FNP Board Practice Questions - PART 2
Karen Ann, age 52, has four children and a very stressful job. After you perform her physical, which was normal, she tells you she has insomnia. You make several suggestions for lifestyle changes that might assist in promoting helpful sleep. You know she misunderstands when she states which of the following? 1. "I'll wind down before bedtime by taking a warm bath or by reading for 10 minutes." 2. "I'll try some valerian extract from the health food store." 3. "I'll exercise in the evening to tire myself out before bed." 4. "I won't read or watch television while in bed."
"I'll exercise in the evening to tire myself out before bed." (Exercising before going to bed is stimulating, but evidence suggests that an afternoon workout improves sleep quantity and quality. In a large study, people fell asleep twice as fast and slept an extra hour once they began going for brisk walks in the afternoon)
Thomas, age 35, uses a high-potency corticosteroid cream for a dermatosis. He also currently has tinea corporis. You tell him the following regarding the cream: 1. "You must use this for an extended period of time for it to be effective." 2. "It will work better if you occlude the area." 3. "It may exacerbate your concurrent tinea corporis." 4. "Be sure to use it daily."
"It may exacerbate your concurrent tinea corporis." (If a client uses a high-potency corticosteroid cream for a dermatosis, tell the client that it may exacerbate concurrent conditions such as tinea corporis and acne. Topical corticosteroids should not be used indiscriminately on all cutaneous eruptions)
Barbara, age 27, had her spleen removed after an automobile accident. You are seeing her in the office for the first time since her discharge from the hospital. She asks you how her surgery will affect her in the future. How do you respond? 1."Your red blood cell production will be slowed." 2."Your lymphatic system may have difficulty transporting lymph fluid to the blood vessels." 3."You'll have difficulty storing the nutritional agents needed to make red blood cells." 4."You may have difficulty salvaging iron from old red blood cells for reuse."
"You may have difficulty salvaging iron from old red blood cells for reuse." (The spleen is not essential for life. When it is removed, the liver and bone marrow assume its functions. Although the bone marrow will produce and store hematopoietic stem cells, from which all cellular components of the blood are derived, it will not remove iron from old red blood cells for reuse)
A 60-year-old patient with diabetes has a blood pressure reading of 150/96 mmHg. After three months of increased exercise and decreased calories, the patient has lost 10 lb (4.54 kg). The patient's follow-up blood pressure is 142/94 mmHg. Which medication does the family nurse practitioner prescribe? 1. Enalapril (Vasotec). 2. Furosemide (Lasix). 3. Hydrochlorothiazide (HydroDIURIL). 4. Propranolol (Inderal).
1. Enalapril (Vasotec).
The FNP asks a patient to perform rapid, alternating movements of the hands to evaluate: 1. cerebellar function 2. cognitive function 3. reflex arc function 4. stereognostic function
1. cerebellar function
To comply with regulations for third-party payor reimbursement and documentation, a family nurse practitioner correlates: 1. evaluation and management code with history, examination and medical decision making. 2. health outcomes with physical examination findings and plan of care. 3.medication orders and treatment plan with electronic billing. 4. patient privacy with informed consent.
1. evaluation and management code with history, examination and medical decision making.
A 38 yo Vietnamese patient tells the FNP that his parent died in her 40s from liver cancer. That patient is at risk for: 1. hepatitis B 2. malaria 3. tularemia 4. tyrosenemia
1. hepatitis B
Routine immunization guidelines recommend administering the hepatitis B vaccine at birth and repeating doses at: 1. one month and six months. 2. one month and two months. 3. four months and two years. 4. six months and 12 months.
1. one month and six months.
A patient who had a total gastrectomy one year ago complains of a sore mouth, indigestion, and tingling in the lower extremities. Which test is ordered by the family nurse practitioner? 1. Blood urea nitrogen level. 2. Complete blood count. 3. Liver function study. 4. Thyroid function study.
2. Complete blood count.
Which health promotion strategy is most appropriate for adolescents who are obese? 1. individual-based behavior modification. 2. Motivational interviewing. 3. Parents should regulate meals. 4. Presenting video case studies.
2. Motivational interviewing.
A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and mild euphoria shows symptoms associated with the use of: 1. benzodiazepine (Alprazolam). 2. cocaine. 3. morphine (MS Contin). 4. oxycodone (OxyContin).
2. cocaine.
What is the caloric content of infant formula and breast milk? A: 10kcal/30ml B: 15kcal/30ml C: 20kcal/30ml D: 25kcal/30ml
20kcal/30ml
Which of the following individuals is more likely to be affected by alpha thalassemia anemia? A: 53 year old Greek pt B: 25 year old Chinese pt C: 62 year old Russian pt D: 38 year old African American patient
25 year old Chinese pt
On auscultation of the chest, a split s2 is best heard at: A: 2 ICS, right sternal border B: 2 ICS, Left sternal border C: 5th ICS, midclavicular line D: 4 ICS, left sternal border
2nd ICS left sternal border
You are examining a patient in the intensive care unit (ICU) after a motor vehicle accident. The patient is intubated but opens his eyes in response to verbal commands. What score would you give him on the eye-opening portion of the Glasgow Coma Scale? 1. 4 2. 3 3. 2 4. 1
3
The posterior fontanel should be completely closed by:
3 months
To determine whether sufficient evidence exists to prescribe glucosamine for a patient who has osteoarthritis (OA) of the knee, the family nurse practitioner reviews three article summaries. Place the article summaries in sequential order of strength of evidence from strongest to weakest: 1. Investigators conducted a retrospective review of 1000 charts of patients who were diagnosed with OA and had glucosamine on their medication list. The investigators assessed the pain rating scale at the time the glucosamine was prescribed and compared this score with the pain rating scale three months after the medication had been prescribed. They also reviewed the progress notes and included only patients for whom clinicians stated in the note that the patient took the medication regularly. 2. Investigators randomly assigned a group of 1600 patients with OA of the knee to receive either a placebo or glucosamine for six months. The goal was to determine if glucosamine and/or chondroitin treats pain related to OA of the knee and could help prevent structural damage. The study found no benefit for pain relief for the study group compared with the placebo group. 3. Researchers evaluated the benefit of glucosamine for osteoarthritis of the hip and/or knee by searching MEDLINE and the Cochrane database for studies that investigated this question. The researchers included only studies that were double-blind, placebo-controlled, randomized trials of at least four weeks duration and tested glucosamine's effectiveness in treating OA in the knee or hip. Fifteen studies were included in the analysis and the investigators applied a statistical formula to evaluate these studies, giving the larger studies more weight. 1, 2, 3 1, 3, 2 2, 1, 3 2, 3, 1 3, 1, 2 3, 2, 1
3, 2, 1
Treatment of viral conjunctivitis includes the use of: 1. antihistamine/decongestant drops. 2. antihistamine/mast cell stabilizer drops. 3. cold compresses. 4. steroid eyedrops.
3. cold compresses.
a difficult aspect of determining occupational exposure to disease is the: 1. confidentiality of the information in company records 2. inaccuracy of disease reporting 3.long latency period between exposure and disease development 4. reliance on workers' memories
3. long latency period between exposure and disease development
A 40-year-old patient has had a generalized, nonpruritic skin eruption with intermittent exacerbations over the past 10 years. Currently, a well-circumscribed erythematous plaque appears over the patient's left gluteal fold area. The lesion is covered with scales and has some fissuring. The family nurse practitioner makes a diagnosis of: 1. atopic dermatitis. 2. ichthyosis. 3. psoriasis. 4. tinea corporis.
3. psoriasis.
All of the following are implicated in causing chronic cough except: A. Chronic bronchitis B. Allergic rhinitis C. Acute viral URI D. GERD
C Acute viral URI: The key in this question is where it says what causes "CHRONIC COUGH." An acute viral illness will resolve, while chronic bronchitis, GERD, and allergic rhinitis can all cause chronic coughs.
A 12 y.o. male's peak inspiratory flow rate results show 60-80% of the predicted range. How would you classify his asthma? A. Mild intermittent B. Mild Persistent C. Moderate persistent D. Severe asthma
C moderate persistent- 60-80% peak flow tests is moderate persistent and anything less than 60% is severe
The patient reports that the lesion does not itch, but it has slowly enlarged over the past few years. Which of the following conditions is most likely in this patient? A) Nodular melanoma B) Squamous cell carcinoma C) Basal cell carcinoma D) Actinic keratosis
C) Basal cell carcinoma
what is the main reason for giving a progestational medication to perimenopausal women who use estrogen? 1. preventing hot flashes 2. preventing osteoporosis 3. promoting growth of uterine lining 4. decrease the risk of endometrial hyperplasia
4. decrease the risk of endometrial hyperplasia
A 45-year-old patient who is an opera singer reports progressive hoarseness for the last four weeks. The hoarseness began after a three-hour opera performance. The patient does not smoke and reports no weight loss, upper respiratory infection, dysphagia, or shortness of breath. The family nurse practitioner manages this patient by: 1. ordering a computed tomography scan of the head. 2. ordering an immediate lateral neck x-ray. 3. prescribing systemic antibiotics and cool mist inhalations. 4. requesting a referral for evaluation of the larynx.
4. requesting a referral for evaluation of the larynx.
Clinical practice guidelines are designed to: 1. be used in every patient situation. 2. increase variations in clinical care. 3. mandate practice decisions. 4. serve as a handbook to best practice.
4. serve as a handbook to best practice.
A patient who sustained a myocardial infarction comes to the clinic for a refill of atorvastatin (Lipitor). The family nurse practitioner explains that the medication is prescribed for: 1.cancer prevention. 2. primary prevention. 3. secondary prevention. 4. tertiary prevention.
4. tertiary prevention.
The family nurse practitioner examines a patient who has sustained a non-work-related injury that interferes with the patient's ability to perform his or her job. The patient does not qualify for medical disability and has a reasonable chance of engaging in a suitable occupation with proper therapy. The nurse practitioner recommends that the patient apply for: 1. Family and Medical Leave Act benefits. 2. home health services. 3. Social Security benefits. 4.vocational rehabilitation services.
4.vocational rehabilitation services.
At what age can a child draw a person with 6 separate body parts
5 years old
The span of the normal adult liver is?
6-15cm in the midclavicular line
The following abnormal lab result may be seen in patients with acute mononucleosis except: A. Lymphocytosis and/ or atypical lymphocytes B. Positive EBV titers for (Ig) M and Ig G C. Elevated liver function tests D. Elevated BUN and Ct
A Lymphocytosis and/ or atypical lymphocytes- Mono caused by virus not infection. More likely to see EBV titers, elevated LFTs, and BUN CT elevation
In a young child, unilateral purulent rhinitis is most often caused by: 1. A foreign body. 2. A viral infection. 3. A bacterial infection. 4. An allergic reaction
A foreign body (keyword here is unilateral!)
A bulla is defined as: A: A solid nodule less than 1cm in size B: a superficial vesicle filled with serous fluid greater than 1cm in size C: a maculopapular lesion D: a shallow ulcer
A superficial vesicle filled with serous fluid greater than 1cm in size
A 75-year-old woman with mild dementia, hyperlipidemia, and emphysema is brought in by her middle-aged daughter as a walk-in patient in a community clinic with a complaint of the sudden onset of red rashes on her left lower arm and hand. During the skin exam, the NP notes that there are a few blisters. When the NP touches one of the blisters, it ruptures and drains clear serous fluid. Which of the following three conditions should the NP consider in the differential diagnosis? A) Contact dermatitis B) Erysipelas C) Psoriasis D) Impetigo E) Thermal burn
A) Contact dermatitis D) Impetigo E) Thermal burn
A 30-year-old chef complains of pruritic hives over her chest and arms, but denies difficulty swallowing or breathing. She reports a family history of allergic rhinitis and asthma. Which of the following interventions is most appropriate? A) Obtain a complete and thorough history B) Recommend an oral antihistamine such as diphenhydramine 25 mg PO QID C) Give an injection of epinephrine 1:1000 intramuscularly stat D) Call 911
A) Obtain a complete and thorough history Before prescribing medications, a thorough history must be obtained to determine possible causes of hives. The patient denied difficulty with swallowing and breathing, so there was no medical emergency that would require calling 911.
a 28 y.o. male nurse of Hispanic descent reports hx of a cold that resolved two weeks ago except for a dry cough, and pain in his cheek that worsens when he bends down. Pt denies fever, tells NP he is very allergic to keflex and erythromycin. Vitals: Temp 99.2F, HR: 72, and RR: 12 breaths/min. Which of the following is most likely? A. Acute sinusitis B. Acute bronchitis C. Fever 2ndary to recent URI D. Munchausen's syndrome
A. Acute Sinusitis: acute sinusitis sx include facial pain, cough, and low grade fever
A 13 y.o. pt has a throat culture that is positive for strep throat. She reports that her younger brother was recently diagnosed with strep and was treated. The pt has a severe allergy to penicillin and reports erythromycin makes her very nauseated. Which of the following ABX is the best choice? A. Azythromycin B Cephalexin (keflex) C. Cefuroxime axetil (Ceftin) D. Levofloxacin (Levaquin)
A. Azythromycin: Don't use Levaquin in kids, 10% cross reactivity between penicillin and Keflex, Erythromycin commonly has nausea as side effect but not allergy, azythromycin better tolerated.
Which of the following is recommended for erythema migrans treatment in early stages of lyme disease? A. Doxycyline (Vibramycin) 100mg PO BID X21 days B. Ciprofloxacin (Cipro) 250 mg PO BID X14 days C. Erythromycin (E-mycin) 333mg PO TID X10 days D. Dixoxacillin 500mg PO BID X 10 days
A. Doxycyline 100mg PO BID X21 days- Recommended by the CDC as gold standard treatment
Which of the following tests would you recommend to patients to confirm DX of beta thalassemia or sickle cell anemia? A.Hemoglobin Electrophoresis B. Bone Marrow Biopsy C. Peripheral Smear D. Reticulocyte count
A. Hemoglobin Electrophoresis
When Molluscum Contagiosum is found in the genital area of children, which of the following is the best explanation? A. It should raise suspicion of sexual abuse B. It is not considered an STI C. It is caused by Atypical bacteria D. It is caused by the poxvirus and will resolve on it's own
A. It should raise concern for sexual abuse: Molluscum Contagiosum is spread by skin to skin contact, if found in the genital area it should raise concern for sexual abuse
What bacteria most commonly causes otitis externa? A. Pseudomonas aeroginosa B. Strep pyogens C. Haemophilis influenza D. Maraxella catarrhalis
A. Pseudomonas aeroginosa is the most common. Staphylococcus is the second most common seen in otitis externa. Treat with neomycin ear drops of Ofloxacin ear drops
30 y.o. c/o pruritic hives over chest/ arms but denies SOB, difficulty swallowing. Reports family hx allergic rhinitis, & asthma. Which of the following interventions is most appropriate? A. Perform thorough History B. Prescribe PO antihistamine such as benadryl 25mg PO QD C. IM Epinephrine 1:1000 STAT D. Call 911
A. Take a thorough history prior to prescribing medications: find cause of rash. No airway difficulty/ swallowing so no need for 911
Which of the following is associated with having 3 stages of rashes? A. Fifth disease B. Erythema infectiosum C. Varicella D. Rocky mountain spotted fever
A: Fifth disease: (Prodromal phase) begins with sx of URI such as fever, malaise, headache, and chills. Second stage: Rash begins on the cheeks known as the "slapped cheek" usually resolves in 2-3 days. Third stage: rash moves to arms and legs and appears "lacey" that is flat and purple in appearance. May last 3-4 weeks
Orchitis is caused by which of the following? A. Mumps virus B. Measles virus C. Chlamydia Trachomatis D. Chronic UTIs that are not correctly treated
A: Mumps: Orchitis (or inflammation of one or both of the testicles) occurs with the mumps
10 y.o. male who was recently accepted to his school's soccer team has a hx of exercise induced astnma and he wants to know when he should take his albuterol inhaler. The NP should advise him: A. Premedicate himself 20 min before starting exercise B. Wait until he starts to exercise to use the inhaler Premedicate 60 min prior to starting exercise D. Wait until he finishes his exercise to use inhaler
A: Premedicate 20 min prior to starting exercise
Which of the following is the correct statement regarding the size of the arterioles and veins on the fundi of the eye? A. Veins are larger than arterioles B. The arterioles are larger than veins C. The arterioles are half the size of the veins D. The veins and the arterioles are equal in size
A: The veins are larger than the arterioles- this should be apparent on a fundoscopic exam
A chest radiograph shows an area of consolidation on the lower lobe. Which of the following conditions is the most likely? A. Bacterial pneumonia B. Acute bronchitis C. COPD D. Atypical pneumonia
A; Bacterial pneumonia: Consolidation is not seen on CXR in the other three options
The mother of an 8 y.o. boy reports presence of round red rash on the child's left lower leg. It appeared 1 week after the child returned from his grandparents house in Massachusets. During the skin exam, the NP notes a maculopapular rash with areas of clearing making it resemble a large target. Which of the following is best described? A. Erythema Migrans B. Rockey Mountain spotted fever C. Meningococcemia D. Larva Migrans
A; Erythema Migrans: "Bulls eye rash" seen in Lyme disease. Needs immediate treatmemt with ABX, seen in NE region of USA
What is the first line class of ABX recommended by the American Thoracic Society for patients younger than 60 with CAP with no co morbidities? A. First gen cephalosporins B. Second Gen cephalosporins C. Macrolides D. Beta Lactam antibiotics
C. Macrolides
What is the least common pathogen found in community-acquired atypical pneumonia? A. Moxarella catarrhalis B. Strep Pneumo C. Pseudomonas aeruginosa D. Mycoplasma Pneumonia
C. Pseudomonas: is an uncommon cause of CAP but is very difficult bacteria to treat
New patient who recently visited relative in north carolina c/o a new onset fever, and red rashes that started 2 days ago. First rash appeared on wrists and ankles, and included palms of hands. Pt reports the rash is spreading to his trunk. His eyes are not injected, and no enlarged nodes are palpated on his neck. There is no desquamation of the skin. Which of the following is most likely? A. Kawasaki's disease B. Meningococcemia C. Rocky Mountain spotted fever D. Measles
C. Rocky Mountain Spotted fever: given recent travel, rash location. Tick born illness
An elderly pt with productive cough + fever diagnosed with pneumonia. All of the following organisms are capable of causing CAP except: A. Haemophilus influenzae B. Mycoplasma pneumoniae C. Treponema pallidum D. Strep Pneumo
C. Treponema pallidum is a spirochete that causes syphilis
A 62 y.o. male with COPD complains to his NP that his ipratropium bromide (Atrovent) is not working. He reports he still feels SOB after using it 4X per day for 3 months. Which of the following actions is the next step for the NP? A. Increase pt's dose to 3 inhalations QID B. Continue the atrovent and start the pt on O2 via NC C. Continue the atrovent and add albuterol 2 inhalations QID D. Start the pt on O2 at night time abd PRN during the day
C: COntinue atrovent and add albuterol. The plan of care is always start with an anticholinergic (Atrovent) and then add short acting beta agonist
A cauliflower like growth with fowl smelling discharge is seen in an otoscopic exam of the left ear of an 8 y.o. boy with a hx of chronic otitis media. No tympanic membrane, ossicles, are visible and the pt seems to have difficulty hearing out of the affected ear. Which condition is the best described? A. Chronic perforation of TM with secondary bacterial infetcion B. Chronic Mastoiditis C. Cholesteatoma D. Cancer of the middle ear
C: Cholesteatoma
Lead poisoning can cause which type of anemia? A. A mild macrocytic anemia B. Normocytic anemia C. Microcytic anemia D. A mild hemolytic anemia
C: Microcytic anemia: Lead poisoning can cause microcytic anemia. Causes anemia by mimicking healthful minerals such as Calcium, iron and zinc. Is absorbed by the bones where it disrupts the formation of RBCs.
Acute Bronchitis is best characterized by: A. Fever and wheezing B. Purulent Sputum and fever C. Paroxysms of coughing that is dry or with productive of mucoid sputum D. A gradual onset and fatigue
C: Paroxysms of coughing: Bronchitis is characterized by intermittent cough that is either dry or productive with mucous
4 y.o. female comes in after just starting pre school complaining of burning/ itching in both eyes along with runny nose. Child's eyes appear injected bilaterally, the throat is red and her inferior nasal turbinates are swollen. Which is most likely? A. Herpes Keratitis B. Corneal Ulcer C. Viral Conjunctivitis D. Bacterial conjunctivitis
C: Viral- no signs of infection but pts often complain of red/ itchy/ swollen eyes
12 y.o. complaining of 2 week history of facial pressure, that worsens when she bends over. She c/o tooth pain in her upper molars on the right side of her face. On physical exam, her lung and heart sounds are normal. Which of the following is the most likely DX? A. An acute dental abscess B. Chronic sinusitis C. Acute sinusitis D. Severe allergic rhinitis
C; Acute sinusitis: s/s include facial pressure, headache, pain that worsens when bending over, eye/ear pain, aching in upper jaw/ teeth, reduced smell/ taste and cough.
Beta thalassemia minor is considered a: A. Macrocytic anemia B. Normocytic anemia C. Microcytic anemia D. Hemolytic anemia
C; Microcytic anemia: Beta thalassemia is a genetic disorder in which the bone marrow makes small pale RBCs (microcytic hypochromic), and microcytic anemia occurs.
Decreased facial strength indicates a lesion of which cranial nerve? 1. Cranial nerve III 2. Cranial nerve V 3. Cranial nerve VII 4. Cranial nerve VIII
CN VII [Decreased facial strength indicates a lesion of cranial nerve (CN) VII]
The increased presence in a urinalysis of which of the following indicates the presence of bacteria or protein, which is seen in severe renal disease and could also indicate urinary calculi? 1. Crystals. 2. Casts. 3. Nitrites. 4. Ketones.
Casts (The presence in a urinalysis of increased amounts of casts indicates the presence of bacteria or protein, which is seen in severe renal disease and could also indicate urinary calculi)
Systemic lupu erythematosus is more common among patients from all of the following ethnic and racial backgrounds except: A: african american B: Asian C: Hispanic D: caucasian
Caucasian
Goodpasture syndrome is: 1. Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes. 2. Characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. 3. An inflammatory autoimmune disorder affecting the connective tissue of the body, with inflammatory lesions involving the supportive tissues of the glomeruli. 4. Typically the end stage of other glomerular disorders, such as rapidly progressive glomerulonephritis, lupus nephritis, or diabetic nephropathy.
Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes
When teaching smokers about starting nicotine gum to aid in smoking cessation, tell them to: 1. Chew the gum like regular gum. 2. Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa. 3. Drink a cup of coffee before chewing the gum because it assists the nicotine absorption. 4. Chew 1 piece every 4 hours for the first 6 weeks,
Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa (A piece is chewed only long enough to release the nicotine—which produces a peppery taste—and then it is "parked" between the gums and buccal mucosa to allow for nicotine absorption)
which of the following is the most common cause of nongonococcal urethritis? A: ecoli B: chlamydia trachomatis C: neisseria gonorrhoeae D: mycoplasma genitalium
Chlamydia trachomatis
an asthmatic exacerbation is characterized by all of the following symptoms except: A: tachycardia B: severe wheezing C: Chronic coughing D: tachypnea
Chronic Coughing
Asthmatics may have all of the following symptoms during an asthma exacerbation except: A. Rapid Pulse B. Wheezing C. Chronic coughing D. Tachypnea
Chronic coughing
all of the following drugs interfere with the metabolism of oral contraceptives except: A: tetracycline B: rifampin C: phenytoin (Dilantin) D: ciprofloxacin
Ciprofloxacin
which of the following drugs is recommended by the CDC for prophylaxis after exposure to Bacillus Anthracis?
Ciprofloxacin (cipro)
A male 16 year with a recent hx of a cat bite is brought to the walk in clinic. By his. Mother. The bite occurred about 2 hours before the visit. The NP evaluates the wound and notes 2 small puncture wounds. There is no redness or purulent discharge. The. Mother. Reports that the teenager received a testanus booster when he was 12 years old. Which of the following is the correct action to take?
Clean the wound with soap and water and prescribe Augmentin 500mg BID for 10 days
When trying to differentiate pulmonary from cardiac causes of dyspnea on exertion, it is important to remember that which of the following statements is true? 1. When the cause is pulmonary, recovery of normal respiration is slow, and dyspnea eventually abates after cessation of exercise. 2. Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise. 3. In dyspnea arising from cardiac causes, the heart rate will return to pre-exercise levels within a few minutes after cessation of exercise. 4. Clients with pulmonary dyspnea have minimal dyspnea at rest
Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise (Clients with severe cardiac dyspnea demonstrate a volume of respiration that is greater than normal at every level of exercise, and they experience dyspnea sooner after beginning the exertion)
All of the following findings are associated with the secondary stage of an infection by the organism Treponema pallidum except: A: condyloma acuminata B: maculopapular rash of the palms and soles C: lymphadenopathy D: condyloma lata
Condyloma acuminata
Cataracts are a common occurrence in patients over 60 years of age. You counsel your patient that the best cure for cataracts is: 1. Medications. 2. Dietary supplements. 3. Corrective lens surgery. 4. Optical devices.
Corrective lens surgery (The definitive management for a cataract is a surgical approach, one that removes the defective lens and replaces it with an artificial one)
Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal infection of the bowel? 1. Giardiasis. 2. Amebiasis. 3. Cryptosporidiosis. 4. Escherichia coli.
Cryptosporidiosis (Cryptosporidiosis, a protozoal infection of the bowel, is common in immunocompromised clients. It causes villous atrophy and mild inflammatory changes and may secrete an enterotoxin)
The following findings are considered benign lesions of the skin except: A: lentigo B: seborrheic keratosis C: Actinic keratosis D: Rosacea
Actinic keratosis
A 35-year old sexually active man presents with a 1-week hx of fever and pain over the left scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to touch. He denies flank pain, nausea, and vomiting. He reports that the pain is lessened when he uses scrotal-support briefs. The urinalysis shows 2+ blood and a large number of leukocytes. What is the likely diagnosis? A: acute UTI B: acute pyelonephritis C: acute orchitis D: acute epididymitis
Acute epididymitis
Jeff, age 20, presents to the college health clinic with complaints of difficulty passing his urine and a discharge from his penis. Upon further investigation, you note that the discharge is urethral in origin. The most common cause of these symptoms in the young adult male population is: 1. Chronic prostatitis. 2. Prostatic abscess. 3. Acute prostatitis. 4. Prostatic hyperplasia.
Acute prostatitis (usually from gonorrhea or other bacterial infections in young males)
A 25-year-old female presents to your primary care clinic complaining of difficulty concentrating in graduate school ever since she was in a car accident 18 days ago. She had to be hospitalized for 1 day due to a concussion and broken ribs. Her car was totaled. She is fearful of driving. She also wakes up in the middle of the night with night terrors that involve getting into a car accident. What is the patient's diagnosis? 1. Post-traumatic stress disorder. 2. Acute stress disorder. 3. Panic disorder. 4. Phobia of driving
Acute stress disorder (The patient is experiencing acute stress disorder as a result of her car accident, as she is having symptoms of post-traumatic stress within 30 days of her accident)
When teaching Alice, age 77, to use a cane because of osteoarthritis of her left knee, an important point to stress is: 1. Carrying the cane in the ipsilateral hand. 2. Advancing the cane with the ipsilateral leg. 3. Making sure the cane length equals the height of the iliac crest. 4. Using the cane to aid in joint protection and safety
Advancing the cane with the ipsilateral leg (The cane should be carried in the contralateral hand, advanced with the ipsilateral (affected) leg, and the length should equal the height of the greater trochanter)
Which of the following is the preferred treatment for an enterobiasis infection? A: wash clothes and bedsheets with hot water B: strict hand washing C: albendazole (Albenza) D: Fluconazole (diflucan)
Albendazole (Albenza)
A 55-year-old African American man with newly diagnosed hypertension presents to your primary care clinic for medication management. Today his blood pressure reads 145/95. He denies headache, blurred vision, chest pain, and shortness of breath. Which medication would you start him on? 1. Catapres. 2. Hydralazine. 3. Amlodipine. 4. Metoprolol.
Amlodipine (Calcium channel blockers along with thiazide diuretics are first-line treatment for African Americans with hypertension)
Rovsing's Sign is associated with which of the following? A: an acute abdomen, such as during a ruptured appendix B: knee instability C: Damage to the meniscus of the knee D: Acute cholelithiasis
An acute abdomen such as during a ruptured appendix
Which of the following is used to confirm a dx of hashimoto's thyroiditis? A: Serum TSH B: Free T4 C: Anti-thyroid peroxidase and anti-thyroglobulin antibodies D: Thyroid ultrasound
Anti-thyroid peroxidase and anti-thyroglobulin antibodies
A medium-pitched mid systolic murmur is best heard at the right second ICS. It radiates to the NECK. Which of the following is correct? A: aortic stenosis B: pulmonic stenosis C: aortic regurgitation D: mitral stenosis:
Aortic Stenosis
Susan, age 59, has no specific complaints when she comes in for her annual examination. She does, however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you diagnose her? 1. As a healthy adult with several problems. 2. As having a glycemic event. 3. As having metabolic syndrome. 4. As having multiple organ dysfunction. (cards 23-43 obtained from DavisEdge)
As having metabolic syndrome
A 20year old patient has recently been diagnosed with migraines. The NP is educating the pt about factors that are known to be trigger for migraine headaches. WHich of the following is INCORRECT advice ? A: avoid foods high in tyramine content B: avoid foods high in potassium content C: get enough sleep D: avoid fermented foods
Avoid foods with high potassium content
All of the following are false statements about atopic dermatitis except: A) Contact with cold objects may exacerbate the condition B) It does not have a linear distribution C) It is associated with bullae D) The lesions have vesicles that are full of serous exudate
B) It does not have a linear distribution Atopic dermatitis, also known as eczema, is a skin condition in which the lesions occur in a linear fashion. They may have many different stages, including erythematous papules and vesicles, with weeping, drainage, and/or crusting. Lesions are commonly pruritic and are found on the scalp, face, forearms, wrists, elbows, and backs of the knees.
When initially treating adults for bronchitis, which would the NP be least likely to order? A. Expectorants B. Antibiotics C. Bronchodilators D. Antitussives
B. Antibiotics
A new patient is being interviewed by an NP, and states she had a gastrectomy procedure 5 years ago. The NP knows that this patient is at risk for which of the following? A. Folate deficiency anemia B. b12 deficiency anemia C. Iron deficiency anemia D. Normocytic anemia
B. B12 deficiency anemia: intrinsic factor is made by parietal cells in fundus of the stomach. IF is needed to sufficiently absorb B12. Gastrectomy pts have damaged fundus usually so they are at risk.
What is the best procedure for evaluating corneal abrasion? A. Tonometry B. Fluorescein stain C. Visual Field test D. Funduscopy
B. Fluorescein stain
Koplik's spots are associated with: A. Poxvirus infections B. Measles C. Kawasaki's disease D. Reye's syndrome
B. Measles: S/S of the measles includes 3 C's! Cough, coryza, conjunctivitis, rash, fever over 101F and Koplik's spots in buccal mucosa
28 y.o. student presents with "hacking cough." Productive with small amounts sputum, runny nose. Doesn't take any meds, no allergies, no significant PMH. Temp: 99.9F, Resp: 16/min, HR: 90 BPM, diffuse fine crackles. CXR shows diffuse infiltrates in lower lobe of right lung. CBC shows WBC count 10,500. What is most likely diagnosis? A. Strep pneumo B. Mycoplasma pneumo C. Acute Bronchitis D. Legionnaires disease
B. Mycoplasma: most commonly seen in children and young adults. spread through droplets, sneezing and coughing at close distance. DX made through sx and CXR showing infiltrate to lower lobes
A 15 m.o. child who is eating and behaving normally is found to have a high fever. A few days after, the fever resolves and the infant breaks into a maculopapular rash. This is a description of which of the following? A. Erythema infectiosum B. Roseola Infantum C, Fifth disease D. Scarlet fever
B. Roseola Infantum (Also known as fifth disease). Slapped cheek appearance. The happy rash, kids don't seem sick
The mother of a 12 m.o baby reports to the NP that her baby had a high fever for several days that resolved spontaneously. A few days later she broke out into a maculopapular rash. Which of the following is the most likely DX? A. Fifths disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes
B. Roseola Infantum (exanthum subitum) is a common viral rash that is caused by the human herpes virus. The most common ages of onset is 6months -2 yrs old. The rashes are maculopapular (round and pink) and appear first on the trunk and then spread to the extremities
You would advise an 18 y.o. at the student health clinic who just got an MMR booster which of the following: A. She may have low grade fever over next 24-48 hrs B. Not to get pregnant within the next 4 weeks C. Her arm will be very sore for the next 48 hrs at injection site D. Her arm will have some induration at IM site for 48 hrs
B. Women should not get MMR while pregnant, and need at least 28 days between vaccination and conception, preferrably at least 4 weeks
An infant who does not have a history of reactive airway disease and allergy has both insiratory and expiratory wheezing accompanied by fever and profuse clear nasal discharge, which of the following are most likely? A. Tracheobronchitis B. Bronchiolitis C. Croup D. A small foreign body that is lodged in the left main bronchus
B: Bronchiolitis: Tracheobronchitis include prominent dry, non productive cough; later coughing up sputum is common. Bronchiolitis is a viral infection caused by RSV that is commonly seen during the winter/ spring months in infants & young children. Typical S/S include fever/ inspiratory/ expiratory wheezing, with clear drainage. Croup is viral infection with classic "barking" cough; the pt may have runny nose but no fever with croup. Foreign body ruled out due to fever and runny nose
67 y.o female presents to the clinic with 50 pk year hx of smoking for physical. C/o being easily short of breath/ frequent fatigue. Physical reveals diminished breath sounds, hyperresonance and hypertrophied resp muscles. Her CBC shows that her hematocrit level is slightly elevated. Her pulmonary function test shows increased total lung capacity. What is most likely DX for this pt? A. Bronchogenic carcinoma B. COPD C. Chronic bronchitis D. CHF
B: COPD: results in polycythemia (Increased Hematocrit) due to chronic hypoxia. Also you may note digital clubbing, dyspnea on exertion, accessory muscle use
Which of the following viral infections is associated with occasional abnormal forms of lymphocytes during an acute infection? A. Cytomegalovirus (CMV) B. Epstein-Barr virus (EBV) C. HPV D. Coxsackie Virus
B: Epstein Barr Virus (EBV)
An 8 y.o. boy is seen by the NP and the mother reports he has had a fever X2 days, not eating well due to painful sores inside pt's mouth. Temp is 101F, Pulse is 88 BPM, and respirations are 14. Np notices several small blisters and shallow ulcers on the pt's pharynx and oral mucosa. He also has small red rashes on both palms and soles. Which of the following is the most likely? A. Herpes simplex infection B. Hand Foot and mouth disease C. Varicella infection D. Secondary syphilis infection
B: Hand foot and mouth disease: spread by fecal/ oral route and direct contact with toys etc., caused by coxsacksie virus, treatment is supportive.
What test would you use on a 7 y.o. to screen for color blindness? A. Snellen chart B. Ishihara chart C. Cover/uncover test D. Red Reflex
B: Ishihara chart
RMSF is caused by bite of: A. Mosquito B. Tick C. Insect D. Flea
B: Tick with parasite Rickettsia rickettsii
An older man is diagnosed with conductive hearing loss in the left ear by the NP. What is the expected result when performing a Rinne test on this patient?
BC>AC
A 30 year old woman who is sexually active complains of a large amount of milk-like vaginal discharge for several weeks. A microscopy slide reveals a large number of cells that have BLURRED margins. Very few white blood cells are seen. The vaginal pH is 6.0. What is most likely? A: Trichomonas infections B: Bacterial Vaginosis C: Candidal infection D: A normal finding
Bacterial Vaginosis
The most common type of skin malignancy in the united states is: A: squamous cell skin cancer B: Basal cell carcinoma C: Melanoma D: dysplastic nevi
Basal Cell Carcinoma
Jim, age 22, a stock boy, has an acute episode of low back pain. The nurse practitioner orders a nonsteroidal anti-inflammatory drug (NSAID) and should educate him in which of the following? 1. Maintaining moderate bed rest for 3 to 4 days. 2. Calling the office for narcotic medication if there is no relief with the NSAID after 24 to 48 hours. 3. Beginning lower back strengthening exercises depending on pain tolerance. 4. Wearing a Boston brace at night.
Beginning lower back strengthening exercises depending on pain tolerance (resuming normal activity within the limits imposed by the pain has an effect as good as, if not better than, 2 days of bed rest, letting pain be your guide. Exercise should begin as soon as possible after the acute injury and be directed at building endurance and stamina, with consideration given to one's pain tolerance)
Which of the following classes of drugs is implicated with blunting the signs and symptoms of hypoglycemia in diabetics? A; CCB B: Diuretics C: Beta Blockers D: ARB
Beta blockers
Which class of antihypertensive agents may be problematic for clients with diabetes? 1. Angiotensin-converting enzyme (ACE) inhibitors. 2. Calcium channel blockers. 3. Beta blockers. 4. Alpha blockers.
Beta blockers (they block tachycardia, which is 1st sign of hypoglycemia)
You are referring a 73-year-old client for management of his prostate cancer with hormonal therapy. It is understood that goserelin acetate (Zoladex) acts as a method of androgen ablation by: 1. Blocking the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). 2. Blocking 5-alpha-reductase, which converts testosterone into dihydrotestosterone. 3. Inhibiting the binding of testosterone to cancer cells. 4. Inhibiting the progression of cancer cells through the cell cycle.
Blocking the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) [Goserelin acetate (Zoladex) and leuprolide acetate (Lupron) block the release of FSH and LH; administered IM]
Chadwick's Sign is characterized by: A: softening of the cervix B: Blue coloration of the cervix and vagina C: softening of the uterine isthmus D: nausea and vomiting during the first trimester of pregnancy
Blue coloration of the vagina and cervix
Which type of hepatitis virus infection is more likely to result in chronic hepatitis and increased risk of developing hepatocellular carcinoma?
Both Hepatitis B and Hepatitis C
You note bony nodules at the proximal interphalangeal joints on both the hands of your 65 yr old female pt. Which of the following is most likely? A. Bouchard's node B. Herberden's node C. Osteoarthritic nodules D. Tophi deposits
Bouchard's nodes
The inspiratory rate equals the expiratory rate with which breath sound? 1. Bronchial. 2. Bronchovesicular. 3. Vesicular. 4. Tracheal.
Bronchovesicular (With bronchovesicular breath sounds, the inspiratory rate equals the expiratory rate; With bronchial breath sounds, the inspiratory rate is shorter than the expiratory rate; With vesicular breath sounds, the inspiratory rate is greater than the expiratory rate; With tracheal breath sounds, the inspiratory rate is shorter than the expiratory rate)
What structure of the eye is responsible for 20/20 vision? A. Rods B. Cones C. Optic disc D. Fovea and macula
D. Fovea and Macula
Which of the following is associated with Vitamin B-12 anemia? A. Spoon shaped nails and Pica B. An abnormal neuro exam C. Vegan diet D. Tingling/ numbness in both feet
D. Tingling and numbness in both feet: B12 can cause nerve damage if left untreated, also dementia, memory loss, difficulty walking, mood changes, depression also
All of the following factors increase risk of mortality for patients diagnosed with bacterial pneumonia except: A. Alcoholism B. Very young age or the elderly C. Multiple lobar involvement D. Hypertension
D: Hypertension
Which of the following findings are seen in a patient with folate deficiency anemia? A. Microcytic and Hypochromic RBCs B. Microcytic and normochromic RBCs C. Normal size and color RBCs D. Macrocytic and Normocytic RBCs
D: Macrocytic and Normocytic RBCs are found in Folate deficiency anemia
All of the following are associated with an increased risk for normocytic anemia except: A. Rheumatoid arthritis B. Lupus C. Chronic immune disorders. D. Pregnancy
D: Pregnancy, during pregnancy women at risk to develop microcytic, hypochromic anemia due to dilutional effect of increased blood volume in pregnancy.
An NP is giving dietary counseling to an alcoholic male who has been recently diagnosed with folic acid deficiency anemia. Which of the following foods should the NP recommend? A. Tomatoes, oranges, bananas B. Cheese, yogurt, milk C. Lettuce, beef, dairy products. D. Spinach, liver, and whole wheat bread
D: Spinach liver and whole wheat
A 70 y.o male c/o bright red spot in his left eye for 2 days. He denies pain, visual changes, or headaches. New onset cough from recent viral illness. The only med he was on was Bayer Aspirin 1 tablet daily. Which of the following is most likely? A. Corneal Abraison B. Acute bacterial conjunctivitis C. Acute uveitis D. Subconjunctival hemorrhage
D: Subconjunctival hemorrhage: caused by increased intraocular pressure due to straining, coughing, heavy lifting etc. Self limiting- disappears in 1-3 weeks
Which of the following is considered an objective finding in patients who have a case of suppurative otitis media? A: erythema of tympanic membrane B: Decreased mobility of the tympanic membrane as measured by tympanogram. C: Displacement of the light reflex D: Bulging of the tympanic membrane
Decreased mobility of the tympanic membrane as measured by tympanogram.
Heberden's nodes are commonly found in which of the following diseases? A: rheumatoid arthritis B: Degenerative Joint disease C: Psoriatic arthritis D: septic arthritis
Degenerative Joint disease (OA)
A woman who is in her 3rd trimester of pregnancy present the NP for a physical exam. During the physical exam, the NP finals all of the following cardiac changes associated with pregnancy except: A: systolic ejection murmur B: Diastolic murmur C: displaced apical impulse D: louder s1 or s2.
Diastolic murmur
When performing a sports physical exam on Kevin, a healthy 16-year-old boy, which question in the history is important to ask Kevin or his guardian? 1. Did anyone in your family ever have sudden cardiac death? 2. Does anyone in your family have elevated cholesterol levels? 3. Did you ever have any injury requiring stitches? 4. Does anyone in your family have a history of asthma?
Did anyone in your family ever have sudden cardiac death (The risk of sudden death during sports activities from hypertrophic cardiomyopathy may be greatly reduced with a thorough cardiac history and examination. If a child has a relative who died of sudden cardiac disease before age 55, that child could possibly have hypertrophic cardiomyopathy)
Which of the following white blood cell types are elevated in parasitic infections, hypersensitivity reactions, and autoimmune disorders? 1. Neutrophils. 2. Eosinophils. 3. Basophils. 4. Monocytes.
Eosinophils (Eosinophils are elevated in parasitic infections, hypersensitivity reactions, and autoimmune disorders; Neutrophils are increased in acute infections, the stress response, myelocytic leukemia, and inflammatory or metabolic disorders; Basophils are increased after a splenectomy and in hypersensitivity responses, chronic myelogenous leukemia, chickenpox, smallpox, and hypothyroidism; Monocytes are increased in chronic inflammatory disorders, tuberculosis, viral infections, leukemia, Hodgkin disease, and multiple myeloma)
Which of the following viral infections is associated with occasional abnormal forms of lymphocytes during an acute infection? A: Cytomegalovirus (CMV) B epstein-barr virus (EBV) C: Human papillomavirus (HPV) D: coxsackievirus
Epstein-Barr virus EBV
A 25 year old man with schizophrenia comes in for. Routine annual physical. He is a heavy smoker and has a BMI of 28. The pt has been on Olanzapine (Zyprexa) for 10 years. Regarding the pts prescription, which of the following laboratory test is recommended for monitoring the adverse effects of atypical antipsychotics? A: fasting blood glucose, fasting lipid profile, and weight B: urinalysis, serum creatinine, 24 hour urine for protein and creatinine clearance C: Liver function tests only D: CBC with differential, LFT, and weight
Fasting blood glucose, fasting lipid profile and weight
which of the following conditions is associated with 3 stages of rashes? A: fifth disease B: erythema infectiosum C: varicella D: Rocky MTN spotted fever
Fifth disease
Which of the following drugs is classified. As a 5-alpha reductase inhibitor? A: terazosin (Hytrin) B: tamsulosin (Flomax) C: Finasteride (Proscar) D: sildenafil (Viagra)
Finasteride (Proscar)
what is the treatment for C-diff
Flagyl 500mg TID for 10 days
What does a potassium hydroxide (KOH) prep help the nurse practitioner diagnose? A: Herpes zoster infections B: Fungal infections C: Herpes simplex infections D: Viral infections
Fungal infections
A high school teacher complains of cough X6 weeks. Worse when lying down. He has episodes of heartburn, which he treats with OTC TUMS. He chews mints for his "bad breath" which is most likely causing his cough? A. Asthma B. Gastroesophageal Reflux C. Pneumonia D. Chronic Post nasal drip
GERD: Common cause of chronic cough, worse when lying down because acid splashes up into upper esophagus
Podagra is associated with which of the following? A) RA B) Gout C) Osteoarthritis D) Septic arthritis
Gout
while assessing for a cardiac murmur, the first time that a thrill can palpated is at: A: grade 2 B: grade 3 C: Grade 4 D: grade 5
Grade 4
Which of the following drug classes is indicated for initial tx of an uncomplicated case of helicobacter pylori- negative peptic ulcer? A: PPI B: H2 receptor antagonists C: antibiotics D: antacids
H2 Receptor antagonists
You have a patient you are considering starting on bupropion (Wellbutrin) for tobacco cessation and depression. What in the patient's past medical history would prevent you from prescribing this? 1. History of epilepsy. 2. Failure of other antidepressants to treat depression. 3. Obesity. 4. Coronary artery disease.
History of epilepsy (Bupropion lowers a patient's seizure threshold and is contraindicated in patients with a seizure history)
A small abscess on a hair follicle on the eyelid is called: A. Hordeolum B. Aortic Stenosis C. Pinguecula D. Ptosis
Hordeolum- painful acute bacterial infection of a hair follicle on the eyelid
All of the following factors increase the risk of mortality for patients diagnosed w/ bacterial pneumonia except: A: alcoholism B: very young/old C: Multiple lobar involvement D: hypertension
Hypertension
All of the following signs and symptoms are present with an anticholinergic drug overdose except? A: dilated pupils B: flushing and tachycardia C: hypertension D: confusion.
Hypertension
What is the name of immune process that is responsible for anaphylactic reactions? A: IgE-mediated reaction B: IgG-mediated reaction C: antibody reaction D: atopic reaction
IgE-mediated reaction
Which of the following is involved with sensorineural hearing loss? A: outer ear B: middle ear C: Inner ear D: cranial nerve VIII
Inner ear
Koilonychia is associated with which of the following conditions? A: lead poisoning B: beta thalassemia trait C: B12 deficiency anemia D: Iron-deficiency anemia
Iron-deficiency anemia
Which of the following statements is true of mitral regurgitation? 1. It may be noted as a holosystolic murmur. 2. It is caused by stiff leaflets that limit flow from the left atrium to the left ventricle. 3. It occurs only as a result of congenital malformation of the mitral valve, which inhibits contact and closure of the cusps. 4. It results in a prolonged PR interval on electrocardiogram.
It may be noted as a holosystolic murmur (Because ventricular pressure exceeds atrial pressure at the beginning of systole, regurgitant backflow begins with the first heart sound (S1). The ensuing regurgitant murmur persists up to the second heart sound (S2), provided that the ventricular pressure at the end of systole still exceeds the atrial pressure. The direction of the regurgitant flow may be noted on auscultation. Mitral regurgitation is caused by shrunken, deformed cusps or shortened, fused chordae tendineae, which prevent closure of the leaflets)
For which patient would you administer the human papillomavirus (HPV) vaccination? 1. Susie, age 7. 2. Janice, age 17, who had a baby 6 months ago and is breastfeeding. 3. Alice, age 18, who is allergic to yeast. 4. Jill, age 25, who is pregnant.
Janice, age 17, who had a baby 6 months ago and is breastfeeding (Women who are lactating or immunocompromised are eligible to receive the vaccine. It is also recommended for females aged 9 to 25 years, regardless of whether they have had sex yet and even if the women already have a history of genital warts, a positive HPV test, or an abnormal Pap test)
A patient who recently returned from a vacation in Latin America complains of a severe headache and stiff neck that were accompanied by a high fever for the past 12 hours. While examing the pt, the NP flexes both the pts hips and legs and then tells the pt to straighten them against resistance. The name of this test is: A: kernig's maneuver B: Brudzinski's maneuver C: Murphy's sign D: Homan's sign
Kernigs maneuver
which of the following is considered abnormal result on a weber test?
Lateralization to 1 ear
Which of the following is a benign neoplasm? 1. Leiomyoma. 2. Osteosarcoma. 3. Glioma. 4. Seminoma.
Leiomyoma (A leiomyoma is a benign neoplasm of the smooth muscle)
a kindergarten teacher is dx'd with acute streptococcal pharyngitis. On exam, her throat is a bright-red color with no tonsillar exudate, and clear mucus is seen on the lower nasal turbinates. The urinalysis shows a large amount of white blood cells and is positive for nitrites. The patient has a sulfa allergy and thinks she is also allergic to PCN. Which of the following is the best tx chocie? A: augmentin 500mg PO BID B: Levaquin 250mg PO Daily C: Bactrim DS po BID D: Biaxin (clarithromycin) 500mg PO BID
Levaquin 250mg PO daily
Which of the following statements about Medicaid is true? 1. Medicaid is a federal plan created to provide care for indigent persons. 2. Medicaid pays for family planning services, dental care, and eyeglasses. 3. Eligibility requirements for Medicaid are mandated by the Health Care Financing Administration. 4. Medicaid is a program for the indigent financed jointly by the federal and state governments
Medicaid is a program for the indigent financed jointly by the federal and state governments (Financed jointly by the federal and state governments, Medicaid is a program created to pay for health care services for the indigent. Minimally, Medicaid must provide inpatient, skilled nursing facility, and home care; physician services; outpatient care; family planning services; and periodic screening, detection, and treatment of children under age 12)
Medicare part A will pay for all of the following services except A; minor surgery in a walk in surgical center B: plastic surgery to repair facial damage from a burn C: kidney transplantation D: Medical Supplies and drugs That are used while the pt is. In the hospital.
Minor surgery in a walk-in surgery center
During a routine phycial exam of a 90-year old woman. a LOW pitched diastolic murmur grade 2/6 is auscultated. it is located on the 5th ICS on the left side of the midclavicular line. Which of the following identifications is correct?
Mitral Stenosis
What type of murmur can radiate to the left axilla? A: aortic regurgitation B: aortic stenosis C: Mitral stenosis D: Mitral regurgitation
Mitral regurgitation
You note a HIGH pitched and BLOWING pansystolic murmur while assessing a 70-year old male patient. It is a grade 2/6 and is best heard at the apical area. Which of the following is most likely? A: ventricular Septal Defect B: Tricuspid regurgitation C: Mitral regurgitation D: mitral stenosis
Mitral regurgitation
Jill, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities, and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Jill in? 1. Intermittent. 2. Mild persistent. 3. Moderate persistent. 4. Severe persistent.
Moderate persistent (Jill is in the step 3 (moderate persistent) category of asthma severity. This is because she has daily symptoms, with exacerbations affecting her activity, and nocturnal symptoms that occur more than once per week)
Orchitis is caused by which of the following?> A: mumps virus B: measles virus C: chlamydia trachomatis D: chronic UTI that are not treated adequately
Mumps Virus
Which of the following findings is associated with thyroid hypofunction? A: graves disease B Eye disorder C Thyroid Storm D Myxedema
Myxedema
The research term/symbol that is used to indicate the "total population" in a research study is stated as: A: n B: N C: p D: P
N
Greg, age 68, has just been given a diagnosis of congestive heart failure (CHF). Which of his medications should be discontinued? 1. Nifedipine (Procardia XL) for long-term management of his chronic stable angina. 2. Hydrochlorothiazide (HydroDIURIL) for his hypertension. 3. Enalapril (Vasotec) for his hypertension. 4. Butalbital for his headaches.
Nifedipine (Procardia XL) for long-term management of his chronic stable angina (Nifedipine (Procardia XL), a calcium channel blocker, should be discontinued, along with most antiarrhythmic agents, when a client develops CHF because both of these classes of medications are important causes of worsening heart failure)
A 68 year old woman has recently been diagnosed with polymyalgia rheumatica. The NP is discussing the Tx options with the patient. Which of the following medication is the first line tx for this condition? A: Etanercept (Enbrel) B: oral prednisone C: indomethacin D: methotrexate
Oral prednisone
Which of the following is not recommended for hoarseness? 1. Vocal rest. 2. Tobacco cessation. 3. Decrease in caffeine use. 4. Oral steroids.
Oral steroids (caffeine is dehydrating and should not be used in excess w/hoarseness; PO steroids are not routinely used to Tx hoarseness)
a patient is positive for anti-HCV (hepatitis C virus Antibody). WHat is the next step to further evaluate this patient? A: refer the patient to a gastroenterologist B order a hepatitis C RNA test C. order a hepatitis B comprehensive panel D. The pt is immune to hep C and no further testing is indicated
Order a hepatitis C RNA test
A middle-aged woman who works in the housekeeping department of a hospital presents to the employee health clinic with a complaint of a needlestick to her left thumb. The needle was in one of the garbage bags from the ER. The patient had a little bleeding that stopped spontaneously. Which of the following is the next step? A: order an enzyme-linked immunosorbent assay (ELISA) test as soon as possible B: recommend a tetanus booster in 1 week C: offer the patient hepatitis B immunoglobulin D: order a chest xray
Order an ELISA test as soon as possible.
A 68-year-old male patient reports an unintended weight loss of 15 lbs (6.8 kgs) over the last two months. The patient states that he feels well. His problem list includes depression, tobacco use, hyperglycemia, obesity, and dyslipidemia. The patient's medications are sertraline (Zoloft), metformin (Glucophage), simvastatin (Zocor), and famotidine (Pepcid). The family nurse practitioner initiates which three interventions? Decreasing the statin medication. Increasing the Glucophage dose. Evaluating medication side effect profile. Ordering a thyroid-stimulating hormone level test. Performing a depression screening.
Ordering a thyroid-stimulating hormone level test. Performing a depression screening. Evaluating medication side effect profile.
A low thyroid-stimulating hormone (TSH) can lead to: 1. Osteoporosis. 2. Weight gain. 3. Bradycardia. 4. Brittle hair.
Osteoporosis (due to increased metabolic state of hyperthyroidism)
All of the following are cover under Medicare part B except: A: person aged 65 years or older B: Durable medical equipment C: Mammograms annually starting at age 50 D: outpatient anesthesiologists services
Outpatient Anesthesiologist services
The positive signs for pregnancy include: A. palpation of the fetus and auscultation of fetal heart tones by the NP B: palpation of the fetus and a positive quantitative serum pregnancy test C: Fetal heart tones and a positive quantitative serum pregnancy test D: fetal heart tones and feeling of movement of the fetus by the mother
Palpation of the fetus and Auscultation of the fetal heart tones.
a 40-year old cashier complains of periods of dizziness and palpitations that have a sudden onset. The EKG shows P waves before each QRS complex and a heart rate of 170beats/min. A carotid massage decreases the heart rate to 80bpm. These findings best describe? A: ventricular tachycardia B: paroxysmal atrial tachycardia C: afib D: vfib
Paroxysmal atrial tachycardia
All of the following are complications of severe preeclampsia except: A: Liver Failure B: Hypertensive Encephalopathy C: Pulmonary Edema D: Placenta Previa
Placenta Previa
A 28-year old multipara who is at 32 weeks gestation presents to your office complaining of a sudden onset of small amounts of bright-red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely? A: placenta abruptio B: placenta previa C: acute cervicitis D: Molar Pregnancy (hydatidiform mole)
Placental previa
Which of the following diseases is associated with a high risk of giant cell arthritis? A: Hx of TIA B: frequent migraine headaches with focal neurological findings C: polymyalgia rheumatica PMR D: SLE
Polymyalgia rheumatic (PMR)
A 76 year old woman reports that for the previous 4 months, she has noticed severe stiffness and aching in her neck and both shoulders and hips that is worsened by movement. She reports having a difficult time getting out of bed because of the severe stiffness and pain. It is difficult for her to put on a jacket or blouse or to fasten her bra. Along with these symptoms, she also has a low-grade fever, fatigue, loss of appetite, and weight loss. starting yesterday the vision in her right eye has progressively worsened. She has annual eye exams and denies that she has glaucoma. Which of the following conditions is most likely? A: RA B: Degenerative Joint Disease C: polymyalgia rheumatica PMR D: fibromyalgia
Polymyalgia rheumatica (PMR)
Max, age 35, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action? 1. Prescribe nasal steroids and oral decongestants. 2. Prescribe antibiotic ear drops. 3. Prescribe systemic antibiotics. 4. Refer Max to an ear, nose, and throat specialist
Prescribe nasal steroids and oral decongestants (Barotrauma of the auditory canal, causing a sensation of abnormal middle ear pressure, may be relieved by the use of nasal steroids and oral decongestants. There is no infection, just swelling of the airways, which causes the sensation of abnormal pressure)
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
Probable sign of pregnancy.
All of the followign are included in the criteria used to diagnose pts with AIDS except: A: profound fatigue B: Thrush C: Kaposi's sarcoma D: Hairy leukoplakia of the tongue
Profound fatigue
You are working in an emergency department as an advanced practice registered nurse (APRN). An adolescent boy is brought in, unconscious, with a head injury after being struck by a car. He has no identification, and there is no parent or adult with him. What should you do? 1. Provide the appropriate medical treatment even if it involves surgery. 2. Do everything except order a blood transfusion, even if it is indicated, because you do not know the client's religious preferences. 3. Call the hospital attorney before instituting any care. 4. Contact all local police stations in an attempt to identify the client and find his parents before instituting treatment.
Provide the appropriate medical treatment even if it involves surgery. (The emergency treatment exception allows you to treat minors in emergency or life-threatening situations when a parent or guardian cannot be reached to give consent for treatment. This includes transfusions when necessary. The legal definition of an emergency medical condition is any condition that threatens the loss, impairment, or serious dysfunction of life or limb or causes severe pain)
What is the least common pathogen found in CAP? A: moraxella catarrhalis B: Streptococcus pneumoniae C: pseudomonas aeruginosa D: mycoplasma pneumonia
Pseudomonas Aeruginosa
Which bacterium is the most common pathogen seen in otitis external infections? A: pseudomonas aeruginosa B: Streptococcus pyogenes C: hemophilia influenzae D: moraxella Catarrhalis
Pseudomonas aeruginosa
Which of the following conditions is associated with a positive Auspitz sign? A: contact dermatitis B: seborrheic dermatitis C: systemic lupus erythematous D: psoriasis
Psoriasis
During a routine physical exam of an elderly woman, a triangular thickening of the bulbar conjunctivia on the temporal side is noted to be encroaching on the cornea. She denies any eye pain or visual changes. Which of the following is most likely? A: corneal Arcus B: pterygium C: pinguecula D: chalazion
Pterygium
Which lifestyle change decreases the risk of mortality greatest in regard to coronary heart disease? 1. Quitting smoking. 2. Weight loss. 3. Fasting low-density lipoprotein (LDL) cholesterol less than 100. 4. Moderate exercise—greater than 30 minutes a day 3 times a week.
Quitting smoking (Smoking decreases one's risk the greatest—12% in comparison to physical activity, which reduces the risk 5%)
a 13-year old boy wants to be treated for his acne. He has a large number of closed and open comedones on his face. The patient has been treating himself with OTC benzoyl peroxide and topical salicylic acid products. Which of the following would be recommended next? A: isotretinoin (Accutane) B: tetracycline C: Retin-A 0.25% gel D: careful face washing with medicated soap at bedtime
Retin-A 0.25% gel
All of the following are foods best avoided by pts with celiac spruce except: A: rice cereal B: blueberry muffins C: Organic wheat bread D: Rye bread
Rice cereal
The mother of a 12 month old infant reports to the NP that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A: fifth disease (Erythema infectiosum) B: roseola infantum (Exanthema subitum) C: varicella D: infantile Maculopapular rash
Roseola infantum (Exanthema subitum)
Koplik's spots are associated with: A: poxvirus infections B: Rubeola C: Kawasaki's disease D: Rubella
Rubeola
Which human papillomavirus serotypes most commonly cause cancer? 1. Serotypes 16 and 18. 2. Serotypes 6 and 11. 3. Serotypes 3 and 10. 4. Serotypes 27 and 29.
Serotypes 16 and 18
you are reviewing a pap smear result for a 25-year old woman. Which of the following cells should be obtained in a pap smear sample to be classified as a satisfactory specimen? A: clue cells and endometrial cells B: vaginal cells and cervical cells C: squamous epithelial cells and endocervical cells D: leukocytes and RBC's
Squamous epithelial cells and endocervical cells
Jan's mother has Alzheimer disease (AD). Jan tells you that her mother's recent memory is poor and that she is easily disoriented, incorrectly identifies people, and is lethargic. Jan asks you, "Is this as bad as it gets?" You tell her that her mother is in which stage of the disease? 1. Stage 1. 2. Stage 2. 3. Stage 3. 4. Stage 4.
Stage 3 (In stage 3, personality change is marked and depression may occur. Directions must be specific and repeated for safety, recent memory is poor, disorientation occurs easily, people are incorrectly identified, and the person may be lethargic)
The bacterium responsible for the highest mortality for pts with community-acquired pneumonia is: A: streptococcus pneumoniae B: mycoplasma pneumoniae C: Moraxella catarrhalis D: Haemophilus influenzae
Streptococcus pneumoniae
The bacterium responsible for the highest mortality in pts with CAP is: A. Strep Pneumo B. Mycoplasma pneumo C. Moraxella catarrhalis D. Haemophilus influenzae
Streptococcus pneumoniae
an adolescent females areola, nipples, and breast tissue develop and become elevated as one mound. which of the following is the correct tanner stage for this phase of breast development?
Tanner stage III
In assessing a patient, you place the tips of your first 2 fingers in front of each ear and ask the patient to open and close his mouth. Then you drop your fingers into the depressed area over the joint and assess for smooth motion of the mandible. With this action, you are checking for: 1. Maxillomandibular integrity. 2. Well-positioned permanent teeth or well-fitting dentures. 3. Temporomandibular joint syndrome. 4. Mastoid inflammation.
Temporomandibular joint syndrome (place the tips of your first 2 fingers in front of each ear and ask him to open and close his mouth. Then drop your fingers into the depressed area over the temporomandibular joint (TMJ) and check for smooth motion of the mandible. With this action, you are assessing for TMJ syndrome. Clicking or popping noises, decreased range of motion, pain, or swelling may indicate TMJ syndrome. However, an audible and palpable snap or click does occur in many normal people as they open their mouths. In rare cases, this may indicate osteoarthritis)
Swim therapy (aqua therapy) for a 13-year old with cerebral palsy is an example of: A: primary prevention B: Secondary prevention C: tertiary prevention D: health prevention
Tertiary Prevention
a patient who has been prescribed warfarin sodium (Coumadin) is advised to avoid eating large amounts of leafy green vegetables because: A: the high vitamin K level will decrease the INR B: they have too much ascorbic acid, which can interact with the medicine C: the high-fiber content will decrease the absorption of the warfarin (coumadin) D: The vitamins in the vegetables will bind with, and inactivate, the warfarin (Coumadin)
The high vitamin K levels will decrease the INR
A split s2 heart sound is best heard at which of the following areas? A: the aortic area B: The pulmonic area C: The tricuspid area D: the mitral area
The pulmonic area
A fracture on the navicular area of the wrist is usually caused by falling forward and landing on the hands. The affected wrist is hyperextended to break the fall. The NP is aware that all of the following statements are true regarding a fx of the schaphoid bone of the wrist except. A: it has a higher rate of unonunion compared with the other bones in the wrist when it is fractured B: The fx frequently does not show up on an xray film when it is taken immediately after injury. C The xray film will show the fx if the film is repeated in 2 weeks. D. These fractures always require surgical intervention to stabilize the joint.
These fx's always require surgical intervention to stabilize the joint
All of the following drug classes are approved for treating HTN. Which of the following antihypertensive drug classes is associated with the largest number of research studies?
Thiazides Diuretics
Acanthosis nigricans is associated with all of the following disorders EXCEPT: A: obesity B: diabetes C: colon cancer D: tinea versicolor
Tinea Versicolor
a 20-year old white man is being seen for a physical exam by the nurse practitioner. He complains of pruritic macerated areas in his groin that have been present for the past 2 weeks. Which of the following is the most likely? A: Tinea Cruris B: Tinea Corporis C: tinea capitis D: Tinea Pedis
Tinea cruris
Which of the following benzodiazepines has. The shortest half life? A: Ativan B: Xanax C: triazolam (Halcion) D: klonapin.
Triazolam (Halcion)
All of the following are factors important in determining the peak flow rate except: A. Weight B. Height C. Age D. Gender
Weight
Doug, age 6, appears with abdominal distention and pain, an abdominal mass on the right side, fever, and slight hematuria. There is no precipitating event. What do you suspect? 1. A urinary tract infection (UTI). 2. Appendicitis. 3. Wilms tumor. 4. An intestinal obstruction.
Wilms tumor (A child with Wilms tumor commonly has abdominal distention or an abdominal mass. There may also be fever, abdominal pain, or hematuria. This kidney tumor requires surgical removal followed by chemotherapy. Radiation therapy is not necessary)
A menopausal woman with osteopenia is attending a dietary education class. Which of the following foods are recommended? A: yogurt and sardines B: spinach and red meat C: Cheese and red meat D: low-fat cheese and whole grain
Yogurt and sardines
Jill, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order? 1. Aspirin. 2. Ibuprofen. 3. Opioids. 4. Antihistamines.
antihistamines (Transient urticaria requires antihistamines on a regular basis)
Signs and symptoms of depression include all of the following except: A: anhedonia B: Low Self-esteem C: Apathy D: Apraxia
apraxia
A pt who is complaining of a new onset of severe headache is being examined. The pt is instructed to lie down on the examining table while the NP flexes his head and neck forward to his chest. The patient reacts quickly flexing his hip and knee. What is the name of this positive finding?
brudzinski's sign
A family nurse practitioner advises a nursing mother who has postpartum mastitis to take antibiotics as prescribed and: 1. continue to nurse with both breasts. 2. pump the unaffected breast with a lactation pump. 3. take cool showers. 4. temporarily switch to formula.
continue to nurse with both breasts.
RhoGAM's mechanism of action:
destruction of Rh-positive fetal red blood cells that are present in the mother's circulatory system. It is given to Rh negative mothers during the 28th week of pregnancy.
All of the following statements reflect inadequate breast milk production except: A: full term infant is at birth weight by the second week of life B: fewer than 6 wet diapers and fewer than 4 stools per day C: Infant is nursing fewer than 8 times in a 24 hour peroid D: weight loss more than 10% of birth weight
full-term infant is at birth weight by the second week of life
women with PCOS have an increased risk for..
heart disease and endometrial cancer
A small abscess on a hair follicle on the eyelid is called: A: hordeolum B: Pterygium C: Pinguecula D: ptosis
hordeolum
which drug is associated with increased lipoprotein levels? 1. furosemide (Lasix) 2. Hydroclorothiazide (HCTZ) 3. Spironolactone (Aladactone) 4. Triamterene
hydrochlorothiazide (HCTZ)
The Lachman Maneuver is used to detect which of the following? A: Instability of the knee B: Nerve Damage of the knee due to past knee injuries C: Integrity of the patellar tendon D: Tears of the meniscus
instability of the knee
Which of the following is correct regarding the best site to listen for mitral regurgitation ? A it is best heard in the apical area during S2 B: it is best heard at the base during S1 C: it is best heard at the apex during S1 D: it is best heard at the base during S2.
it is best heard at the apex during S1
Beta Thalassemia minor is considered a: A: macrocytic anemia B: normocytic anemia C: microcytic anemia D: hemolytic anemia
microcytic anemia
During cardiac auscultation, a soft first heart sound with a holosystolic apical murmur that radiates to the left axilla suggests: 1. aortic stenosis. 2. mitral regurgitation. 3. mitral stenosis. 4. mitral valve prolapse.
mitral regurgitation.
All of the following patients have an increased risk of developing adverse effects from metformin (Glucophage) except: A: pts with renal disease B: pts with hypoxia C: Obese pts D: pts who are alcoholics
obese patients
After determining that a two-and-half-year-old patient has a lead level of 16 mcg/dL, the family nurse practitioner: 1. advises the parent to avoid giving the patient bottles of whole milk. 2. consults with a physical therapist for muscle strengthening. 3. observes for signs of diminished reflexes on the physical exam. 4. orders an increase of iron supplements to 6 mg/kg per day divided in two doses.
observes for signs of diminished reflexes on the physical exam.
all of the following conditions are contraindications for bupropion except: A: anorexia nervosa and bulimia B: seizure disorders C: peripheral neuropathy D: Brain injury
peripheral neuropathy
A young primagravida reports to you that she is starting to feel the baby's movements in her uterus. This is considered to be which of the following? A: presumptive sign B: probable sign C: positive sign D possible sign
presumptive sign
The following statements are true about Wilms' tumor EXCEPT: A: the most frequent clinical sign is a palpable abdominal mass B: it is a congenital tumor of the kidneys C: microscopic or gross hematuria is sometimes present D: the tumor commonly crosses the midline of the abdomen when it is discovered.
the tumor commonly crosses the midline of the abdomen when it is discovered.
