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a. an ACE inhibitor

An example of a drug that targets the renin-angiotensin-aldosterone system is: a. an ACE inhibitor b. a beta blocker c. a calcium channel blocker d. a diuretic

a. Calcium carbonate

What medication used to treat patients who have GERD provides the fastest relief of heartburn symptoms? a. Calcium carbonate b. Ranitidine c. Amantadine d. Pantoprazole

a. Cigarette smoking

a. Cigarette smoking A 74 year-old patient has peripheral artery disease (PAD). Which item listed below is the most important risk factor for PAD? b. Hyperlipidemia c. Diabetes d. Alcohol consumption

a. Chronic

A skin disorder has a hallmark finding of silvery scales. What word below describes this common condition? a. Chronic b. Infectious c. Contagious d. Acute

b. 5-fluorouracil

A topical treatment for basal cell carcinoma is: a. sulfacetamide lotion b. 5-fluorouracil c. tetracycline lotion d. trichloroacetic acid

b. Memory issues and glossitis

A vitamin B12 deficiency might be suspected in an older patient with what complaints? a. Fatigue and restless legs b. Memory issues and glossitis c. Painful legs with exercise d. Insomnia and anorexia

a. Doxycycline

A 16 year-old has been diagnosed with Lyme disease. Which drug should be used to treat him? a. Doxycycline b. Amoxicillin-clavulanate c. Trimethroprim-sulfamethoxazole d. Cephalexin

b. Amoxicillin, doses 80-100 mg/kg/d

A 3 year-old healthy child is diagnosed with pneumonia. He is febrile but in no distress. What is the preferred treatment for him? a. Supportive measures, it is probably viral b. Amoxicillin, doses 80-100 mg/kg/d c. Azithromycin d. Doxycycline

a. This should be monitored

A 4 year-old was diagnosed and treated for left acute otitis media 4 weeks ago. She is here today for a well-child visit. There is an effusion in the left ear. She denies complaints. How should this be managed? a. This should be monitored b. She should be given another antibiotic c. She should be evaluated with pneumatic otoscopy d. She needs a tympanogram

c. Azithromycin

A 44 year-old non-smoker is diagnosed with pneumonia. He is otherwise healthy and does not need hospitalization at this time. Which antibiotic can be used for empirical treatment according to the 2007 Infectious Diseases Society of America/American Thoracic Society? a. Erythromycin b. Levofloxacin c. Azithromycin d. Amoxicillin

a. The patient has hepatitis C

A 48 year-old patient has the following laboratory values. How should they be interpreted? HCV IgG (+), RIBA (radio immuno blot assay) (+) a. The patient has hepatitis C b. The patient does not have hepatitis C c. The patient should consider immunization d. The results are indeterminate

c. Change antibiotics to a penicillin

A 6 year-old being treated for community-acquired pneumonia (CAP) has been taking azithromycin in therapeutic doses for 72 hours. His temperature has gone from 102F to 101F. What should be done? a. Continue the same dose and monitor his status b. Increase the dose to high dose azithromycin c. Change antibiotics to a penicillin d. This is probably viral, stop the antibiotic

c. Acute lymphocytic leukemia (ALL)

A 6 year-old complains that his legs hurt. His mother states that he has complained for past 2 weeks, and she thought it was from "playing too hard". When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What should be part of the differential diagnosis? a. Osgood-Schlatter disease b. Growing pains c. Acute lymphocytic leukemia (ALL) d. Psychogenic pain

d. Order a hepatitis panel and stop his lovastatin and aspirin

A 63 year-old male has been your patient for several years. He is a former smoker who takes simvastatin, ramipril, and an aspirin daily. His blood pressure and lipids are well controlled. He presents to your clinic with complaints of fatigue and "just not feeling well" for the last few days. His vital signs and exam are normal. His CBC, TSH, urine analysis are normal. His liver enzymes are six times the upper limits of normal. What should be done next? a. Order a hepatitis panel and stop his medications b. Refer to gastroenterology c. Refer for a toxicology evaluation d. Order a hepatitis panel and stop his lovastatin and aspirin

c. Daily grapefruit consumption for the past 10 days

A 63 year-old male has been your patient for several years. He is a former smoker who takes simvastatin, ramipril, and an aspirin daily. His blood pressure and lipids are well controlled. He presents to your clinic with complaints of fatigue and "just not feeling well" for the last few days. His vital signs and exam are normal. His hepatitis panel is negative for infectious hepatitis. What is the most likely cause of his elevated liver enzymes? a. He has received a generic version of simvastatin b. He is an alcoholic in denial c. Daily grapefruit consumption for past 10 days d. Rare liver toxicity from a usual dose of simvastatin

a. He has tragal pain

A 7 year-old has a complaint of ear pain. If he has otitis externa, which complaint is most likely? a. He has tragal pain b. He has difficulty hearing the TV c. He has fever d. He has a concurrent upper respiratory infection

b. Iron deficiency anemia

A child and father live in an old house. They both are found to be lead toxic. What type anemia is typically observed in patients who are lead toxic? a. Pernicious anemia b. Iron deficiency anemia c. Lead anemia d. Anemia of chronic disease

b. His visual acuity should be measured in each eye

A contact lens wearer presents with an erythematous conjunctiva. He denies blurred vision. There is scant drainage and crusting around the eye. He reports that there was crusting when he woke up this morning. How should the exam begin? a. The patient should wash his hands b. His visual acuity should be measured in each eye c. Fluorescein stainging should be assessed d. Extraocular eye movements should be assessed

a. Cotton wool spots

A nurse practitioner performs a fundoscopic exam. He identifies small areas of dull, yellowish-white coloration in the retina. What might these be? a. Cotton wool spots b. Microaneurysms c. Hemorrhages d. Exudates

b. Order a CBC

A patient exhibits petechiae on both lower legs but has no other complaints. How should the NP proceed? a. Refer to hematology b. Order a CBC c. Order blood cultures d. Stop aspirin and re-assess in one week

b. On the chest

A patient has a "herald patch" and is diagnosed with pityriasis rosea. Where is the "herald patch" found? a. On the affected limb b. On the chest c. Close to the scalp d. Behind one of the ears

c. Positive leukocytes, positives nitrites

A patient has a urinary tract infection. What findings on a urine dipstick best describe a typical urinary tract infection? a. Positive leukocytes b. Positive nitrates c. Positive leukocytes, positive nitrites d. Positive nitrates and hematuria

d. Doxycycline

A patient has been diagnosed with MRSA. She is sulfa allergic. Which medication could be used to treat her? a. Augmentin b. Trimethoprim-sulfamethoxazole (TMPS) c. Ceftriaxone d. Doxycycline

d. Cocaine abuse

A patient has nasal septal erosion with minor bleeding. There is macerated tissue. What is a likely etiology? a. Improper use of a nasal steroid b. Chronic sinusitis c. Severe allergic rhinitis d. Cocaine abuse

d. Monopril

A patient is diagnosed with mild chronic heart failure (CHF). What drug listed below would be a good choice for managing his symptoms and improving long-term outcomes? a. Verapamil b. Digoxin c. Furosemide d. Monopril

b. yeast

A patient is diagnosed with thrush. A microscopic exam of this patient's saliva demonstrates: a. hypahae b. yeast c. spores d. a combination of hyphae and yeast

a. Usual visual acuity

A patient presents to clinic with a complaint of a red eye. Which assessment below rules out the most worrisome diagnoses? a. Usual visual acuity b. Normal penlight exam c. Normal fundoscopic exam d. Negative photophobia

a. Pulpitis

A patient presents with severe toothache. She reports sensitivity to heat and cold. There is visible pus around the painful area. What is this termed? a. Pulpitis b. Caries c. Gingivitis d. Periodontitis

b. Dyshidrotic dermatitis

A patient presents with small vesicles on the lateral edges of his fingers and intense itching. On close inspection, there are small vesicles on the palmar surface of the hand. What is this called? a. Seborrheic dermatitis b. Dyshidrotic dermatitis c. Herpes zoster d. Varicella zoster

b. A nasal swab

A patient presents with symptoms of the flu during flu season. How should he be screened for the flu? a. A nasal culture b. A nasal swab c. CBC d. Based on symptoms

b. Otitis externa

A patient presents with tragal pain. What is the most likely diagnosis? a. Otitis media b. Otitis externa c. Presbycusis d. Mastoiditis

d. Report the bite to animal control and administer appropriate medical care

A patient reports to the minor care area of the emergency department after being bitten by a dog. The patient states that the dog had a tag around his neck and had been seen roaming around the neighborhood. The dog did not exhibit any odd behavior. How should this be managed? a. If the bites are only minor, do not mention rabies prophylaxis to the patient b. Give the patient tetanus immunization only. Don't call animal control. c. Clean the wounds, provide tetanus and rabies prophylaxis d. Report the bite to animal control and administer appropriate medical care

b. potassium supplements

A patient taking an ACE inhibitor should avoid: a. strenous exercise b. potassium supplements c. protein rich meals g. grapefruit juice

c. Tinea versicolor

A patient who has been in the sun for past few weeks is very tanned. He has numerous 3-6mm light colored flat lesions on his trunk. What is the likely etiology? a. Tinea corporis b. Tinea unguium c. Tinea versicolor d. Human papilloma virus

b. normocytic anemia

A patient with anemia of chronic disease probably has a: a. macrocytic anemia b. normocytic anemia c. hypochromic anemia d. hyperchromic anemia

B. an inhaled steroid

A patient with asthma is using his "rescue" medication once daily. How should this be managed? He must receive a prescription for: a. a bronchodilator b. an inhaled steroid c. a long-acting beta agonist d. a leukotriene blocker

a. Wheezing and fever

A patient with asthma presents with an acute episode of wheezing, coughing, and fever. He is wheezing in the right upper lobe. His cough is non-productive, and he denies nasal symptoms. Which symptoms are not likely related to his asthma? a. Wheezing and fever b. Coughing and wheezing c. Fever and coughing d. Coughing and fever

c. Intranasal glucocorticoids

A patient with environmental allergies presents to your clinic. She takes an oral antihistamine every 24 hours. What is the most effective single maintenance medication for allergic rhinitis? a. Antihistamine b. Decongestant c. Intranasal glucocorticoids d. Leukotriene blockers

a. An antacid

A patient with iron deficiency anemia takes iron supplementation daily. What should he be advised to avoid within a couple of hours of taking iron? a. An antacid b. Heavy exercise c. Potassium supplements d. Grapefruit juice

c. He could have negative "Monospot"

A patient with mononucleosis has pharyngitis, fever, and lymphadenopathy. His symptoms started 3 days ago. a. He will have a positive "Monospot" b. He will have a normal CBC c. He could have negative "Monospot" d. He could have a positive Monospot and a normal CBC

a. lymphocytosis

A patient with mononucleosis would most likely have: a. lymphocytosis b. eosinophilia c. leukocytosis d. monocytosis

d. Streptococcus pneumoniae

A patient with pneumonia reports that he has rust colored sputum. What pathogen should the nurse practitioner suspect? a. Mycoplasma pneumoniae b. Chlamydophila pneumoniae c. Staphylococcus aurues d. Streptococcus pneumoniae

b. can be accompanied by abdominal pain

Group A Strept pharyngitis: a. is characterized by a single symptom b. can be accompanied by abdominal pain c. usually does not have exudative symptoms d. is commonly accompanied by an inflamed uvula

b. topical steroids

Most cases of atopic dermatitis exacerbations are treated with: a. emollients b. topical steroids c. antihistamines d. antibiotics

c. It could be an important finding in this patient

Papilledema is noted in patient with a headache. What is the importance of papilledema in this patient? a. It is not related to this patient's headache b. It is an incidental finding in patients with migraines c. It could be an important finding in this patient d. This is a common finding in patients with headaches

c. can cough or wheeze

Patient with asthma: a. all wheeze b. all cough c. can cough or wheeze d. have dyspnea

b. all cough

Patients with cough variant asthma: a. all wheeze b. all cough c. can cough or wheeze d. have dyspnea

b. a rash

Syphilis may present as: a. a discharge b. a rash c. a painful lesion d. dysuria

b. sensorineural hearing loss

The hearing loss associated with aging involves: a. the 8th cranial nerve b. sensorineural hearing loss c. conductive hearing loss d. noise damage

b. leukocytosis

The major laboratory abnormality noted in patients with pneumonia is: a. eosinophilia b. leukocytosis c. Gram stain positive d. leukopenia

b. cough

The most common symptom associated with acute bronchitis is: a. fever b. cough c. pharyngitis d. purulent sputum

b. anti-histamines

The primary therapeutic intervention for patients who present with hives is: a. steroids b. anti-histamines c. calcium channel blockers d. topical steroid cream

b. Unilateral dermatomal rash

What finding characterizes shingles? a. Pain, burning, and itching b. Unilateral dermatomal rash c. Grouped vesicles d. Resolution of rash and crusting

b. Sulfamethoxazole

Which medication should be avoided in a patient with a sulfa allergy? a. Sulfonylurea b. Sulfamethoxazole c. Naproxen d. Cefazolin

a. Vitamin B12

Which of the following can NOT be a microcytic anemia? a. Vitamin B12 b. Anemia of chronic disease c. Iron deficiency anemia d. Thalassemia