as the infants temperature is not higher than 100.4°F D. Because immunization is so important, it should be given to the infant as scheduled

C. An infant with a cold can be immunized as long as the infants temperature is not higher than 100.4°F

A 34-year-old male patient recently lost his wife unexpectedly. His mother brings him into the clinic and reports that he has not been sleeping and is very withdrawn. The patient does not make eye contact with you during the exam, and hardly responds to any of your questions. Which of the following actions would take priority in this situation? A. Prescribe the patient an SSRI to start taking immediately and have him follow up in one week B. Educate the patient's mother that is a normal expression of grief and he just needs time to acclimate to life without his wife C. Ask the patient whether he has any thoughts of harming himself or others D. Refer the patient to a support group with others who have lost their spouses

C. Ask the patient whether he has any thoughts of harming himself or others

A middle-aged man with a past medical history of diabetes, hyperlipidemia, hypertension and smoking comes into your office stating he is having new blurred vision and trouble seeing. What should the NP do next? A. Write the patient a referral for an ophthalmologist as he is at a high risk of diabetic retinopathy B. Assess the patient's eyes using tonometry and fluorescein staining C. Assess the patient's visual acuity using the Snellen chart D. Assure the patient that this is a normal finding as he is Hgb A1c is 9% and his diabetes is uncontrolled

C. Assess the patient's visual acuity using the Snellen chart

A 45-year-old male patient reports to the clinic today for a chief complaint of headaches. He states that the headaches occur every morning when he wakes up near the back of his head, and goes away once he is up for the day. He has never had an issue with headaches before. What would be the most appropriate action for the nurse practitioner to do next? A. Order a CT scan B. Order an MRI C. Assess vital signs D. Obtain a more thorough history from the patient

C. Assess vital signs Daily headaches in the mornings that goes away indicates hypertensive headache

76 year old patient presents for a routine physical examination. His comorbidities include gout, hypertension, diabetes and atrial fibrillation. He had a myocardial infarction approximately 10 years ago. Which finding in his history puts the patient at the highest risk of an ischemic stroke? A. Age B. Hypertension C. Atrial fibrillation D. History of MI

C. Atrial fibrillation

A 45-year-old female patient with no significant past medical history patient over the last several months. You decide to order diagnostic lab work because of your patient symptoms. Which of the following would be inappropriate to order for this patient? Select all that apply: A. CBC B. TSH C. B12/Folate D. Hgb A1C E. T3/T4

C. B12/folate D. Hgb A1C E. T3/T4

A 12 year old male patient was recently diagnosed with asthma. According to the 2019 GINA guidelines, which of the following is considered to be first line treatment as needed for those with intermittent asthma? A. Salmeterol B. Albuterol C. Budesonide-formoterol D. Tiotropium

C. Budesonide-formoterol

An 80-year-old female who is otherwise well has the following blood pressure readings. How should she be managed pharmacologically? Home BP log: Day 1: 167/70; Day 2: 175/68; Day 3: 171/71; Day 4: 168/63; Day 5: 160/60; Day 6: 166/65 A. Thiazide diuretic B. ACE inhibitor C. Calcium channel blocker D. Angiotensin receptor blocker

C. Calcium channel blocker

A 53-year-old man is diagnosed with atrial fibrillation. Warfarin therapy may be safely used by this patient if he also has: A. Active tuberculosis B. Moderate renal impairment C. Chronic obstructive pulmonary disease D. Malnutrition

C. Chronic obstructive pulmonary disease

During the first half of pregnancy, patient receiving levothyroxine for hypothyroidism should have thyroid stimulating hormone (DSH) monitored at least: A. Once B. Every two weeks C. Every four weeks D. Baseline and three months

C. Every four weeks

A four year old patient presents with lacy macular rash and fever. What illness is a common cause of these symptoms? A. Herpangina B. Hand, foot and mouth disease C. Fifth disease D. Measles

C. Fifth disease

A 57-year-old male patient reports to your office for a follow up on a recent elevated blood pressure. His BP on today's visit is 142/78 and you decide to start him on medication. His past medical history includes gout, diabetes, and an appendectomy 25 years ago. Which off the following blood pressure medication would be inappropriate to prescribe for this patient? A. Lisinopril B. Losartan C. HCTZ D. Norvasc

C. HCTZ Thiazides increase uric acid, triglycerides and glucose ACE and ARB = Weworry about hyperkalemia Norvasc = we worry about ankle swelling and headache

A middle-aged adult male smoker with COPD presents to the clinic complaining of several days of fever, loss of appetite, coughing, and chest pain. The cough is productive of purulent sputum. Physical examination reveals a temperature of 102.0ºF (39.0ºC), pulse of 88, and respiratory rate of 24. The lung exam reveals crackles on the lower right lobe and wheezing on the upper airways. Which of the following bacteria is more likely to be the infectious agent? A. Streptococcus pneumoniae and Mycoplasma pneumoniae B. Staphylococcus aureus and Mycoplasma pneumoniae C. Haemophilus influenzae and Streptococcus pneumoniae D. Legionella pneumophilia and Haemophilus influenzae

C. Haemophilus influenzae and Streptococcus pneumoniae

A 19 year old woman has recently been diagnosed with acute hepatitis B. She is sexually active and monogamous. She reports that her partner uses condoms inconsistently. What would you recommend for her male sexual partner who was also tested for hepatitis with the following results: HBsAg (-), anti-HBc (-), anti-HBs (-), anti-HCV (-), anti-HAV (+)? A. Hepatitis B vaccination B. Hepatitis B immunoglobulin C. Hepatitis B vaccination and hepatitis B immunoglobulin D. No vaccination is needed at this time

C. Hepatitis B vaccination and hepatitis B immunoglobulin

A patient has been diagnosed with thrombocytopenia. If this is secondary to poorly controlled lupus, what lab tests might be expected to be abnormal? Select all that apply. A. INR B. PT/PTT C. Hgb/Hct D. Platelet count

C. Hgb/Hct D. Platelet count

Which of the following is a major risk factor for fatal asthma? A. Exercising in cold weather B. Smoking and vaping C. Hospital admission in past year D. Allergy to pet dander and dust mites

C. Hospital admission in past year

The condition that is not considered a precipitating cause of atrial fibrillation is: A. Heart failure B. Hypertension C. Hypothyroidism D. Valvular heart disease

C. Hypothyroidism

A child has recently been diagnosed with allergic rhinitis. What would be the initial treatment in this patient? A. Intranasal corticosteroids (such as Flonase) B. Anti-histamines (such as Benadryl) C. Identifying potential triggers D. Mast cell stabilizers (such as Cromolyn)

C. Identifying potential triggers Avoiding potential triggers may be enough to avoid starting the child on medication.

Which organ system is not affected by chronic NSAID use? A. Cardiovascular system B. Renal system C. Immune system D. Gastrointestinal system

C. Immune system

A complication of endometriosis is: A. Amenorrhea B. Uterine prolapse C. Infertility D. Uterine fibroids

C. Infertility

An elderly female patient was recently diagnosed with osteoporosis and placed on alendronate (Fosamax). Which of the following would be crucial for the nurse practitioner to educate the patient about this medication? A. Educate the client to begin taking vitamin D supplements for better absorption of the medication B. Educate the client to always take the medication with food C. Instruct the client to sit upright for 30 minutes after administration D. Instruct the patient about common side effects including diarrhea and vomiting

C. Instruct the client to sit upright for 30 minutes after administration

A patient's daughter brings a 77-year-old male patient into the office after he recently lost his wife of 50 years 2 months ago. The patient's daughter reports that the patient has been withdrawn and will not participate in any family activities. The patient states that he does not know how to cope without the support of his wife, and is unsure of how to handle his grief. A diagnosis of major depression is made. His only history is hypertension and type 2 diabetes. What medication should the client be started on? A. Elavil (amitriptyline) B. Prozac (fluoxetine) C. Lexapro (escitalopram) D. Effexor (venlafaxine)

C. Lexapro (escitalopram)

A 65-year-old male patient reports to your office today for a routine physical examination. Open auscultation of heart sounds, you notice a systolic murmur that is radiating to the patient's armpit. How would you document this finding in your note? A. Aortic stenosis B. Mitral valve prolapse C. Mitral regurgitation D. Mitral stenosis

C. Mitral regurgitation Systolic murmurs: MR Peyton Manning AS MVP Diastolic murmurs: ARMS MITRAL VALVE - left 5th intercostal space - closest to armpit Radiating = Regurgitation (R = R)

A 23 year old woman is seen in the office by the nurse practitioner for a complaint of weakness, poor balance, and problems with walking. She states, "I am so clumsy. Sometimes I fall when I walk." She reports new onset vision loss and bladder incontinence. Each episode lasts a few days; she has had several in the past six months. When she bends her head forward to tie her shoes, she reports a sharp shooting sensation from the opera to lower back. She's anxious and crying at the office. What is the most likely diagnosis for this patient? A. Vitamin B 12 deficiency B. Tertiary syphilis C. Multiple sclerosis D. Lou Gehrig's disease

C. Multiple sclerosis

Which of the following is indicative of gallbladder Inflammation? A. Rovsing's maneuver B. Rebound tenderness C. Murphy's maneuver D. McMurrays maneuver

C. Murphy's maneuver

Which agent used to treat otitis externa is most associated with allergic reactions? A. Ofloxacin B. Levofloxacin C. Neomycin-polymyxin B D. Acetic acid

C. Neomycin-polymyxin B

A young adult female patient complains of having her fingers turn white and numb when stressed over a recent exam. After a few minutes, her fingers turned bright red and began to throb. What medication would be appropriate to prescribe for this patient in addition to educating the patient about lifestyle interventions? A. Fluoxetine (Prozac) B. Hydrochlorothiazide (HCTZ) C. Norvasc (amlodipine) D. Losartan

C. Norvasc (amlodipine) Raynaud's. First line treatment is a calcium channel blocker. Second line can be fluoxetine and losartan.

A three year old is brought into the clinic today by his mother for a lacy net-like rash across his trunk. The mother explains that he had a fever initially, but after the fever broke this rash appeared. The mother is worried because the child is supposed to go to daycare tomorrow. What should the nurse practitioner tell the mother about this condition? A. Once all the lesions are crusted over, he is no longer contagious and can go back to daycare B. We have an immunization that I can give him today and he will no longer be contagious C. Once the fever resolved and the rash appeared, he was no longer contagious. Therefore, he should be able to return to daycare tomorrow. D. He will need to be removed from daycare for at least two weeks until all symptoms have resolved.

C. Once the fever resolved and the rash appeared, he was no longer contagious. Therefore, he should be able to return to daycare tomorrow. Fifths disease

The most effective treatment for eradication of Group A Streptococcus in those who are carriers is: A. A single dose of intramuscular penicillin (Bicillin) B. Oral rifampin (Rifadin) for four days C. Oral clindamycin (Cleocin) for 10 days D. A single dose of intramuscular ceftriaxone (Rocephin)

C. Oral clindamycin (Cleocin) for 10 days

Which of the following conditions is a possible effect of the mumps virus, which can affect male fertility? A. Salivary gland inflammation B. Cryptorchidism C. Orchitis D. Prostatitis

C. Orchitis

A nurse practitioner evaluates a 12 year old boy for left knee pain that is experienced during running and kneeling and is relieved by rest. He reports no knee injury, so the nurse practitioner assesses for: A. Patellofemoral syndrome B. Neoplasm of the tibia C. Osgood Schlatter disease D. Avulsion of the tibial tubercle

C. Osgood Schlatter disease

What lip/oral cavity symptoms are characteristics in the patient who has herpangina? A. The pharynx is unaffected B. Tonsillar exudate is present C. Painful vesicles are present on the soft palate and mouth D. Pustules appear unilaterally on tonsils, and blisters appear on the lips

C. Painful vesicles are present on the soft palate and mouth

A 43-year-old male patient with a history of hypertension and diabetes comes to the clinic today for a routine physical examination. Which of the following found on the fundoscopic exam would warrant an immediate referral? A. AV nicking B. Copper wire arteries C. Papilledema D. No exudates are present

C. Papilledema = optic disc swelling, could lead to permanent vision loss. AV nicking and copper wire arteries can be managed in office through better BP management

A 14 year old female patient comes in with a chief complaint of headache and facial pressure. She initially was feeling better but had recurrence of symptoms after about eight days. You diagnosed her with sinusitis and prescribe her Augmentin. The nurse practitioner knows that it's important to treat sinusitis with antibiotic therapy to prevent which of the following from occurring? A. Rheumatic fever B. Scarlatina C. Periorbital cellulitis D. Viral exanthem

C. Periorbital cellulitis

An adult with a seizure disorder is experiencing gingival hypertrophy, coarse facial features, and increased hair growth. These are potential side effects of which medication? A. Carbamazepine B. Valproic acid C. Phenytoin D. Venlafaxin

C. Phenytoin

How is an inguinal hernia most commonly diagnosed? A. Ultrasound B. CT scan of the groin C. Physical examination D. MRI of the groin

C. Physical examination

A 57 year old patient was recently diagnosed with new type two diabetes. His Hgb A1c is 8.9%. His past medical history includes hypertension, heart failure and smoking. Which of the following medication's would be inappropriate to start this client on? A. Metformin B. Empagliflozin C. Pioglitazone D. Dulaglutide

C. Pioglitazone Metformin is contraindicated for poor kidney function. Flozins and GLP-1 are cardioprotective. TZD retain fluids so no in HF patients.

The nurse practitioner should avoid prescribing all of the following drug classes to patients with sulfa allergies, except: A. Thiazides B. Loop diuretics C. Potassium sparing diuretics D. Protease inhibitors

C. Potassium sparing diuretics

Constipation during pregnancy is often related to increased production of: A. Iron B. Estrogen C. Progesterone D. Calcium

C. Progesterone

Your patient is complaining of incontinence and some burning with urination over the last week. You perform a urinalysis to rule out UTI. Which of the following findings on the urinalysis warrants an immediate referral? A. Leukocytes B. Nitrates C. RBC casts D. Trace amount of blood

C. RBC casts

A 45 year old female with a BMI of 28 complaints of intermittent burning epigastric pain over the past few months. It is worse at night, especially after a heavy or spicy meal. She goes to sleep about two hours after eating. The pain is partially relieved by antacids or not at all. She's not a smoker and denies radiation of pain to neck, arms, or jaw; diaphoresis; and dyspnea. What is the next step? A. Order a 12 lead EKG B. Prescribe a proton pump inhibitor C. Recommend to stop eating four hours and avoid spicy or heavy meals before bedtime, as well as lose weight D. Schedule a fasting lipid profile, including cholesterol, low density lipoprotein, high density lipoprotein, and triglycerides

C. Recommend to stop eating four hours and avoid spicy or heavy meals before bedtime, as well as lose weight

Which of the following symptoms of irritable bowel syndrome is considered a red flag? A. Abdominal cramping in the lower quadrants B. Mucus in stool C. Rectal bleeding D. Constipation or diarrhea

C. Rectal bleeding

A seven year old female patient has had multiple episodes of acute otitis media throughout her life. She is now complaining again of ear pain and you perform an auto scopic exam. On exam, you find that the patient has a cauliflower like growth present in her middle ear. What should the nurse practitioner do next? A. Prescribe another round of amoxicillin as this is a common finding with chronic otitis media B. Assure the child's parents that is a non-cancerous benign growth that needs no further intervention C. Refer the patient to an ENT for further evaluation D. Educate the parents about risk factors for this condition and how to avoid it in the future

C. Refer the patient to an ENT for further evaluation Cholesteotoma: Benign, noncancerous growth; but needs surgical removal

Potential drug-drug interactions should be monitored closely when administering tolterodine (Detrol) and: A. Phenazopyridine (Pyridium) B. Levofloxacin (Levaquin) C. Scopolamine transdermal (Transderm Scop) D. Propranolol (Indarall)

C. Scopolamine transdermal (Transderm Scop)

Which statement is not true about ectopic pregnancy? A. Fallopian tube rupture may occur shortly after the onset of symptoms. B. Symptoms typically develop about 6 to 8 weeks after the last menstrual period. C. Serum hCG levels double every 24 to 72 hours. D. Lower abdominal pain me a car on the right or left side.

C. Serum hCG levels double every 24 to 72 hours.

Which statements are consistent with polycystic ovarian syndrome (PCOS)? Select all that apply. A. Patients with PCOS are at low risk for endometrial cancer B. The diagnosis of PCOS requires ultrasound studies C. The diagnostic work out for suspected PCOS should be individualized to the patient D. The risks and complications associated with PCOS are numerous and potentially serious

C. The diagnostic work out for suspected PCOS should be individualized to the patient D. The risks and complications associated with PCOS are numerous and potentially serious

An infant who has suspected cystic fibrosis (CF) has a positive sweat test. This means: A. He has cystic fibrosis B. He should be screened again in six months C. The test should be repeated D. He should be referred to a cystic fibrosis clinic

C. The test should be repeated

An adolescent male who runs cross country comes into your office as he is having intermittent knee pain during races that is getting progressively worse. He complains of a bump right below his knee. On exam, there is pain over the tendon insertion site. What guidance should we give the patient and his parents about his new condition? A. We are going to refer you to an orthopedist for further evaluation and possible bracing B. This is going to be a lifelong issue that we will need to monitor closely C. This is common during growth spurts and can be managed supportively with ice and NSAIDs D. We will refer you to physical therapy starting next week in order to get this under control

C. This is common during growth spurts and can be managed supportively with ice and NSAIDs. (Osgood-Schlatter)

And adult blackmail presents with blood under the nail of the grade to that involves approximately 50% of the nail area. He reports dropping a hammer accidentally on his toe about five hours ago. Which of the following is the recommended treatment? A. Biopsy to rule out melanoma B. No treatment is needed C. Trephination D. Nail removal

C. Trephination

Treatment of chronic prostatitis may require prolonged antibiotic regimens, up to: A. 14 days B. 21 days C. 28 days D. 90 days

D. 90 days

A 76 year old woman has a BMI of 30. She takes Met Forman, lisinopril, Empagliflozin, liraglutide, pravastatin and vitamin D. Her blood pressure is 120/64, her heart rate is 72, and a respiratory rate is 15. A1c is 9.8%. She has agreed to start insulin. What is her a.m. fasting glucose goal? A. <100 mg/dL B. 100-140 mg/dL C. 80-130 mg/dL D. 90-130 mg/dL

D. 90-130 mg/dL

The chest x-ray for a seven year old boy shows infiltrates in the left lower lobe. How should this patient be managed? A. Symptomatic treatment only B. Amoxicillin with clavulanate 45 mg/kg/d once daily C. Azithromycin 10 mg/kg x5 days D. Amoxicillin 90 mg/kg/d

D. Amoxicillin 90 mg/kg/d

Which treatment is inappropriate for treatment of a patient who has acute rhinosinusitis? A. Analgesics B. Saline irrigation C. Intranasal glucocorticoids D. Antihistamines

D. Antihistamines

A 16 month old child has been diagnosed with bronchiolitis. He has nasal flaring, intercostal retractions, and poor appetite. How should he be managed? A. As an outpatient with close follow up B. As an outpatient with nebulized albuterol C. As an inpatient, due to his age D. As an inpatient because of his symptoms

D. As an inpatient because of his symptoms

A middle-aged woman that you're diagnosed with hypothyroidism six months ago comes in to have her TSH level checked. She is currently prescribed Synthroid 100 mcg PO daily. When you receive the results, her TSH is 0.3. Which is the next most appropriate action by the nurse practitioner? A. Decrease the Synthroid dosing B. Discontinue the Synthroid permanently C. Increase the Synthroid dosing D. Assess how the patient has been taking her medication

D. Assess how the patient has been taking her medication

A 4 month old boy has a hydrocele. At what age is a hydrocele expected to resolve? A. Between ages 4 and 6 months B. Around, age 6 months C. Between ages 6 and 9 months D. Before age 12 months.

D. Before age 12 months.

Which of the following is an adverse effect from non-dihydropyridine CCB's? A. Hyperkalemia B. Hypertriglyceridemia C. Hyperuricemia D. Constipation

D. Constipation

A patient was started on lamotrigine (Lamictal) four weeks ago, and today presents with a mild rash on the upper left thigh. The nurse practitioner should: A. Treat the rash and continue lamotrigine B. Reduce the dose of lamotrigine until the rash is resolved C. Halt the escalating dose of lamotrigine until the rash is resolved D. Discontinue the lamotrigine immediately

D. Discontinue the lamotrigine immediately Lamotrigine can cause life-threatening rashes. Thus, any signs of rash while on lamotrigine, especially during the first 2 to 8 weeks of treatment initiation, unless it can be identified as contact dermatitis should warrant discontinuation of the drug. Risk of rash is increased by coadministration with valproate, exceeding the recommended initial dose, or exceeding the recommended dose escalation.

Mrs. Boudreaux calls your office the day after Mr. Boudreaux's visit and states that he is not taking the tamsulosin you prescribed. The most likely reason is: A. The high cost B. New onset erectile dysfunction C. Somnolence D. Dizziness

D. Dizziness

A middle-aged woman who was recently placed on antibiotics in your office returns to your office with a severe sunburn after planting her garden over the weekend. She states "I have no idea how this happened! I was only in the direct sun for a couple of hours". Which antibiotic would likely be the etiology of this patient's complaint? A. Amoxicillin B. Keflex C. Flagyl D. Doxycycline

D. Doxycycline

An 18 year old male patient presents today with urinary frequency, burning with urination and penile discharge. Upon further investigation, you discover the patient has gonorrhea. If the patient also has a concurrent chlamydia infection, which of the following would be most appropriate to prescribe? A. Azithromycin (Z-Pak) B. Cephalexin (Keflex) C. Amoxicillin (Amoxil) D. Doxycycline (Vibramycin)

D. Doxycycline (Vibramycin)

A three year old is brought to the clinic by his mother do you do increasing irritability and ear tugging. During the otoscopic exam, it is found that the left tympanic membrane has marked erythema and is bulging. What should the nurse practitioner initiate next? A. Prescribe amoxicillin B. Prescribe Augmentin C. Prescribe corticosteroid eardrops D. Educate the mother to follow up in 2 to 3 days if symptoms do not resolve

D. Educate the mother to follow up in 2 to 3 days if symptoms do not resolve A majority of otitis media is viral in nature, therefore antibiotic should not immediately be prescribed. Viral otitis media should resolve in 2 to 3 days.

A patient has been diagnosed with generalized anxiety disorder (GAD). What medication might be helpful in relieving long-term symptoms? A. Propranolol (Inderal) B. Alprazolam (Xanax) C. Bupropion (Wellbutrin) D. Escitalopram (Lexapro)

D. Escitalopram (Lexapro)

All of the following ethnic groups are at higher risk for heart disease, except: A. Mexican Americans B. African-Americans C. East Asians D. Europeans

D. Europeans

What is the most common type of hemophilia in the United States? A. Hemophilia B B. Hemophilia C C. Von Willebrand disease D. Factor VIII deficiency (Hemophilia A)

D. Factor VIII deficiency

A diagnosis of type 2 diabetes mellitus can be made: A. If risk factors plus a family history of diabetes are present B. With Hgb A1c of 6.3% C. If glucose values of 110, 119, and 115 mg/dL are observed on different days D. Following fasting glucose values of 126 and 130 mg/dL on different days

D. Following fasting glucose values of 126 and 130 mg/dL on different days

Erythromycin inhibits the cytochrome P450 system. All of the following drugs should be avoided because of the potential for a drug interaction, except: A. Theophylline B. Warfarin C. Diazepam D. Furosemide

D. Furosemide

A 24 year old patient presents with a persistent dry, hacking cough over the last week. Vital signs are normal and overall your exam is benign except for occasional wheezes throughout the lung fields. The patient does indoors some yellow sputum in the morning. How should the nurse practitioner treat this patient? A. Prescribe high dose amoxicillin B. Prescribe azithromycin C. Prescribe doxycycline D. Initiate supportive treatment measures

D. Initiate supportive treatment measures 95% of all bronchitis are viral in nature. Supportive treatments including antitussives, albuterol for wheezing, etc. should be utilized. The only instance we use antibiotics to treat bronchitis is if it is due to pertussis. these people are prescribed macrolides, not to shorten the duration of the disease process, but to prevent spread of this disease to others.

The female athlete triad includes all of the following, except: A. Menstrual dysfunction B. Premature osteoporosis C. Disordered eating D. Insulin resistance

D. Insulin resistance

A 35 year old male patient presents today with generalized crampy abdominal pain. He reports that he is currently going through a divorce, and has been having diarrhea almost daily for the last month. The nurse practitioner orders labs including a CBC, CMP, inflammatory markers and stool for ova and parasites. All tests come back normal. What is the likely diagnosis? A. Inflammatory bowel disease B. Acute gastritis C. Diverticulitis D. Irritable bowel syndrome

D. Irritable bowel syndrome All inflammatory markers are negative. Patient is majorly stressed. Diverticulitis pain would be in the left lower quadrant.

A 2 year old girl has a suspected urinary tract infection. What is the least important part of the nurse practitioner's evaluation of this patient? A. Blood pressure B. Abdominal tenderness C. Abdominal mass D. Lower extremity edema

D. Lower extremity edema

Which one of the following findings is associated with diabetic retinopathy? A. AV nicking B. Copper wire arterioles C. Flame shaped hemorrhages D. Microaneurysms

D. Microaneurysms

All of the following groups are considered complicated urinary tract infection, except: A. Males B. Infants C. Pregnant women D. Middle-aged women

D. Middle-aged women

A patient taking phenytoin (Dilantin) has a current level of 22 mcg/mL. Which assessment finding would the nurse practitioner expect to see in this patient? A. Ataxia B. Confusion C. Seizures D. Nystagmus

D. Nystagmus

All of the following pharmacologic agents are indicated for the treatment of plaque psoriasis, except: A. Topical corticosteroids B. Vitamin D analogs C. Ultraviolet light therapy D. Oral antibiotics

D. Oral antibiotics

The nurse practitioner is evaluating a patient to determine the most appropriate birth control method. When assessing the combination options, the nurse practitioner knows that which of the following places the patient at the highest risk for a possible thrombus? A. Mirena B. Loestrin Fe (Norethindrone acetate/thinyl estradiol) C. Nuva-ring D. Ortho-evra patch

D. Ortho-evra patch

A 65-year-old male is being treated with oral medication for hypertension, hyperlipidemia, diabetes, and osteoarthritis. The most likely reason for his iron deficiency anemia is oral treatment for: A. Hypertension B. Hyperlipidemia C. Diabetes D. Osteoarthritis

D. Osteoarthritis Treatment with NSAIDs can potentiate G.I. bleed leading to iron deficiency anemia

A 62 year old patient takes 36 units of basal insulin. The nurse practitioner has added once daily mealtime insulin. What is the most likely reason? A. A1c goal is within 1% of being met B. AM fasting goals were not met C. AM hypoglycemia is a problem D. PPG elevations are occurring

D. PPG elevations are occurring

Your patient comes in to see you after being prescribed ciprofloxacin for a recent uncomplicated UTI. Which complaint requires the most immediate follow up? A. Patient complains of an intermittent headache this morning B. Patient states that they were nauseous the last two days since starting the antibiotic C. Patient complains of vaginal itching/new clumpy discharge D. Patient complains of right heel pain when walking up her stairs this morning

D. Patient complains of right heel pain when walking up her stairs this morning

All of the following medication's have drug interactions with levothyroxine, except: A. Antacids B. Tricyclic antidepressants C. Anticoagulants D. Penicillins

D. Penicillins

Joe is a 54 year old mechanic with type 2 diabetes mellitus. His A1c is 9.0%. The nurse practitioner is considering the addition of glucagon-like peptide-1 (GLP-1) medication such as Byetta, Victoza, and Trulicity, because the mechanism of action is to: A. Delay absorption of carbohydrates B. Increase insulin sensitivity C. Suppress glucagon secretion D. Potentiate insulin secretion

D. Potentiate insulin secretion

Acyclovir (Zovirax), an antiviral: A. Cures genital herpes B. Is only indicated for acute outbreaks of herpes C. Is not affective against varicella D. Requires a dosage adjustment in renal the impaired patients

D. Requires a dosage adjustment in renal the impaired patients

The nurse practitioner has prescribed metformin 850 mg of immediate release metformin BID. On day 3 of metformin, the patient called the office stating that she is having "profound diarrhea". How should this be managed? A. Stop metformin for a day, then restart it. B. Stop Met Forman and try another medication. C. Decrease the dosing interval of metformin to once daily. D. Stop metformin until diarrhea stops, then restart it at once daily. Evaluate response at the next visit in two weeks

D. Stop metformin until diarrhea stops, then restart it at once daily. Evaluate response at the next visit in two weeks

A male patient has type two diabetes mellitus and a " sensitive stomach". Which medication is least likely to cause him gastrointestinal distress? A. Naproxen sodium B. Aspirin C. Erythromycin D. Sucralfate

D. Sucralfate

Nausea and vomiting in pregnancy me warrant medical interventions if: A. Symptoms are severe in the first four weeks B. Symptoms begin after four weeks of pregnancy C. Symptoms persist beyond nine weeks D. Symptoms begin after nine weeks of pregnancy

D. Symptoms begin after nine weeks of pregnancy

An eight year old girl presents with a spiral fracture of the arm. The nurse practitioner suspects abuse because the mothers explanation of the injury doesn't match the child. How should the nurse practitioner proceed? A. Confront the mother about possible abuse B. Ask the child to repeat her recollection of how the injury occurred C. Separate the child from the mother D. Tell the mother that you are concerned about the child's safety

D. Tell the mother that you are concerned about the child's safety

What is the first line treatment for allergic rhinitis? A. Saline nasal spray B. Oral antihistamine C. Topical nasal decongestant spray D. Topical nasal steroid spray

D. Topical nasal steroid spray

Popping, locking, catching, and "giving out" are common patient descriptions for a: A. Torn anterior cruciate ligament B. Torn posterior cruciate ligament C. Torn medial collateral ligament D. Torn meniscus

D. Torn meniscus

The best test of cure after treating a patient with Helicobacter pylori infection is: A. CBC with white blood cell differential B. Stool for occult blood x 3 specimens C. H. pylori IgM and IgG serology D. Urea breath test

D. Urea breath test

A 16 year old male athlete has recently been diagnosed with infectious mononucleosis. During the abdominal exam, the nurse practitioner identifies an enlarged spleen. Abdominal ultrasound confirms this findings. The patient wants to know when he can go back to playing football. Which of the following responses by the nurse practitioner is the most appropriate? A. You may return to play contact sports when your sore throat is gone B. You should avoid all sports and exercise for the next 2 weeks C. You may not play contact sports for 4 to 6 months D. You may return to exercise and sports in 4 to 6 weeks after a follow-up visit to confirm that your splenomegaly has resolved

D. You may return to exercise and sports in 4 to 6 weeks after a follow-up visit to confirm that your splenomegaly has resolved

When does scarlatina occur?

If strep throat is caused by Group A Streptococcus and it goes untreated, we have to worry about scarlet fever and dust, scarlatina rash. Scarlatina rash is sandpapery and bright red.

What is the treatment for temporal arteritis?

Long term steroid to decrease inflammation

Although an elevated ESR is a good clue, what is the definitive diagnosis for temporal arteritis?

Temporal artery biopsy