Pre Exam
Your patient with a diagnosis of autoimmune hepatitis is being seen in your clinic for routine liver serology and follow-up examination. Which of the following correctly identifies the normal liver span when percussing the liver of a HEALTHY adult? *6-12 cm in the midsternal line *4-8 in the left midclavicular line...not this one *4-8 cm in the right midclavicular line *6-12 cm in the right midclavicular line.
6-12 cm in the right midclavicular lin
A patient of Mediterranean descent who presents with microcytic anemia with normal red cell distribution width should be evaluated using gel electrophoresis to confirm which of the following types of anemia? *Aplastic *Thalassemia *Iron deficiency...NOT THIS ONE *Pernicious
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The 43 year old male patient with macrocytic anemia should be evaluated for which of the following lab levels to help narrow down the etiology? *Vitamin B12 *Lead level *Ferritin....NOT THIS ONE *TIBC
?
While assessing the patient, you covered their right eye while you covered your left eye, then brought a set number of fingers or wiggling fingers into each quadrant of the patient's visual field while you had them identify when they saw your fingers/movement. A normal exam would be documented as which of the following? *Normal confrontation *Normal visual acuity...NOT THIS ONE *Normal refractory reflexes *Normal convergence test
?
Your new patient intake history of an elderly man includes a history of Ehlers-Danlos with complications of retinal detachment treated with gas pneumopexy. In discussing this history, you recall the transparent mass of gelatinous material where the gas pneumopexy is performed can be found in which chamber(s) of the eye? *None of the above; it's only seen as an abnormal finding with malignancy...NOT THIS ONE *Anterior only. *Posterior only. *Both but greater in the anterior chamber.
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Upon reviewing an old H&P for a 45 year old male patient new to your practice, you notice they have a documented paresthesia associated with the left hand from an old cerebrovascular accident (CVA). Based on this documentation, which of the following should the nurse practitioner expect to see on their examination? *Patient has a hyper-reactive response to any painful stimulus in their left hand *Patient has edema or excessive swelling in their left hand *Patient has movement difficulty or immobility in their left hand *Patient complains of numbness and tingling sensations in their left hand..NOT THIS ONE
???
While evaluating a patient in your clinic for a routine health visit, you auscultate crackles in the poster left lower lobe, have the patient cough, with follow-up auscultation revealing clear breath sounds. Which one of the following would you suspect? *Congestive heart failure. *Atelectasis. *Laryngospasm. *Bronchiactasis.
?Atelectasis
On examination, Kim, your 68 year old female patient has the following facial muscle movements: Normal upper and lower on the right side, Unable to move both the upper and lower muscles on the left side. You would immediately suspect which one of the following conditions? *A left central lesion. *A right central lesion. *A left peripheral lesion. *A right peripheral lesion.
A left peripheral lesion.
The 19 year old male patient presents with acute symptoms of abdominal pain and a history of intermittent heartburn and spicy food intolerance, as well as anxiety due to his college athletic performance. You have a concern the patient may have a perforated gastric ulcer and is experiencing peritonitis. Which of the following exam findings is NOT supportive of this diagnosis? *Guarding. *Rebound tenderness. *Absence of pain with withdrawal of palpation. *Rigidity.
Absence of pain with withdrawal of palpation.
Your 38 year old male patient Mark is being seen in your clinic for routine health physical and complaints of heartburn. During your evaluation you identify darkened or velvety skin in the neck, groin, and/or axilla with associated achrocordons. This is most likely a diagnosis of which of the following? *Seborrheic Kerstosis *Actinic keratosis *Keratoacanthoma *Acanthuses nigricans
Acanthuses nigricans
Which of the folowing dermatologic lesions si precancerous and likely due to prolonged exposure to UV-B? *Actinic Keratosis. *Basal cell carcinoma. *Verucca. *Seborrheic dermatitis.
Actinic Keratosis.
The 84 year old lethargic patient who lives alone accidentally overdosed their amlodipine (Norvasc) was found by their daughter and taken to your clinic for evaluation. On exam, you found her blood pressure of 80/42 which the daughter says was "about what she found on her home cuff for the last 6 hours before bringing her in to be evaluated". The patient was then transferred to the hospital for evaluation. During her hospitalization she was also evaluated with CBC, BMP, and a UA. The results reflect normal labs except the UA showed trace WBCs in urine and no leukocyte esterases or nitrites and the BMP showed a creatinine of 1.9 with her normal baseline of 1.2 (normal range 0.5-1.2mg/dL) and BUN of 34, with a baseline of 20 (normal range 10-20 mg/dL). What si likely to cause which of her renal issues? *Pyelonephritis. *Chronic kidney disease. *Acute tubular necrosis. *Glomerulonephritis.
Acute tubular necrosis.
The nurse practitioner's evaluation of apatient with Diabetes Mellitus type 2 should include which of the folowing while evaluating for end organ dysfunction of the disease? *Renal function panel. *Urinalysis. *Non-dilated eye exam. *All of these are appropriate options.
All of these are appropriate options.
You are treating a patient who has stopped taking their diuretic regimen against medical advice while they are on vacation since it made them urinate too frequently for their plans. Now they are 21 pounds heavier than their baseline weight, have respiratory crackles in bilateral bases, and have severe generalized lower extremity and truncal edema extending to the sacrum and abdomen. On your documentation, this is referred to as which of the following conditions? *Nephrotic syndrome *Syndrome of inappropriate antidiuretic hormone (SAIDH) *Ascites *Anasarca
Anasarca
Your 32 year old female patient presents with a suspected diagnosis of systemic lupus erythematosus (SLE). Which of the useful labs in making the diagnosis of SLE? *Gel electrophoresis. *Antinuclear antibody. *Rheumatoid factor lab. *Spectrophotometric assay
Antinuclear antibody.
Your 42 year old male patient has been referred to your clinic for establishing care and on his intake survey, you note he has documented diagnosis of interstitial lung disease. You have decided to perform a diaphragmatic excursion test on the patient. Which one of the following results would you expect to see in this patient? *Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration. with a decreased overall inspiratory capacity. *Ascension of 8-12 inches of the diaphragm noted bilaterally on expiration, though often much less on the right side due to the location of the heart and great vessels. *Much greater descent of the diaphragm on the right side due to the liver present (two-three times larger). *Absent or no change in movement of the diaphragm noted between full inspiration and full expiration measurement.
Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration. with a decreased overall inspiratory capacity
Your 39 year old patient who has recently been hospitalized for an appendectomy and is being seen in your clinic for post-operative follow-up with primary care. On assessment, the patient complains of some incisional pain and otherwise examination is normal, with the exception of dull percussion sounds noted on the thorax over lung tissue. Which of the following diagnoses would be explained by this finding in post-operative patient? *Left-sided heart failure. *Chronic bronchitis. *Atelectasis. *Healthy patient with no coexising disease.
Atelectasis
Your 72 year old female patient with a pertinent medical history of coronary artery bypass grafting (CABG) and aortic valve replacement 7 years ago with a porcine bioprosthetic valve has been previously stable on their medical regimen. Today she complains of near syncope when standing, which she states has been getting worse over the past 6 months but failed to tell anyone as she felt it was just part of natural aging and taking medications. Your workup should include evaluation of which of the following potential cardiac complications? *Hypertrophic obstructive cardiomyopathy *Coronary arterial disease progression *Bioprosthetic aortic valve stenosis *Tricuspid regurgitation
Bioprosthetic aortic valve stenosis
Your 32 year old patient exhibits mood changes with a cyclical nature of euphoria and bliss then troughs of depression and anhedonia. In addition to working them up for metabolic causes, you refer them to psychiatry and suggest a likely diagnosis of which of the following? *Schizophrenia. *Borderline personality disorder *Bipolar disorder. *Bulimia Nervosa.
Bipolar disorder
The 18 year old female patient who inappropriately exhibits fear of abandonment, intense interpersonal relationships, affective instability, and recurrent self-harm describes which of the following diagnoses: *Borderline personality disorder. *Seasonal affective disorder. *Reactive attachment disorder. *Bipolar disorder
Borderline personality disorder
Your 22 year old female patient has been identified by labwork for a diagnosis of Systemic Lupus Erythematosus (SLE). In addition to labwork, SLE si most commonly identified by which of the following findings? *Butterfly rash on the face. *Myoglobinuria. *Elevated WBC count. *Diffuse rash on the torso.
Butterfly rash on the face
As a prudent nurse practitioner, you know that a 28 year old male patient with human immunodeficiency virus (HIV) would be considered well managed when they have which of the following in addition to having undetectable or very low viral copies? *CD4 count of 100. *CD4 count undetectable. *CD4 count of 500. *CD4 count of 50.
CD4 count of 500.
Your patient has been diagnosed with acanthosis nigricans. Which of the following exam findings would be consistent with the typical presentation of this? *Central obesity. *Severe malnutrion. *Scaphoidal abdomen. *Body mass index (BMI) of 22.
Central obesity.
Michael, a 72 year old male patient who previously presented with stable cardiac-type chest pain has underwent a stress test. He presents today to review the stress test results, which show EKG findings of ST segment depression during the exam in leads V3 and V4 as well as some concurrent chest discomfort. Based on these findings, which of the following are NOT priority medical decisions? *Prescribe metoprolol (Lopressor) 12.5mg PO BID *Prescribe aspirin 81mg PO daily *Refer to cardiology for angiography • Check for thyroid dysfunction
Check for thyroid dysfunction
You are evaluating a 41 year old female patient in your clinic with symptoms of right upper quadrant pain which worsens with deep breathing. The patient exhibits a positive Murphy sign. These findings are most consistent which one of the following? *Appendicitis. *Cholecystitis. *Crohn's flare *Pancreatitis.
Cholecystitis
The patient with congestive heart failure with an ejection fraction of 35% has become symptomatic with shortness of breath when performing activities of daily living but does not have any symptoms at rest. This is suggestive of New York Heart Association heart failure classification? *Class I *Class III *Class IV *Class I
Class III
Gladys, a 72 year old patient with a history of anemia of chronic disease from kidney failure, diabetes mellitus, and hypothyroidism presents today with concerns her thyroid medication is not working well enough. Her most recent labs reflect her TSH is 5.9 (normal range 0.5-5 kU/mL) and Free T4 is 0.3 ng/dL (normal range 0.8-2.8 ng/dL). Which one of the following clinical signs and/or symptoms would you expect a patient with these findings to present with? *Weight loss. *Excessive sweating *Cold intolerance. *Palpitations.
Cold intolerance.
You are examining the mouth of a patient and ask the patient to put out his tongue and notice the tongue deviates by pointing to the left. Which one of the following is the correct diagnosis of this finding? *Bilateral Vagus (X) lesion. *Cranial XII (Hypoglossal nerve) lesion on the left. *Cranial XI (Hypoglossal nerve) lesion on the right. *Normal response to deviate to the dominant side.
Cranial XII (Hypoglossal nerve) lesion on the left.
You perform a sensory assessment on the face and notice abnormal sensation to sharp/dull testing on the left cheek. Which one of the following cranial nerves would you expect to cause this abnormality? *Cranial nerve V *Cranial nerve XI *Cranial nerve VI *Cranial nerve X
Cranial nerve V
Your patient has made an attempt on their own life, and has survived. In assessing them, it is important the nurse practitioner recognize that patients with a history of self-harm need to be evaluated for which of the following underlying disease states, which is the most common co-diagnosis in patients who have made attempts of self-harm? *Depression *Anxiety. *Schizophrenia *Bipolar Disorder.
Depression
The nurse practitioner is caring for a patient with an elevated WBC, fever, chills, and malaise. When developing a differential diagnosis for this finding, which of the following is not a potential cause of the elevated WBC? *Sepsis. *Diabetes Mellitus Type 2. *Leukemia. *Recent oral corticosteroid therapy.
Diabetes Mellitus Type 2.
During a post-hospital discharge visit, you notice your 71 year old female patient has been diagnosed with a "new murmur" found by the hospitalist during their recent hospitalization for CHF exacerbation. In evaluating the patient, during which phase of the cardiac cycle would you anticipate auscultation of a S3 or S4 heart sound? *Diastole *53 in systole while S4 in diastole *Systole *S4 in diastole while S3 in systole
Diastole
While evaluating Tori, a 24 year old female patient who presented to your clinic for an annual well-visit, you discuss her health history of migraines and endometriosis. She reports heavy menses since menarche, sometimes 14 days in duration which has been well controlled with a combined oral contraceptive (OCP). Her migraines although frequent seem to be well controlled with the use of daily propranolol (Inderal) and abortive therapy of sumatriptan (Imitrex). While evaluating the patient, which of the following questions should the nurse practitioner consider a priority? *Have you ever been evaluated for Thalassemia? *Do you have any visual, sight, or taste symptoms before your migraine symptoms present? *Does anyone in your family smoke? *Do you have any history of premature cardiac disease?
Do you have any visual, sight, or taste symptoms before your migraine symptoms present?
Your 53 year old female patient with pale skin and easy freckling presents for a skin survey due to their family history of skin cancer. When screening for melanoma, which one of the following findings would be considered a suspicious feature of a mole characteristic of a possible melanoma? *Regular border. *Diameter of 0.3 cm. *Dual color, particularly white-reddish or blue-black. *Symmetry of the lesion, mirror-like image when divided in half.
Dual color, particularly white-reddish or blue-black.
Which one of the following sweat glands concentrated in the palms of the hands and soles of the feet and is involved in temperature regulation? *Sebaceous. *Apocrine. *Eccrine. *Epidermis.
Eccrine
While managing the care of the patient with chronic alcoholism, the nurse practitioner would likely anticipate which findings on the CBC with differential? *Low MCV and MCH. *Normal MCV and MCH. *Chronic alcoholism will not affect the differential. *Elevated MCV and MCH.
Elevated MCV and MCH.
A 16-year-old female patient with heavy menses has been diagnosed with iron deficiency anemia. She is also having longer and more irregular periods than is typical as well as extremely painful cramping. You would likely need to consider which of the following diagnoses in your workup: *Sarcoidosis. *Endometriosis. *Pelvic inflammatory disease. *Thalassemia.
Endometriosis
Your 31 year old female patient states they are experiencing lateral lower back pain and urinalysis reveals bacteria in the urine, culture reveals gram negative rods after 24 hours of growth. Which of the following is the least likely agent to cause her urinary tract infection? *Escherichia Coli *Proteus Mirabilis...NOT THIS ONE *Enterococcus *Klebsiella Oxytoca.
Enterococcus
During your visit with a 19 year old patient for a college health physical, your health history includes a diagnosis of angioedema. What of the following parts of the body are were likely involved? *Isolated to the colon *Anywhere in the enteral tract *Chest *Face and Lips
Face and Lips
Your patient with a suspected diagnosis of COPD has been seen by pulmonology and has underwent a pulmonary function test (PFT) with spirometry. As the patient's primary healthcare provider, you have been asked to explain the findings of the PFT to the patient in a follow-up visit at which time the patient asks what the study was evaluating. To describe the PFT to the patient in more useful terms, you state that the large inspiration of air to the furthest extent they could reasonably accomplish followed by a full exhalation is referred to as which of the following measurements during the PFT? *Forced Expiratory Volume over 1 second (FEV1). *Functional Reserve Capacity. *Inspiratory Reserve *Forced Vital Capacity.
Forced Vital Capacity.
Your 22 year old female patient is seeing you for complaints of sinus pressure and congestion. Which one of the following sinuses should be palpated during your examination? *Mandibular *Ethmoid *Sphenoid *Frontal
Frontal
n educating your patient about the non-pharmacologic management of gastroesophageal reflux disease, you include teaching to the patient that their heartburn is aggravated by al of the following except which one? *Activities including lifting or bending over *Alcohol intake. *Foods, such as citrus, onions and coffee. *Gastric dumping, or increased emptying into the small intestines.
Gastric dumping, or increased emptying into the small intestines
Your 18 year old patient has recently been diagnosed with streptococcal infection and has been successfully treated with an appropriate antimicrobial agent. They have no other noteworthy health history, chronic illness, or medications on record. They are complaining to day of hematuria. RBC casts on urinalysis with microscopy have been identified during this visit. Based on this finding, you can make the diagnosis of which of the following? *Pyelonephritis...NOT THIS ONE *Bladder cancer *Glomerulonephritis *Gram negative bacteremia
Glomerulonephritis
During your physical examination of a 49 year old brain cancer patient, you notice their gag reflex is impaired during the exam. This suggests damage to which one of the following cranial nerves? *Abducens. *Hypoglossal. *Glossopharyngeal. *Trigeminal.
Glossopharyngeal
Your 25 year old female patient presents with a recent history of malodorous discharge from their vagina. Their review of systems includes recent history of douching and multiple sexual partners without protection. Which of the following is not a test used to identify bacterial vaginosis? *Gonorrhea and Chlamydia DNA probe *pH *Whiff test. *Clue cells
Gonorrhea and Chlamydia DNA probe
Your schizophrenic patient is agitated during your exam and states "what is that awful taste?" This is an example of which of the types of hallucinations? *Visual *Limbic *Olfactory *Gustatory
Gustatory
During you neurologic examination portion of your comprehensive physical of the new patient to your panel, you perform cranial nerve assessments. Which of the following represents the most effective protocol for assessment of cranial nerve I? *Have the patient cover one nostril, take a breath, and then repeat on the other side to assess air flow. *Examine both the inferior and middle turbinates with a speculum. *Apply gentle pressure to the nasal tip or alae. *Have the patient close their eyes and accurately identify two different scents with one nostril closed at a time.
Have the patient close their eyes and accurately identify two different scents with one nostril closed at a time.
Your 21 year old sexually active female patient states during a routine health exam that they have some "weird bumps" on their vulva. She is concerned she has a sexually transmitted infection. You notify her that condyloma are caused by exposure to which of the following? *Chlamydia *Herpes zoster *Human papilomavirus type 6 and 1 *Parvovirus B19
Human papilomavirus type 6 and 1
While performing an office visit for your patient, you notice an elevated blood pressure of 160/92. Recent visits in the electronic health record reflect similarly elevated readings, yet nothing has been done to treat this at this time. The patient then states the last time he was started on blood pressure medication, his "kidney function became poor so the physician discontinued the medicine." You decide to evaluate further for renal artery stenosis. Al of the following are conditions suspicious for renal artery disease except which one? *Hypertension controlled on 2 medications. *Onset of hypertension at an early age (Onset at age 30 or earlier). *Severe, sudden hypertension or poorly controlled hypertension in a patient 55 years or older. *An unexplained small kidney or size discrepancy betwéen the two kidneys.
Hypertension controlled on 2 medications
A40 year old, female, African American patient presents for history and physical. Upon your initial assessment, you notice she has severe exophthalmos as pictured below. Which one of the following diagnoses below would be the highest on your differential diagnose of this physical examination finding? (eyes bulging out of her head) *Bilateral conjunctivitis. *Hyperthyroidism. *hypothyroidism *myexedma
Hyperthyroidism.
Your 19 year old female patient presents with groin pain, states they were recently involved with a sexual partner who was sexually promiscuous. You notice they are walking with a shuffling gait and their STI testing was positive for Gonorrhea and Chlamydia. Which of the following evaluations should be considered fi this were left untreated for a prolonged period of time? *Echocardiogram *Colposcopy *Pap smear *Hysterosalpingogram
Hysterosalpingogram
While working as a volunteer nurse practitioner at a college football game, a 17 year old female patient who was at the football game has received a bee sting. She is experiencing swelling of the face and is having difficulty breathing. Which of the following representsrect the most common diagnosis? *Type 2 hypersensitivity reaction. *Angioedema. *Tachyphylaxis. *IgE mediated type 1 hypersensitivity reaction
IgE mediated type 1 hypersensitivity reaction
Your patient had a history of Hepatitis Aapproximately one year ago. Which of the following immunoglobulin is most likely to be elevated at this time? *IgD. *IgA. *IgG. *IgM.
IgG
Your patient has just been diagnosed with Hepatitis A. Which of the following immunoglobulin are first to be elevated in the serum? *IgD *IgG *IgA. *IgM.
IgM.
The patient is experiencing acute closed angle glaucoma. Which of the following examination findings by the nurse practitioner is most consistent with their diagnosis? *Macular degeneration *Increase in intraocular pressure *AV nicking *Loss of aqueous humor volume
Increase in intraocular pressure
The 33 year old male patient presents with complaints of abdominal pain after a recent birthday party where other guests also suspected food borne illness and gastroenteritis. To elicit the most accurate evaluation of this patient, which is the order of assessment which should be done for the abdomen? *Inspection, auscultation, palpation, percussion. *Inspection, auscultation, percussion, palpation. *Percussion, auscultation, palpation, inspection. *Auscultation, palpation, percussion, inspection
Inspection, auscultation, palpation, percussion
Based on your evaluation of ABCDE for melanoma, which of the following represents a suspicuous finding? *Irregular borders. *Symmetrical nature. *Brown color. *Diameter of 0.4 cm.
Irregular borders.
The point of maximum impulse (PMI) is MOST often palpable in healthy adults when positioned in the supine or left lateral decubitus position. Which one of the following locations is most commonly described as the PMI in a healthy adult? *Left 2nd intercostal space, midaxillary line. *Left 5th intercostal space, midclavicular line. *Right 4th intercostal space, midaxillary line. *Right 2nd intercostal space, midclavicular line.
Left 5th intercostal space, midclavicular line
When performing a health history, your 52 year old male patient complains of difficulty hearing people when spoken in the right ear. During physical examination, you perform a Weber test with your patient reporting increased hearing of vibrations in the right ear. Which one of the following would you suspect based on these findings? *Left side conductive hearing loss. *Left side sensorineural hearing loss. *Bilateral conductive hearing los. *Bilateral sensorineural hearing loss.
Left side sensorineural hearing loss.
While evaluating your patient for a sick visit, you notice Scott, a 29 year old male patient appears drowsy but open eyes and looks at you when you question him, answers appropriately, but then appears to nearly fall asleep while sitting in the exam chair. Which of the following is the most accurate descriptor of Scott's mental status? *Comatose *Stuporus *Lethargic *Alert but disoriented
Lethargic
Your patient has a diagnosis of Addison's disease. Which of the following might you expect to find during examination? *Abdominal striae. *Dowager hump. *Low body temperature. *Moon face...not this one
Low body temperature.
Which one of the following patients would you most anticipate to complain of hemoptysis? *Acute asthmatic. *Acute laryngitis. *Lung cancer. *Acute bronchitis
Lung cancer
Your patient has presented with a new onset rapid heart rate that is irregularly irregular, heart rate 100, BP 120/74, R 16 non labored, and SP02 is 99%. They state this has been going on for a week or so intermittently, but for the last 4 days straight it hasn't stopped. Your first priority intervention for this patient is to do which of the following: *Treat with vagal maneuvers for suspected supraventricular tachycardia (SVT) *Maintain rate control and anticoagulate prior to rhythm conversion *Notify EMS to initiate transport for emergency evaluation *Ask about their family cardiac history
Maintain rate control and anticoagulate prior to rhythm conversion
Adequate understanding for the newly diagnosed ESRD patient during a teaching session of how dialysis works has been successful when the patient verbalizes that the use of hemodialysis to remove pollution from the body is based primarily on which of the following concepts: *My blood is forced across the filter under high pressure and a low voltage electrical charge. *None of these are correct. *My blood is cleaned by diffusing across a semipermeable membrane. *The water is drawn to the dirty blood to dilute the waste in my body.
My blood is cleaned by diffusing across a semipermeable membrane.
Your 49 year old male patient presents with weight loss, night sweats, anhedonia, and a CXR showing profoundly enlarged hilar adenopathy. Based on these findings, a diagnosis of lymphoma would be in your working differential. Which one of the following assessment findings when palpating lymph nodes would be INCONSISTENT with this diagnosis? *Hard nodes. *Fixed nodes. *Stationary or not moveable with palpation. *Non-tender, minimally palpable anterior cervical chain node palpation.
Non-tender, minimally palpable anterior cervical chain node palpation.
While assessing the complete metabolic profile of the 66 year old female patient with end stage renal disease (ESRD) on dialysis, you find acreatinine of 4.3, BUN of 62, phos of 5.2. On review of the CBC with differential, you would anticipate which of the following levels? *Normal MCH, Hemoglobin 9.6 *Elevated MCH. Hemoglobin 14.5 *Low RDW, Elevated MCV *Low MCV, Hemoglobin 13.4
Normal MCH, Hemoglobin 9.6
The most common causes of uterine cancer include which of the following history items? *Use of oral contraception and steroids. *Heavy menses and alcohol use. *Obesity and smoking. *Multiple sexual partners and HPV type 4diagnosis.
Obesity and smoking
The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where would the S1 heart sounds correlate with the electrocardiographic waves? *At the end of the T wave. *At the start of the T wave. *Peak of the R wave. *At the start of the P wave.
Peak of the R wave.
The sexually active 19 year old female patient with a shuffling gate and inguinal pain is most likely to be diagnosed with the following assessment and plan of care? *Molar pregnancy, order transvaginal ultrasound *Pelvic inflammatory disease, treat for Chlamydia only in females *Ectopic pregnancy, check human chorionic gonadotropin (HCG) level *Pelvic inflammatory disease, treat for Gonorrhea and Chlamydia
Pelvic inflammatory disease, treat for Gonorrhea and Chlamydia
In evaluating a patient with suspicion of mononucleosis, the nurse practitioner percusses the left upper quadrant of the abdomen. Which of the following would raise your suspicion of splenomegaly when percussing the spleen? *Percussion that changes from tympany to dull as you percuss from the right midaxillary line to the right anterior axillary line. *Percussion that changes from dull to tympany as you percuss from the left anterior axillary line to the left sternal border. *Percussion that changes from tympany to dull as you percuss from the right midaxillary line to the right anterior axillary line. *Percussion that changes from tympany to dul as your percus from hte left orierant axillarylineot hte left midaxillary line.
Percussion that changes from dull to tympany as you percuss from the left anterior axillary line to the left sternal border.
Your 55 year old male patient with a history of diabetes, systolic heart failure, and hyperlipidemia presents to your clinic for a new complaint of progressive onset over the past 6 months of left lower posterior leg pain with prolonged ambulation, at which time he also becomes short of breath, but this does resolve with rest. He also describes that at rest, he experiences numbness down the left lower leg and is having some noticeable hair loss over the anterior tibial surfaces. Based on these limited exam findings, which of the following would be the best leading diagnosis and plan? *Pulmonary embolism, order 2D echocardiogram. *Venous thromboembolism, order anticoagulation. *Aging, recommend exercises. *Peripheral arterial disease, order an ankle brachial index.
Peripheral arterial disease, order an ankle brachial index.
While examining a 53 year old female patient, you auscultate abnormal breath sounds over all fields, and now assess transmission of voice sounds by having the patient say "ee" while auscultating the chest with the diaphragm of your stethoscope. Normally, you should auscultate a muffled "e" sound, however, you hear hear a nasally "a" sound. Which one of the following will you document is present? *Positive stereognosis. *Positive for egophony. *Negative for bronchophony. *Negative for egophony
Positive for egophony
Your 29 year old male patient was a military soldier who states he "saw some pretty awful things" during his time in service. When you knock to enter the room, you notice he jumps up from the exam table and stands facing the door and states he always has to have his face toward the entrance to the room. This is most suggestive of which of the following diagnoses; *Untreated anxiety. *Post traumatic stress disorder. *Sundowning. *Situation depression.
Post traumatic stress disorde
The 19 year old female patient complains of jaw pain anterior and inferior to the ear bilaterally. Al of the following are common symptoms of a temporomandibular joint (TMJ) disorder EXCEPT which one? *Pain and tenderness with palpation, often increases with chewing. *Facial asymmetry and unilateral pain with jaw clenching. *Palpable swelling and tenderness of the joint. *Relief from pain with joint displacement
Relief from pain with joint displacement
In assessing your patient with suspected pyelonephritis, the following test may be sensitive to elicit a confirmatory response. *Renal punch test. *Morton's test. *Murphy's test. *Romberg test.
Renal punch test
Mike, your 48 year old construction worker patient presents to your clinic with a chief complaint of floaters, some flashes of light, and a curtain coming down over the visual field. As a prudent nurse practitioner, you notify Mike that he needs to be seen by ophthalmology immediately as these are al signs and symptoms of what condition? *Cataract. *Acute angle closure glaucoma. *Retinal detachment. *Diabetic retinopathy.
Retinal detachment.
You are assessing a 26-year-old male patient who complains that his arm hurts. When assessing ROM of the shoulder, you ask him to touch the opposite scapula by placing his arm up and over the back of his neck, but the patient reports tremendous pain when attempting to do this. Which one of the following would you suspect? *Humeral malignancy *Rotator cuff injury. *Ulnar nerve injury. *Biceps brachii injury.
Rotator cuff injury.
The diagnosis of anxiety in your 28-year-old male patient may be differentiated from hyperthyroidism following testing? *Free cortisol. *Electrocardiogram. *PHQ-9 screening *TSH and free T4.
SH and free T4.
Unequal shoulder height with a lateral and rotary curvature of the spine would be associated with which one of the following spinal deformity diagnosis? *Scoliosis *Rhuematoid Arthritis (RA). *Kyphosis. *Lordosis.
Scoliosis
A62 year old female patient with erythema on the face surrounding the nasolabial folds as well as very fine dandruff in the hair and skin is most likely describing with which of the following diseases? *Rosacea. *Tinea capitis. *Photosensitivity reaction. *Seborrheic Dermatitis.
Seborrheic Dermatitis
Your patient has expressed concern about a skin lesion which you identify as darkened, round, and raised. This benign lesion that appears like "stuck on" to the skin. Which of the following lesions best fits this description? *Seborrheic Keratosis. *Hemangioma. *Basal cell carcinoma. *Achrocordon.
Seborrheic Keratosis.
Your patient is complaining of hypersomnia, lack of motivation, weight gain, and anhedonia. Suspecting a diagnosis of clinical depression, you anticipate the patient will benefit from treating their underlying deficit of which of the following neurotransmitters? *GABA. *Serotonin. *Dobutamine. *Glutamate.
Serotonin
Your patient has presented with dysfunctional uterine bleeding (DUB). Based on the most common cause of DUB, which of the following lab tests should be ordered by the nurse practitioner first? *Vitamin K. *Serum urine ketones *Serum beta human chorionic gonadotropin (HCG) *СВС.
Serum beta human chorionic gonadotropin (HCG)
Your 50 year old Caucasian male patient has not seen a primary care giver in 20+ years and is here for a history and physical examination. While examining the head and face, you see your patient has nonpitting periorbital edema, particularly underneath their eyes and very dry, thinned hair, including the lateral third of eyebrows (as pictured below: Sparse hairline, thin lateral eyebrows, Periobital edema). Which one of the folowing would you expect to cause this finding? *Severe hypothyroidism *Addison's disease *Grave's disease *Alzhemiers.
Severe hypothyroidism
Your patient who has underwent a recent major medical medical procedure is at a rehabilitation center and is having a hard time being motivated to do therapy. When you interview them as the nurse practitioner on staff for the subacute rehab center, they appear despondent, and are having a hard time being wakeful during therapy sessions. They have stable vital signs, temperature, urine output, and are not ill-appearing. As a prudent nurse practitioner, you understand this may represent which of the following; *Cushing syndrome. *Situation depression. *Addison's disease *Untreated anxiety.
Situation depression
While performing sensory cortex testing on your patient, you gave them close their eyes and place a familiar object such as a paper clip, key or pencil in their hand, having them manipulate it skillfully and identify it within 5 seconds. This is known as which of the following tests? *Monognometrics *Graphesthesia *Two Point discrimination *Stereognosis
Stereognosis
Your patient has provided you with a research paper about a new treatment plan that is being used, somewhat controversially, in other areas of the world to treat sinus infections. She asks for your opinion. In reviewing the article, you educate the patient that they should look for which of the following, which are considered the highest level of research quality? *Unblinded retrospective analysis *Expert opinion statement *Cohort study *Systematic review
Systematic review
Your patient Steve, a 56 year old male with a history of smoking, sedentary lifestyle, and diabetes mellitus presents for follow-up from a recent hospitalization where he was documented to have symptoms of a transient ischemic attack (TIA). Which one of the following correctly identifies the etiology of TIA? *TIAs are global cerebral, spinal cord or retinal dysfunction caused by a central nervous system infarction...NOT THIS ONE! *TIAs are caused by focal brain, spinal cord or retinal ischemia, without acute infarction. *TIAs are a unrelated risk factor of a patient developing a stroke in the future. *TIAs cannot last longer than 15 minutes, otherwise it's considered a stroke.
TIAs are caused by focal brain, spinal cord or retinal ischemia, without acute infarction.
Your late adolescent female patient presents with a history of heavy menses and pale conjunctiva. Your review of systems is fairly unremarkable other than she lives in a house built in 1965, has an unrestricted diet, and her family heredity si Italian. She denies any history of chronic health conditions. Initial CBC with differential shows a microcytic hypochromic anemia which has not yet been diagnosed or treated and the red cell distribution width (RDW) is elevated at 15%. Based on the most common cause of microcytic hypochromic anemia, which of the following labs will you order first? *B12 and Folate *Gel Electrophoresis *Serum Lead *TIBC and Ferritin
TIBC and Ferritin
The patient you just saw in the clinic a week ago was just admitted to the hospital in hyperthyroid crisis. The nurse practitioner at the emergency department calls your office to let you know and also ask some information about the patient. They asked about what the patient symptoms were during their most recent a visit a week ago. Which one of the following signs and symptoms would suggest a patient undergoing a hyperthyroid crisis? *Hypothermia. *Lethargy. *Tachycardia. *Decreased systolic blood pressure.
Tachycardia
Your 32 year old female patient presented for a routine health exam states they have a diagnoses of hyperthyroidism by another provider a year ago. In addition to evaluation with TSH and T4 labwork, which of the following represent typical signs of hyperthyroidism expected on your exam of this patient? *Hypersomnia *Tachycardia. *Lethargy. *Recent unplanned weight gain.
Tachycardia
You are working in an urgent care setting as a NP when a patient presents with shortness of breath after a fall from a ladder earlier this morning. You obtain a chest xray and radiologist on call notifies you that it appears to be a tension pneumothorax. Which one of the following findings would you expect to see on the xray if this was the correct diagnosis? *The trachea shifted toward the unaffected side. *The trachea shifting toward the pneumothorax on inspiration and away from the pneumothorax on expiration...NOT THIS ONE *The trachea shifted toward the side of the pneumothorax. *Midline with no movement due to changes in intrapleural pressure.
The trachea shifted toward the unaffected side.
Your 43 year old female patient with no otherwise remarkable health history has a routine health visit and when evaluating the labwork, you notice a platelet count of 80,000. Which of the following is a correct diagnosis for this patient? *Thrombastemia. *Pancytopenia. *Thrombocytopenia. *Thrombocytosis.
Thrombocytopenia
After a recent hospitalization for weakness, a diagnosis of myasthenia gravis has been made in a patient under your long term management. In the process of the examination, a CT of the chest was performed, and an object was identified as enlarged and was remarked that it needs to be removed as it is thought to be related to this diagnosis. The patient now in your clinic states they don't remember what the object was and hoped you might know. The prudent nurse practitioner understands that the item likely represents which of the following? *Potts tumor. *Coumeral's diverticulum. *Arenal tumor. *Thymic remnant.
Thymic remnant.
Your newly established patient states in the past year, they have progressively developed a noticeable bump on their neck and when asked about symptoms, they report feeling very anxious, have developed a tremor, and are commonly feeling palpitations in their chest. On examination, you identify an enlarged thyroid gland suspicious for a goiter. Of the following diagnoses, which is most likely for the patient to develop based on these findings above? *Thyrotoxicosis. *lodine Excess. *Myxedema Coma. *Hashimotos Thyroiditis...not this one
Thyrotoxicosis
While assessing the 19 year old patient for a new onset cough, the nurse practitioner may inspect, auscultate, palpate, and/or percuss. How does performing percussion of the thorax assist the provider during the physical examination? *To assist with the confirmation of cardiac origin of angina. *To assess for deep-seated lesion and tumors. *To assess for any pain or discomfort prior to palpitation of the chest wall. *To identify if underlying tissue are air-filled, fluid-filled or consolidated
To identify if underlying tissue are air-filled, fluid-filled or consolidated
You are evaluating a 63 year old male patient with symptoms of chest pressure, arm numbness and tingling, as well as shortness of breath with excursion. Their health history includes diabetes mellitus, hypertension, hyperlipidemia, and rheumatoid arthritis. This relieves with rest and is not becoming more frequent in the episodes. Based on these findings, you diagnose and plan for the patient includes which of the following? *Stable angina, and initiate a long-acting oral nitrate. *Acute myocardial infarction, and transfer to the hospital via EMS. *Heart failure, and initiate carvedilol and a loop diuretic. *Unstable angina, and treat with sublingual nitroglycerin and order a cardiac stress test.
Unstable angina, and treat with sublingual nitroglycerin and order a cardiac stress test.
As a prudent nurse practitioner, the diabetic, hypertensive patient you are seeing should be evaluated for early evidence of renal damage from both diabetes and hypertension. Which of the following assessment tools should the nurse practitioner order first for the evaluation of early renal dysfunction secondary to diabetes or hypertension? *BUN/creatinine ratio *Urinalysis with micro/macro albumin. *Renal biopsy *Urine sodium
Urinalysis with micro/macro albumin.
Your 22 year old male patient states during his review of systems that his scrotum is very enlarged and feels like it is full a powerlifter and works as a trash collector. You suspect the patient likely has which of the following diagnoses? *Varicocele *Meningocele *Rectocele. *Hydrocele.
Varicocele
In addition to patient symptoms of painful urination and frequency, which of the following findings confirms a diagnosis of pyelonephritis? *Gram positive bacteria in bloodstream. *RBC casts on urinalysis with microscopy. *Enterococcus in urine. *WBC casts on urinalysis with microscopy.
WBC casts on urinalysis with microscopy.
