Questions 4

A 30-year-old patient comes to the office complaining of hearing loss in the right ear. When assessing him you discover cerumen impaction. Which type of hearing loss is this an example of? A. Conductive hearing loss B. Acquired hearing loss C. Presbyacusis D. Congenital hearing loss

A Conductive hearing loss is usually caused by cerumen impaction in adults or a side effect of an upper respiratory tract infection that is causing a transient eustachian tube dysfunction. This is often corrected with medical treatment or surgical therapy

A 4-week-old male presents to clinic for follow up appointment and mom reports his spit up 'just flies out of his mouth' after feeds. She states she has been propping him up after his feeds but it does not seem to help. She said she's exhausted because baby wants to constantly nurse. What would you expect to find on physical exam? Pick all that apply. 1. Olive shaped mass in upper right quadrant 2. Rigid abdomen with decreased bowel sounds 3. Enlarged liver 4. visible left-right peristaltic waves

1 & 4 Pyloric stenosis is the probable dx for this infant. There is increased peristalsis in pyloric stenosis as the body tries to push the gastric contents past the pylorus. And the classic olive-shaped palpated mass in the upper right quadrant is a result of the hypertrophic pyloric muscle ring.

A 3-year-old girl is seen for her well child visit. When you start interviewing mom about her daughter's diet she starts fussing about how picky she has become. She states her little girl use to have a very diverse diet but now only eats chicken nuggets and potato chips. She also reveals that her daughter has started having bowel movements only twice/week for the past three months and cries during the entire episode. What is your first line intervention? 1. Miralax 1kg/day mixed in 4 ounces of water 2. Glycerin suppository 3. Increase fiber and water in diet 4. No intervention needed

3: The definition of constipation includes (not limited to) fewer than three bowel movements/week for two months and pain with defecation. Constipation can be caused by both a change in diet and the absence of fiber and vegetables. The first line of treatment is to increase water intake and add fiber back to diet. If this is not effective, then medications can be tried.

A mother brings her two-month-old to your clinic to establish care after a recent move. She asks you about a raised red "mole-like" spot on the infant's forehead that has grown in size over the last few weeks. You determine it is most likely a hemangioma. The mother then asks what the treatment is. What would be an appropriate response? A. Watchful approach is appropriate as these lesions typically fade as the child ages B. Oral steroids can be taken to shrink the size of the lesion C. Topical antibiotics to treat the infection causing the redness D. Surgical intervention to remove the lesion

A : A hemangioma is a red, rubbery nodule that is becomes noticeable around 2-4 weeks of age and rapidly grows in size within the first 5-7 weeks of life. Growth stabilizes around 9-12 months of age and reaches maximal regression between ages 5-9 years. Hemangiomas are typically benign tumors of capillary endothelial cells that are superficial, deep or a mixture of both. They can be anywhere on the body and size greatly varies. The term "strawberry" is widely used but can be misleading and should not be used to describe the nodules.

A 29 year old male presents to the clinic with recent history of IV drug use. He complains of nausea, vomiting, and fatigue. Physical assessment reveals jaundice and his liver enzymes are elevated. He is leaving your clinic and asks what medications can he take for pain. What medication should you advise him to avoid? 1. Tylenol 2. Aspirin 3. Naproxen 4. Ibuprofen

A : Hepatitis is a liver disease that can result in chronic infection. While being treated for hepatitis, it is best to avoid medications that are metabolized by the liver in order to prevent further injury. Hepatotoxic drugs include acetaminophen, iron, and other drugs. It is best to avoid alcohol and refrain from starting new OTC medications and herbal supplements.

Jane, a 32-year-old accountant, presents to the clinic today with 3-4 episodes of loose watery stool over the past 2 days with mild abdominal discomfort. She has not had any recent illnesses, has not had any antibiotics in the last year, denies blood in stool, and only takes a multivitamin daily. During the physical exam she is afebrile, mild tenderness to lower abdomen on palpation, mouth moist, & skin turgor immediate. Which of the following is most appropriate? A. Instruct patient to maintain a BRAT diet with adequate oral consumption, may take Pepto Bismol OTC as directed for symptomatic relief. B. Obtain stool studies for analysis for viral, protozoan, & bacterial pathogens. C. Prescribe Ciprofloxacin 500 mg po daily for 3 days. D. Admit to hospital for IV antibiotics and rehydration.

A : The type of diarrhea and its associated symptoms can give you information on possible treatment options. For example, bloody diarrhea that presents with a fever is usually indicative of tissue damage. Watery, nonbloody diarrhea associated with mild abdominal discomfort, gas or bloating is usually associated with viruses. Most cases of diarrhea resolve on their own by maintaining hydration status and antidiarrheal medications. When diarrhea last for more than 7 days, stool studies should be considered.

A 54-year-old male patient presents to the clinic for a wellness exam. The patient is obese with a BMI of 30. The AST and ALT are slightly elevated with mild steatosis noted on the ultrasound. The provider diagnoses this patient with non-alcoholic fatty liver disease. What is the next step for the provider? a. Discuss lifestyle changes with the patient including exercise and healthy eating b. Discuss placing the patient on the liver transplant list c. Discuss starting patient on a medication such as Semaglutide (Ozempic) that will help the patient with blood sugar control d. Discuss bariatric surgery with patient

A : Treatment for non-alcoholic fatty liver disease focuses on lifestyle changes. Examples of this include exercise, healthy dieting, and reducing alcohol intake. In order to improve steatosis a 3-5% loss of body weight is needed. Improving weight loss to at least 10% can come with more positive changes such as reducing inflammation. Liver transplants can be used with those patients that have advanced cirrhosis but are associated with increased mortality. Diabetic medications are able to help reduce insulin resistance, but do not reliably improve liver changes. Bariatric surgery can be considered as a treatment option, but patients must have a BMI of 35 or greater.

A lab review of a 42-year-old Hispanic American female reveals: Na 135, K 3.0, Ca 9, Mg 2.2. What should the NP do next? A. Review patient's medications B. Refer patient to nephrology C. Prescribe Kdur 20 mg po qd D. Start lisinopril 10 QD to protect kidneys

A Hypokalemia has a wide range of causes. The initial step the NP should take is to investigate the possible cause of hypokalemia. The NP should then decide what action to take next based on the findings

A lab review of a 42-year-old Hispanic American female reveals: Na 135, K 3.0, Ca 9, Mg 2.2. What should the NP do next? A. Review patient's medications B. Refer patient to nephrology C. Prescribe Kdur 20 mg po qd D. Start lisinopril 10 QD to protect kidneys

A Hypokalemia has varieties of causes. The initial step the NP should take is to investigate the possible cause of hypokalemia. The NP should then decide what action to take next based on the findings

A new mother brings her 2-week-old in for a checkup and the NP notices the infant is not gaining weight as projected. The mother states that she breastfeeds every 4 hours during the day with a 6 hour stretch during the night. The NP's recommendations are: A) At 2 weeks old, the infant should be nursing every 2-3 hours, at least 8-10 times in a 24-hour period to ensure proper milk supply. B) Educates the mother that it is ok if infant does not use proper latch technique. C) Not completely emptying breast with each feed has no effect on weight gain in infant. D) Encourage the mother to keep up the good work, sometimes it just takes longer for some infants to gain weight

A Newborns needs to feed q2-3h (8-10 x d) to stimulate a generous milk supply. Proper latch for nipple stimulation. Engorgement can rapidly decrease a mother's milk supply.

An 11-month old male presents with 2 days persistent vomiting, non-bloody diarrhea, and lethargy. He has been unable to keep any fluids down, including Pedialyte, since yesterday. Fever has been low grade. Child is pale and sleeping against mom's chest. He is not in distress. Mucous membranes are dry, lips are slightly cracked. Anterior fontanel is soft, and slightly sunken. Capillary refill is ~4 second. Vital signs are as follows: T 99, HR 164, BP 89/50, RR 28, O2 sat 94% on room air. Which of the following treatment options would you do FIRST while awaiting transport to the ER? a. PIV placement and administration of bolus 20 ml/kg of isotonic fluids b. Zofran PO (0.15 mg/kg) x 1 c. Apple juice for oral fluid replacement via nasogastric tube d. Labwork to evaluate serum electrolytes

A Quick IV therapy is indicated if patient is showing signs of "compromised perfusion" such as increased cap refill and heart rate, pallor, decreased UOP, or hypotension. Goal is to quickly expand blood volume to prevent "circulatory collapse" with a 20 ml/kg bolus (isotonic fluid).

You are seeing a 77-year-old male patient in the clinic for follow up of his declining renal function. The patient states, "Lately I have just been so tired, I sleep between 8-10 hours at night and wake up tired. I also have this constant metallic taste in my mouth." As the provider, you should understand the patient is experiencing what? A. Uremia related to the decline in the patients GFR and accumulation of metabolic waste in the body. B. Myoglobinuria related to necrotic muscle releasing large amounts of myoglobin into the body. C. Functional proteinuria related to orthostatic proteinuria. D. Hematuria related to renal calculi.

A Signs and symptoms of a declining GFR includes uremia which presents with generalized weakness, fatigue, anorexia, nausea, and metallic taste in mouth. Neurologic symptoms could present as irritability, memory loss, insomnia, restless legs, paresthesia's, and twitching. Myoglobinuria is related to rhabdomyolysis which this patient does not have any signs of. Orthostatic proteinuria is usually seen in patient younger than 30 years old. And there is no mention of the patient having renal calculi, nor did he mention any blood in his urine

A 24 year old female presents to the clinic with gradual onset, throbbing, left sided headache accompanied by nausea and photophobia that she has been experiencing before menstruation for the past 3 months. She states Tylenol and Motrin are not effective. A nurse practitioner considers the following pharmacologic prophylaxis options except: a. Sumatriptan b. Topiramate c. Propranolol d. Amitriptyline

A Sumatriptan is a rapidly effective medication given subcutaneously for aborting migraine attacks. It is an as needed medication that is not used as a prophylaxis agent. Topiramate, propranolol, and amitriptyline are used for prophylactic treatment of migraine headaches.

A fair skinned patient is asking about avoiding excessive skin exposure and sunburns. Which is the best advice? A. Use sunscreen with at least SPF 30 everyday. B. Use a sunscreen with only UVA protection. C. Only have sun exposure during the peak hours of the day. D. Only worry about sunburns on sunny days.

A Sunscreen with at least SPF 30 is necessary, Sunscreen with UVA AND UVB protection is recommended, avoid sun exposure during peak hours of the day and sunburns are still possible on cloudy days.

A patient comes to the clinic with complaints of muscle weakness, fatigue, and muscle cramps. He informs you that he was recently started on 20 mg Lasix PO daily by his cardiologist. What lab values would you assess as the PCP? A. Potassium and Mag B. Calcium and Phosphorus C. HCG and CBC D. Chloride and Sodium

A The correct answer is A. Muscle weakness, fatigue, and muscle cramps are frequent complaints with hypokalemia. Loop diuretics, such as lasix, can cause significant renal potassium and magnesium loss. Magnesium is an important cofactor for potassium uptake and maintenance of intracellular potassium levels. Loop diuretics can cause substantial renal potassium and magnesium losses. Magnesium depletion should be considered in refractory hypokalemia.

Which of the following must be present to diagnose a patient with CKD? A. eGFR <60 or ACR >30 for more than 3 months B. Creatine > 2 for more than 3 weeks C. BUN < 30 for more than 1 month D. eGFR >60 and ACR >30 for more than 6 months

A The correct answer is A. eGFR < 60 and/or ACR >30 must be present x 3 months to diagnose a patient with CKD. These diagnostic findings also help the PCP discern the patients stage of kidney disease. eGFR of 45- 59 + stage 3A, 30-44 = stage 3B, 15-29 = stage 4. ACR of <30= WNL, 30-299 = moderately high, >300 = severely high. By establishing the severity of kidney disease, the PCP can establish a proper plan of care.

You perform a cover/uncover test on your 6-year-old patient. You notice her right eye shifts as it is uncovered and recognize that this is abnormal. Which eye disorder could this indicate? a. Strabismus b. Cataract c. Glaucoma d. Myopia

A The cover/ uncover test is used the assess alignment of the eyes. Strabismus is defined as a misalignment of one or both eyes. A cataract is cloudiness of the natural lens that can be first discovered with an abnormal red reflex test and decreased visual acuity. Glaucoma is indicated with an increased intraocular pressure and an increasing cup to disc ratio. Myopia (nearsightedness) is a refractive error and is often discovered after abnormal visual acuity testing.

A patient presents to clinic with complaints of generalized cramps. The patient experiences carpal spasm while BP was taken in office. The NP expects which of the following lab finings. A. K+ 3.4 B. Cal 7.9 C. A1C 5.2 D. Na 135

B : Classic physical findings of hypocalcemia include Chvostek sign & Trousseau sign (carpal spasm as a result of occlusion of the brachial artery by a BP cuff )

All of the following are true regarding Inflammatory Bowel Disease except: A. Both Ulcerative colitis and Crohn's disease are chronic conditions B. Crohn's disease involves the rectum and may extend to include part or all the colon C. Long term use of corticoid steroid use is associated with potentially irreversible side effects D. Discontinue methotrexate at least 6 months before pregnancy due to its teratogenicity

B : Crohn's disease is a chronic, recurrent disease characterized by patchy transmural inflammation involving any segment of the gastrointestinal tract from the mouth to the anus. However, Ulcerative colitis is a chronic recurrent disease characterized by diffuse mucosal inflammation involving only the colon. Longterm use of corticoid steroids causes irreversible osteoporosis, osteonecrosis of the femoral head, myopathy, cataracts, and susceptibility to infections. Methotrexate is teratogenic and should be discontinued 6 months before conception.

A 45-year-old man comes in with LLQ aching abdominal pain, fever of 100.6, and diarrhea for the past 3 days. On examination, there is a palpable mass in the LLQ that is tender to palpation. CT shows colonic diverticula and wall thickening in descending colon. Treatment would include all of the following, except A. Broad spectrum oral antibiotics such as amoxicillin/Clavulanate BID for 7-10 days B. Colonoscopy as soon as possible C. Clear liquid diet until symptoms improve D. High fiber diet once acute episode is over

B : It's appropriate to start oral antibiotics in an uncomplicated case, Clear liquid diet can keep patient hydrated while in the acute phase, and high fiber diets can help prevent reoccurrence of diverticulitis. Colonoscopies are not recommended during the initial stages of an acute attack due to the risk of perforation.

The following are all associated with metabolic acidosis except: a. Diabetic ketoacidosis b. Iron deficiency c. Salicylate ingestion d. Uremia

B : Metabolic acidosis is oftentimes associated with the acronym MUDPILES (methanol, uremia, diabetic ketoacidosis, paraldehyde, iron overdose, lactic acidosis, ethylene glycol, salicylate). This occurs from a primary decrease in serum bicarbonate which decreases pH (due to loss of bicarb via the kidneys and GI tract).

John is a 12-year-old male that comes to clinic today with his mother. Mom is concerned because over the past four days John has been complaining of a headache several times per day. John describes his headache as pressure and says it "feels like I have a tight band around my head". He denies nausea or vomiting and says the headache lasts mostly all day and the pain is a 7/10. He says he does get some relief from Tylenol. John admits to feeling stressed out at school lately due to upcoming tests. As the nurse practitioner, you would suspect John is suffering from. a. Trigeminal autonomic cephalalgias b. Tension-type headache c. Migraines d. Stroke

B : tension-type headaches generally have a duration of 30 minutes to seven days, are usually described as a pressure or tight band, are mild to moderate in severity, are commonly caused by stress, and rarely cause nausea and vomiting

Parents can anticipate all of the following during the 12 month well-child appointment EXCEPT: a. Determining child's height and weight. b. Maternal depression screening. c. Immunization against measles, mumps, and rubella. d. Screening for anemia.

B According to the Bright Futures' most recent 2019 Recommendations for Pediatric Preventative Health care table, maternal depression screenings stop after the 6 month well child appointment

As a Family Nurse Practitioner, you understand that newborn patients with a diagnosis of ankyloglossia are at most increased risk for: A. Delayed neurological development B. Feeding difficulties C. Delayed bone growth D. Minor spine deformities

B Ankyloglossia is the medical term used to describe the condition that is more commonly known as "tongue-tie." Newborn patients with this condition present with a lingual frenum that attaches more closely to the tip of the tongue than usual and often causes restriction of tongue movement. As a result, these patients may have trouble with feedings (particularly with latching at the breast). Ankyloglossia is not known to be associated with normal growth or overall development

A patient presents to clinic with complaints of generalized cramps. The patient experiences carpal spasm while BP was taken in office. The NP expects which of the following lab finings. A. K+ 3.4 B. Cal 7.9 C. A1C 5.2 D. Na 135

B Classical physical findings of hypocalcemia include Chvostek sign & Trousseau sign (carpal spasm as a result of occlusion of the brachial artery by a BP cuff)

A 12-year-old female comes to the clinic accompanied by her mother with complaints of headaches. After taking a thorough history and doing a thorough physical exam, you learn that the patients' headaches occur daily in last 2 weeks. She has not taken any OTC medicine for the headaches. She denies worsening during physical activities. She reports photophobia. Patient's neurological exam is normal. Mom asked, "Will you please prescribe her some medication for these headaches?". Regarding your knowledge on headaches in children, what would be your best response to the patient's mother? A. "Headaches are not normal in children. I am sending her to the Emergency Room. We need to do a CT STAT." B. "I believe she might be having Tension Headaches. It is important to give her Tylenol or Motrin as soon as it happens. I also would like for her to keep a headache diary and increase her water intake." C. "I believe she has COVID 19. We need to test her for it. Please quarantine her for 10-14 days." D. "Of course! These headaches are terrible in children. I don't want her to suffer any longer. I will prescribe her Topiramate (Topamax) 50mg twice a day"

B Headaches in children are common. Red flags for headaches in children are the following: headaches in children less than 5 years of age; recent head trauma; "worse headache of my life"; new or worsening headaches on a previously healthy child; nighttime headaches or awakening with headache; headache followed by vomiting (after history taking); and neurocutaneous stigmata (Hay et al., 2020). If normal Neuro exam, no need for imaging. The first line of treatment for headaches in children are OTC analgesics such as Tylenol and Motrin. The treatment should be given as early as possible after the onset of headaches. Keeping a headache diary will help the nurse practitioner to understand the headache type and pattern; therefore, helping to decrease frequency and disabilit

A 57 year old female patient presents for her annual physical and reports being a former smoker and quit 5 years ago. The patient states she had a mammogram 1 month ago and has a history of a hysterectomy with removal of the cervix. What screening should be considered as a form of secondary prevention for this patient? a. Chest x-ray b. CT of the chest c. Pap smear d. Mammogram

B Lung cancer screening is recommended by the USPSTF to be completed annually in individuals between the age of 55 years old to 80 years old that are current smokers with at least 30 pack years. They also recommend screening individuals between 55-80 years old who have quit smoking in the last 15 years. The screening involves a CT scan of the chest and can be stopped after the individual has not smoked for 15 years or if their life expectancy becomes affected by another significant health problem.

All the following are true regarding immunization safety EXCEPT: a. A child with a congenital immunodeficiency should not receive a live-virus vaccine b. A minor acute illness is a contraindication for a child to be vaccinated. c. A majority of chronic illnesses are not a contraindication for vaccination d. Hypersensitivity reactions are typically due to a component of the vaccine and not to the antigen.

B There is no evidence that if a child has a minor acute illness (with or without a low-grade fever) that it increases the risk of adverse reactions or decreases the efficacy of the vaccine. If the child presents with a more moderate to severe febrile illness- that could be a potential reason to postpone vaccination

A concerned mother of a 18 month old male calls the clinic and states her son has vomited several times, has had 2 episodes of diarrhea, she reports his mouth seems more dry than normal but he is having normal amount of wet diapers and is producing tears when crying. She also reports he is cheerful and acting his normal self and tolerating liquids and foods now. The practitioner told the mother her baby has mild dehydration and to replace fluids orally for now. All of following are signs of severe dehydration and reasons the baby needs to be seen immediately for evaluation except: A. Altered level of consciousness B. Two more episodes of diarrhea C. No wet diapers D. Absent tears

B No wet diapers and absent tears are signs of severe dehydration that warrants further evaluation of hemodynamic status and probable IV hydration. Oral rehydration is contraindicated with altered level of consciousness and respiratory distress. If baby continues to have diarrhea but remains clinically stable, oral rehydration is still recommended if tolerating.

A 5-year-old female presents to your clinic with her mother who complains of honey-colored crusted "sores" around the child's mouth for four days. After examining the patient, you notice the lesions are dry, isolated to the mouth, appear to be healing, and the patient is afebrile. What is your presumptive diagnosis? A. Herpes simplex B. Nonbullous impetigo C. Varicella D. Contact dermatitis

B Nonbullous impetigo are erosions that burst and are then covered by honey-colored crusts that affect the upper epidermis, commonly the face. They are invasions of bacteria and are common in children ages 2-5 years in areas of high humidity. If they are not surrounded by fluid-filled blisters, they typically are self-limiting and will clear withing two weeks.

A 48-year-old African American male with type 2 diabetes comes into your office for follow-up. His past medical history includes stage 3a CKD and HTN. He verifies his current medical regimen is Metformin 1000 mg twice daily, Hydrochlorothiazide 12.5 mg twice per day, and Lisinopril 20 mg daily. His home BP record shows well-controlled readings on current therapy. A review of his most recent labs include the following: HbA1c 7.2%, glucose 154 mg/dL, BUN 34 mg/dL, creatinine 1.6 mg/dL, eGFR 52 mL/min/1.73 sqm, and urine microalbuminuria 125 mcg/min. Which diabetes drug class would be the most appropriate choice to add to the patient's regimen that would provide renal protection as well as slow the progression of diabetic nephropathy? A. GLP-1 receptor agonists (dulagatide, semaglutide) B. SGLT-2 inhibitors (canagliflozin, empagliflozin) C. DPP- 4 inhibitors (sitigliptin) D. Sulfonylureas (glipizide, glyburide)

B SGLT-2 inhibitors, including canagliflozin and empagliflozin, are cardioprotective and also slow the progression of diabetic nephropathy (Dirkx & Woodell, 2020). GLP-1 receptor agonists are both cardioprotective and renal protective but have not shown to slow progression of diabetic nephropathy, (Betônico et al., 2016; UpToDate, 2021). DPP-4 inhibitors have exhibited variable suitability in CKD. (Kawanami et al., 2021). There is an increased risk for hypoglycemia in patients with renal failure and contraindicated in stage 3 CKD

A 24-year-old female presents to the clinic today complaining of epigastric pain. She describes the pain as steady and severe in nature. She reports that the pain and discomfort has occurred for at least one day. The patient also reports nausea and vomiting earlier today. The nurse practitioner can anticipate which of the following signs to support the diagnosis of acute cholecystitis? A. McBurney's sign B. Murphy's sign C. Cullen's sign D. Kehr's sign

B The clinical presentation of acute cholecystitis is accompanied by steady, severe abdominal/epigastric pain. Symptoms include nausea, vomiting and often fever. Acute cholecystitis is often exacerbated by large or fatty meals. Patients upon presentation often present with associated muscle guarding or rebound tenderness. The Murphy's sign is elicited by inhibition of inspiration by pain on palpation of the right upper quadrant. The sign is almost always present when patients present with acute cholecystitis. McBurney's sign is associated with appendicitis. Cullen's sign is associated with retroperitoneal hemorrhage or hemorrhagic pancreatitis. Kehr's sign is associated with ruptured spleen or ruptured ectopic pregnancy

An 8-year-old child is brought into the pediatrician's office for complaints of red eyes. The mother says she also noticed the patient having thin stringy discharge from both eyes. The patient is continuing to try and rub his eyes because they itch. What kind of conjunctivitis does this child have and how should it be treated? a. Bacterial conjunctivitis; treat with Ciprofloxacin 0.3% drops b. Allergic conjunctivitis; treat with Cromolyn sodium drops c. Viral conjunctivitis; treat with cold compresses & artificial tears d. Fungal conjunctivitis; treat with warm compresses

B The discharge that is associated with allergic conjunctivitis is described as thin and stringy. Allergic conjunctivitis can be treated with a mast cell stabilizer such as cromolyn sodium drops to help relieve symptoms and can also be used prophylactically. The discharge seen in viral and bacterial conjunctivitis is usually watery or purulent. Fungal conjunctivitis is very rare and not discussed.

A 22-year-old male was diagnosed with Hepatitis A in the clinic. What is the best response to inform the patient of the most likely means of transmission? a. IV drug use b. Contaminated food and water c. Contaminated bodily fluids d. Maternal-fetal transmission

B The hepatitis A virus is most commonly transmitted by the fecal-oral route. This can occur from person to person or can occur through consumption of contaminated food and water. Although the number of people developing hepatitis A has decreased significantly due to vaccinations, the United States still see occasional outbreaks.

Hypernatremia is a condition of hyperosmolality when the body's sodium concentration is above 145 mEq/L. Which of the following options regarding treatment of hypernatremia is TRUE? A. Replace fluids and electrolytes as quickly as possible. B. Replace fluids and electrolytes gradually over a 48-hour period. C. Consensus shows that the optimal rate of serum sodium correction is an increase in 1 mEq/L per day. D. Fluid replacement is not necessary as the sodium is already at an elevated level.

B The patient with increased serum sodium is usually dehydrated due to water loss. If hypernatremia is corrected too rapidly, then cerebral edema and other neurological impairment may arise due to osmotic imbalance. Rather than rapid infusion, fluids should be administered over approximately 48 hours. No consensus exists regarding the optimal rate of sodium correction for elevated serum sodium.

A 67 year old female presents to clinic for a painful rash on her nose that has been present for two days. Upon further discussion, she reports a headache, fever and burning sensation around right eye prior to the rash appearing and two weeks ago had what she believed was a head cold when the weather changed. Assessment reveals multiple small vesicles on her lower right lid margin as well as the tip of her nose, some are open and have a purulent drainage as well as a redness surrounding her iris. How would the nurse practitioner proceed? 1. Advise the patient to monitor for changes in vision and contact the clinic if symptoms worsen. 2. Prescribe high dose oral antiviral for 7-10 days and urgent referral to ophthalmology for herpes zoster ophthalmicus. 3. Begin workup for HIV and advise patient to abstain from sexual activity with spouse of 38 years till results have been received. 4. Advise the patient her symptoms are consistent with shingles, which will resolve on its own, recommend she get Shingrix vaccination immediately and schedule an appointment with her optometrist for a vision screening.

B Though it is important to monitor for vision changes and contact the clinic immediately should this occur, with the presence of vesicles on the right lower lid margin and tip of the nose, antiviral treatment should be initiated and an urgent referral to ophthalmology for evaluation and monitoring is of higher priority. 2) Initiating high dose oral antivirals within 72 hours of rash onset is important to reduce long term complications, such as post herpetic neuralgia, optic neuritis and cranial nerve palsy (Papadakis & McPhee, 2020). 3) Patients with HIV are at higher risk of herpes zoster ophthalmicus, and discussion with the patient should occur to determine risk factors and need for further workup, but this is not the first priority in this situation. 4) Patient's symptoms are consistent with shingles (herpes zoster), probably flared after a recent allergic rhinitis episode and immunological response, but has progressed to a more serious condition involving the eye, which requires immediate intervention. Vaccination should be delayed till the active herpes zoster infection has resolved. An eye exam by an ophthalmologist to assess the condition of the eye anatomy is necessary, not vision testing

A mother brings her 11-year-old daughter to the clinic for evaluation of watery red eyes. The practitioner observes a watery discharge, some eyelid edema, and conjunctival injection of both eyes. The daughter reports a couple of her friends have the same problem and were diagnosed with pink eye or viral conjunctivitis. All are true regarding viral conjunctivitis except: A. Treatment is supportive and disease is usually self-limiting B. Antibiotic eye drops should be started immediately C. Stay out of school and group activities until discharge and redness resolve D. Strict hand washing precautions is recommended

B Viral conjunctivitis is generally self-limiting, and findings include watery discharge and conjunctival injection of one or both eyes. It can be very contagious so educate to practice good hand hygiene and stay out of school or groups until the discharge and redness resolve. Treatment with steroids can potentially prolong the disease, and antibiotic drops are not needed unless findings suggest bacterial conjunctivitis like purulent discharge.

A 35 year-old woman comes in with hematuria, edema, hypertension, and hypertension. One possible diagnosis is: a) glomerulonephritis b) nephritic syndrome c) asymptomatic glomerular hematuria d) IgA Nephropathy

B a) glomerulonephritis - proteinuria greater than 1 gram/day, systemic symptoms, hematuria (do not have hypertension and edema commonly) b) nephritic syndrome: hematuria, proteinuria, hypertension, edema (this is the best match for her symptoms) c) asymptomatic glomerular hematuria: hematuria with RBCs that are dysmorphic, proteinuria greater than 1 gram/day d) IgA nephropathy requires proteinuria, positive IgA staining from a kidney biopsy, proteinuria (can be minimal)

The NP is providing education to first time parents. Understanding that frequent episodes of emesis in newborns is common, which of the following statements is correct? a. Gastroesophageal reflux (GER) is the most common symptom in newborns and should resolve by itself by 18 months old. b. Gastroesophageal reflux disease (GERD) is the most common symptom in newborns and should resolve by itself by 18 months old. c. Gastroesophageal reflux (GER) is the most common symptom in newborns and usually requires pharmacologic management for resolution. d. Gastroesophageal reflux disease (GERD) is the most common symptom in newborns and usually requires pharmacologic management for resolution

B gastroesophageal reflux is the uncomplicated, recurrent 'spit up' and emesis in healthy infants. This benign physiological event resolves spontaneously by 12-18 months of age. Gastroesophageal reflux disease (GERD) is noted in infants with failure to thrive, GI bleeds, or food refusal, usually requiring pharmacologic intervention

A 60-year-old AA female presents to clinic with complaints of swelling on lower extremities & SOB. Review of recent labs shows albumin 2.5 g/dl, urine albumin creatinine ratio 3.2 g/dl, and BNP is 70 pg/ml Kidney biopsy shows no sclerosis. What is the presumed diagnosis? A. CHF B. Nephrotic syndrome C. Focal segmental glomerulosclerosis (FSGS) D. End stage liver disease

B. Nephrotic syndrome is associated with significant proteinuria (> 3 gm/dl) & hypoalbuminemia. FSGS has associated kidney sclerotic finding on biopsy.

When providing care to a 11 months-old child who has a resent history of febrile seizure, NP should consider which of the following to be true: a) Prophylactic treatment with phenytoin has been shown to be effective b) Recurrence of simple-febrile seizures does not worsen the long-term outlook. c) The main causative agent is bacterial infection d) Sponging or tepid baths are ineffective at preventing recurrent febrile seizures

B. Simple-febrile seizures don't have long term negative side effects. It is a myth that mild-fever can place a child at risk for brain damage.

A newborn presents to the clinic for a routine well visit. Upon your assessment you note a difference between the red reflexes of the two eyes. Your next step is: A. Check both eyes for foreign bodies B. Refer to retinal specialist for surgical treatment C. Refer to ophthalmology for positive Bruckner test D. No intervention is necessary. This is a normal newborn finding.

C Checking for the red reflex is essential in all newborn visits. Any unilateral or bilateral abnormal red reflex can be caused by things such as retinal detachment or retinoblastoma and therefore must be referred for further evaluation. This is known as a positive Bruckner test.

A follow-up patient in clinic expresses his desire to follow the recommended dietary restrictions but finds it rather difficult to organize a meal plan that will best manage his diabetes and CKD. After a teaching session about his dietary food options, you ask him to create a sample daily menu. Which of the following lunch plans would be most appropriate and take into consideration a diabetic and renal diet? A. Lean chicken with brown rice and a banana B. Chicken nuggets, potato wedges, and chocolate pudding C. Grilled chicken breast on pita bread with green beans and a fresh fruit salad of berries, apples, and pineapple. D. Ham and cheese sandwich on whole wheat bread with potato chips and a Coke

C : A meal of grilled chicken, pita bread, green beans, and fruit salad is low in phosphorus, potassium, saturated fat, with limited sodium and simple carbohydrates. Choice A, B, D have higher potassium and/or phosphorus. (American Kidney Fund, 2019; Dirkx & Woodell, 2020; National Institute of Diabetes and Digestive and Kidney Diseases, 2019).

A 7-year-old female presents to the pediatric clinic with her mother for a well visit. Her vision screening results are 20/30. What is your next action? A. Repeat vision screening at next visit B. No action necessary, finding is normal C. Refer to an ophthalmologist D. Reassure the mother the child's vision will improve

C : Vision screening performed on children that are six or older should be referred to an ophthalmologist if there is a two-line discrepancy between the two eyes. Even if the vision screening is normal if the discrepancy exist the child should still be referred. To keep patients' vision at its best it's important to screen regularly.

A patient with Asian descent presents to clinic with blue-black papule on back that has changed shape and patient reports that it is "growing". What is the appropriate response? A. Nothing. This is normal for people of Asian descent. B. Watch it for a year then reassess. C. Refer to dermatology to rule out a nodular melanoma. D. Lecture patient about taking better care of their skin.

C : small and slightly elevated blue-black nevi are common in patients of Asian descent and they may have had them for a long time without changes, but if there is a new or growing blue-black papule, that will need further evaluation to rule out nodular melanoma. This patient has presented to your clinic because they noticed a change. They should be positively received and commended for noticing and coming in. Education is always beneficial but lecturing is not.

A patient comes to the clinic complaining of abdominal pain that radiates to his back. He notes that he feels better when he sits up and leans forward. His abdomen is distended with tenderness to the upper quadrants. He admits to drinking a lot at a bachelor party the night before. What labs does the provider expect to be abnormal? 1. ALT and AST 2. Urine analysis 3. Lipase and amylase 4. Sed rate

C Abdominal pain that is relieved by leaning forward is a classic sign of acute pancreatitis. Heavy meals or drinking may precipitate an attack. Lipase and amylase are elevated during pancreatitis and are accurate for diagnosis

An 8-year-old patient has recently been diagnosed with migraines and presents to your clinic with his parents to discuss abortive treatment options. You advise that the options best suited for this patient include all of the following EXCEPT: a. Ibuprofen b. Acetaminophen c. Almotriptan and zolmitriptan d. Rizatriptan

C Acute treatment of pediatric migraines includes use of both simple analgesics and migraine-specific medications. Simple analgesics include acetaminophen and ibuprofen which are often used as first-line therapy. Almotriptan has been approved as abortive therapy in patients ages 12 to 17 and rizatriptan has been approved for ages 6 to 17. Studies have shown that zolmitriptan nasal has shown significant benefit in patients 12 and up.

A 10-year-old patient with a history of focal seizures presents to your clinic with her mother today. The patient's antiseizure medication regimen includes levetiracetam which has been successful in abating the patient's seizures for 7 months. Her mother is wondering at what point the medication can be discontinued. Your best response as the FNP is: a. "Great news. The medication can be stopped if the patient remains seizure-free for the first 6 months after initiation." b. "Unfortunately, antiseizure medication is not a medication to be discontinued and is typically required for life." c. "Antiseizure medication therapy ideally is taken until the patient has been seizure-free for at least 1 to 2 years. At that point, stopping the medication can be considered." d. "How often are you giving her the medication? The medication only needs to be given should a seizure occur."

C Any child with an initial seizure diagnosis has a 50% chance of seizure recurrence. Because of this, medication therapy should be continued until the patient is seizure-free for 1 to 2 years. Up to 25% of children who withdraw from medications too quickly will experience recurrent seizures. However, in about 75% of patients, seizures will not recur after discontinuation of medications after 2 years of remission.

A healthy 5-year-old male with no prior medical history comes to see the family nurse practitioner for a well child check. The screenings and examinations that will occur today with this child should include: A. Height and weight, head circumference, BMI, BP, Physical Exam, Anticipatory guidance B. Height and weight, BMI, BP, Physical Exam, and Depression screening C. Height and weight, BMI, BP, Physical Exam, Vision screening and Immunizations D. Height and weight, BMI, BP, Physical Exam, and Tobacco/ETOH/Drug Use assessment

C Based on the American Academy of Pediatrics Bright Futures Guidelines a well child check for a 5 year old should include History, Height/Weight, BMI, BP, Vision and Hearing Screening, Developmental Surveillance, Psychosocial/Behavioral Assessment, Physical Exam, Immunization, Flouride Varnish (for those who do not see a dentist regularly), and Anticipatory Guidance. Head Circumference measurement for a healthy child ends at 24 months. Depression Screening doesn't begin until age 12. Tobacco/ETOH/Drug Use assessment doesn't begin until age 11.

A 22-year-old female presents with a localized erythematous vesicular rash that itches and has mild edema around her neck and right wrist. She states she attended a formal event the previous evening. She denies any known allergies but states she did have to purchase new jewelry for the event. The rash is most characteristic of: A) Atopic dermatitis B) Psoriasis C) Contact dermatitis D) Seborrheic dermatitis

C Contact dermatitis can present as erythema and edema, with pruritis, vesicles, bullae, weeping or crusting. It can present only in area of direct contact with irritant or extend beyond area of direct contact with allergen.

A 3-month-old boy is brought to the clinic with his mother for a well child visit. The mother has no concerns today. Using an ophthalmoscope, the nurse practitioner examines the red reflex and finds a reddish-orange reflex in the right eye and a white reflex in the left eye. The practitioner notes a positive Bruckner test with leukocoria in the left eye. What would be the next best step? A. Chart the finding and no follow up B. Close follow up to reassess in 1 month C. Urgent referral to an ophthalmologist D. Assure the mother this is a normal finding

C Evaluation of a bilateral red reflex is a crucial exam that should begin in the newborn period during every exam, and it is called the Bruckner test. A normal red reflex can be anywhere from yellow-orange in light pigmented eyes to dark red in dark pigmented eyes. Leukocoria or white pupil is an abnormal finding that should be referred to ophthalmologist urgently to rule out retinoblastoma

A 58-year-old woman comes into the clinic reporting tinnitus which makes it difficult to hear her husband at times of the episodes combined with vertigo, and pressure in her left ear. Which of the following would be the diagnosis for these symptoms? A. Acoustic neuroma B. Migraine C. Meniere's disease D. Vestibular dysfunction

C Meniere's disease has classic symptoms which are; episodic feeling of pressure and vertigo in the affected ear with tinnitus

A 13-year-old girl presents to the clinic after catching "the stomach virus" from a classmate. She states she has vomited multiple times and has stomach cramping, but she has had no diarrhea. Due to the imbalance of electrolytes and a disruption of the acid/base balance this student is at highest risk for which metabolic state? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis

C Metabolic alkalosis is characterized by a primary increase in HCO- and pH resulting from a loss of strong acid or gain of buffer base. The most common cause for a metabolic alkalosis is the loss of gastric juice via nasogastric suction or vomiting.

A 72-year-old female patient with a history of CKD stage 4 presents to the clinic for her annual wellness visit. She states "My nephrologist placed me on a special renal diet. I can't remember what restrictions there are. Can you tell me about it?" How would you as the provider educate the patient on a renal diet? A. Limit animal protein intake, increase your fluid intake, and restrict your calcium intake. B. Decrease your fluid intake, increase your phosphorus intake, and increase your animal protein intake. C. Limit animal protein intake, limit fluid intake, and limit sodium intake. D. Increase potassium intake, increase your calcium intake, and decrease your phosphorus intake

C Patients with CKD should restrict animal protein intake to about 0.6-0.8 g/kg/day. This could help decrease the progression of CKD. In CKD the kidney is unable to adapt in the sodium and fluid balance. Fluid intake should be less than 2L/day and sodium intake should be 2g/day. In addition to these restrictions CKD patients should restrict their potassium intake when the GFR is <10-20 or if the patient has history of hyperkalemia. Patients should limit their intake to less than 50-60 mEq/day. Patients with hyperkalemia in addition to potassium restriction should be on a bowel regimen and should have at least 2 regular bowel movements daily since a large percent of the potassium is excreted through the GI tract. Dietary phosphate restrictions should be 800-1000 mg/day in all stages of CKD.

2. NP patient is first grade student with impetigo. Mother is advised that she can send her child back to school________ hours after initiating antimicrobial therapy: a) 48 b) 72 c) 24 d) 96

C Per CDC, after 24h after the initiation of the antibiotic the child can return to school, but lesions needs to be covered and hands washed often

All of the following are examples of prevention measures that the Family Nurse Practitioner can teach caregivers to do in an effort to help protect against the development of dental caries in pediatric patients except: A. Consulting a dentist to establish a dental home at an early age B. Weaning from bottle feedings between the ages of 12-18 months C. Practicing daily oral hygiene with use of fluoride toothpaste after 12 months of age D. Applying a rice-sized amount of fluoride toothpaste at each oral hygiene session for patients less than 3 years of age

C Practicing daily oral hygiene with use of fluorinated toothpaste should begin with the first tooth eruption for pediatric patients (not after 12 months of age). Research has found that pediatric patients are more protected from developing dental caries by completing routine dental screening, weaning from bottle feeding (after 12-18 mths of age), and using an age-appropriate amount of fluoride-containing toothpaste for daily oral hygiene sessions.

In a child who is born to an HCV positive mother, testing anti-HCV IgG is not informative until the child is at least what age? a) 12 months, b) 6 months, c) 18 months, d) 9 months

C Since anti-HCV IgG crosses the placenta, the antibody test should not be performed until 18 months old. Subsequent testing for HCV RNA should be done in patients older than 18 months who test positive for antiHCV IgG in order to determine present of an active infection. Most infants who test positive have a high rate of spontaneous resolution. Learning the signs and knowing about potential infections can help aid in the treatment of symptoms before permanent damage is done.

A 70-year-old new patient comes into the office this October to establish care. When looking at the immunization records from the patient's previous PCP you see the patient is up to date with their childhood immunizations, Zostavax, & Tdap 7 years ago. What other immunizations would you recommend to the patient? a. PCV 13 & influenza b. PCV 13 & Zoster c. PPSV 23, Shingrix, & influenza d. Tdap, PPSV 23, & Zoster

C The PPSV 23 vaccine is recommended for adults over the age of 65, including those that received the PCV 13 as a child. If an adult has never received PCV 13 then the recommendation is to get the PCV 13 first followed by the PPSV 23 at least 1 year later. Patients who have had the Zostavax are recommended to still get the Shingrix two dose series per ACIP guidelines. The Zoster vaccines are recommended in patients over the age of 50. The flu vaccine is given during flu season to ages > 6 months old. The typical flu season is from September to April

A mother brings in her 6-month-old for a well-child visit and states that the patient has an allergy to eggs. When discussing influenza immunization with the parent, what is the appropriate action by the nurse practitioner? A. Tell the mother that influenza immunization is not recommended until 12 months of age B. Prepare administration of the LAIV vaccination C. Ask the mother what symptoms the child developed after eating eggs D. Tell the mother that an egg allergy is contraindicated for influenza immunization

C The correct answer is C. Inactivated influenza virus vaccine (IIV) is safe for children starting at 6 months of age. Live attenuated influenza vaccine (LAIV) should not be administered to children younger than 24 months of age, therefore should not be administered to this patient. Asking the parent what symptoms the child developed with exposure to eggs helps the nurse practitioner determine the severity of the allergy. Children with a mild reaction to eggs, such as urticaria, can safely receive IIV. However, severe allergy symptoms such as angioedema, respiratory symptoms or anaphylaxis require a referral to an allergist for high-risk evaluation.

You are rounding on a patient at a long-term care facility. The nurse caring for your patient informs you that the patient has new onset confusion, somnolence, and mental status change. The patient has a history of chronic COPD and has been refusing to wear her oxygen. What acid-base imbalance would you first suspect as the primary care provider? A. Respiratory Alkalosis B. Metabolic Acidosis C. Respiratory Acidosis D. Metabolic Alkalosis

C The correct answer is C. Respiratory acidosis results from hypoventilation and subsequent hypercapnia. Pulmonary and extrapulmonary disorders can cause hypoventilation. Chronic respiratory acidosis is generally seen in patients with underlying lung disease, such as chronic obstructive pulmonary disease

A 48 year old African American male with a past medical history of hypertension and obesity, has not been seen in the clinic for more than two years and presents today for blurred vision, increased thirst and a wound on his foot that he has not been able to heal at home. Following work up, you find his A1C is 10.5%, average fasting blood glucose is 255 mg/dl and he has glycosuria. He is diagnosed with Diabetes Mellitus type 2, started on oral glucose lowering agents and referrals are placed clinic's registered dietician and diabetic educator. What is another referral that should be placed for this patient? 1. Referral to endocrinology to evaluation and management of new onset diabetes mellitus type 2. 2. Referral to cardiology for uncontrolled hypertension. 3. Referral to ophthalmology for dilated eye exam to assess for diabetic retinopathy. 4. Referral to nephrology for presence of excessive glucose in urine

C The nurse practitioner will recognize that individuals are at higher risk for diabetic retinopathy when they are over the age of 45 years, have high blood pressure, are of African descent and have poorly controlled diabetes. In approximately 20% of individuals diagnosed with diabetes type 2, patients will have diabetic retinopathy, and early detection is essential to help reduce progression of diabetic retinopathy, macular edema and blindness (Papadakis & McPhee, 2020). In treating this patient, the nurse practitioner will also know that controlling blood sugar is the number one modifiable factor, followed by blood pressure control. A referral to endocrinology, cardiology and nephrology for the above reasons are not necessary in the initial treatment of new onset diabetes and can be managed by the nurse practitioner.

A 50-year-old male presents to your clinic with complaints of a dull, aching pain that is localized in the epigastric region. He states that the pain sometimes wakes him at night. Often when he eats the pain is relieved, but generally the pain returns 2-4 hours later. Your next step as the provider is: A. Order an abdominal CT scan for suspected stomach perforation B. Obtain a barium upper gastrointestinal series for a suspected malignant duodenal ulcer C. Order an upper endoscopy to distinguish between suspected duodenal or gastric ulcer D. Prescribe Omeprazole and have the patient follow up in 2 weeks for urea breath testing

C Upper endoscopy in the procedure of choice for the diagnosis of duodenal and gastric ulcers. Barium upper gastrointestinal series is no longer recommended because it is less sensitive for detection of ulcers and less accurate for distinguishing benign from malignant ulcers than upper endoscopy. Although an abdominal CT scan is used for suspected complications such as perforation, penetration, or obstruction, the patient's symptoms are typical and do not suggest a complication whereas vomiting and weight loss are unusual and suggestive of obstruction or gastric malignancy. Lastly, a urea breath test may be done in patients with a history of PUD to diagnose active infection of following treatment to confirm successful eradication. Use of a PPI may cause a false-negative urea breath test so you would want to withhold treatment 14 days before testing.

A mother brings her 3-year-old son into your clinic and states he has had vomiting and diarrhea for 2 days. She cannot get him to eat or drink much in order to stay hydrated. His lab work shows signs of dehydration. As a practitioner, you decide to use maintenance fluids as a source of replenishment. All the variables below EXCEPT which one are used to calculate maintenance dose requirements? A. Body Surface Area B. Weight C. Gender D. Caloric Expenditure

C Various models have been devised to facilitate calculation of maintenance requirements based on body surface area, weight, and caloric expenditure. Maintenance fluid requirements take into account sensible water losses and water lost in sweat, urine, and stool

A 9-month-old male presents for a well child visit. The mother stopped breastfeeding about a month ago due to low production. Having concerns about the ingredients in formula, the mother chose almond milk and baby food as main sources of nutrition. The clinician would expect the child to be: A. Within appropriate percentile on growth chart for his age. B. Low percentile on height due to lack of calcium in current diet. C. Underweight with protein, zinc, and iron deficiencies. D. Overweight due to hypercaloric contents of almond milk.

C Without proper education, families may not understand proper mixing of formula or approved types of milk. The American Academy of Pediatrics recommends the use of low fat milk for carbohydrate and protein consumption in infants greater than 12 months. Plant source milks lack essential proteins, are not calorie dense, and are not fortified with iron or zinc like infant formulas.

A 65-year-old Women presents to the clinic with complaints of heartburn that often follows meals. She states that it is getting worse and she can't sleep after dinner because of it. After a normal physical exam, what would be the next step you take? A. Order an upper endoscopy B. Tell her to not eat as much C. Start empiric treatment with twice daily H2 receptor antagonists or a once daily PPI for 4-8 weeks D. Order a barium esophography

C upper endoscopies can show the extent of tissue damage but is not always needed. Not eating as much may be helpful but it doesn't help fix the problem. Barium esophographys are not used to diagnose GERD. C is the correct answer because patients with typical symptoms of heartburn and regurgitation should be treated empirically with H2 antagonists or PPIs for 4-8 weeks.

A 23years-old woman is being evaluated for three-day history of painless, very itchy, cluster of five raised bumps on her abdomen. She first notice them when she returned from a wedding trip to a major metropolitan area. NP knows that the most appropriate treatment is: a) Topical clindamycin phosphate solution b) Ketoconazole cream c) Oral azithromycin d)Topical triamcinolone acetonide cream.

D This patient has bedbug bites. Because she complained of itchiness, to ease that you can prescribe a topical corticosteroid. PO antihistamine also can help- but is not an option in this case. Bottom line is that we don't want our patient to scratch and became infected. If left alone bedbug bites will heal in couple of days.

A 4-day old is brought into the clinic for hyperpurulent eye discharge. Upon collection of past medical history you learn that the infant's mother did not receive any prenatal care during her pregnancy and had a home birth. Your assessment shows redness of the conjunctiva, discharge, and eyelid swelling. What is the most likely diagnosis? A. Acute dacrocystitis B. HSV C. Nasolacrimal duct obstruction D. Opthalmia neonatorum

D : A pregnant mother that did not receive prenatal care likely has not been treated for any infections prior to delivery. If the infant was born at home he likely did not receive the prophylactic erythromycin after delivery. This clinical picture is most consistent with opthalmia neonatorum.

When conducting a sports physical for a 12-year-old which of the following findings would prompt the provider to further evaluate the child? A. Blood pressure today is 118/68 B. Patient has a history of seasonal allergies C. Body Mass Index is 19 D. Mother reports at age 49 patients grandfather passed from sudden cardiac arrest

D : A sports physical helps to identify underlying illness by obtaining a thorough history and physical from the patient. Further evaluation and attention are given to cardiac and respiratory conditions as well as reports of cardiac death in family member that are younger than 50. This ensures safe sport participation and early identification and treatment of underlying illness.

Billy is a 8-year-old child that comes in complaining of sudden, severe eye pain and tearing in his right eye. He states that he and his friends were flying paper airplanes and one of the airplanes hit his right eye. Which eye disorder do you suspect Billy has? a. Chalazion b. Amblyopia c. Nystagmus d. Corneal Abrasion

D : Children often accidently get corneal abrasions when playing with siblings, friends, or pets. Signs and symptoms of a corneal abrasion include acute severe pain, tearing, conjunctiva injection, and poor cooperation due to the eye pain. A chalazion is a painless eyelid nodule caused by a congested oil gland. Amblyopia is a decreased visual acuity in one or both eyes as a result of inadequate stimulation of the visual system. Nystagmus is a constant involuntary movement of one or both eyes.

A mother brings in her 5 month old and reports, "last night he was not acting like himself, he was super fussy and screaming. This morning he began vomiting and had red sticky poop." On exam you note abdominal distension and palpate a sausage shaped mass. What is your presumptive diagnosis? a. Pyloric stenosis b. Diverticulitis c. Hernia d. Intussusception

D : Intussusception is seen when a previously healthy 3-12 month old infant develops recurrent episodes of abdominal pain, screaming, and drawing up of the knees. Soon afterwards, vomiting and diarrhea begins, progressing to bloody stools with mucus within the next 12 hours. The infants abdomen is tender, distended, with a sausage-shaped mass in the mid upper abdomen. This is the most common cause of bowel obstruction in the first two years of life

When diagnosing Pseudotumor Cerebri (Idiopathic Intracranial Hypertension), a nurse practitioner must know that: a. Papilledema is caused by increased intracranial pressure and only found in overweight female patients b. Headache is a rare complaint c. CT scan or MRI usually reveals space occupying lesion d. Cerebrospinal fluid is normal when obtained via lumbar puncture

D : Papilledema is a clinical finding in all patients with Pseudotumor Cerebri (Idiopathic Intracranial Hypertension), although it occurs more commonly in overweight females of childbearing age. Headache is a common symptom due to increased intracranial pressure. CT scan or MRI usually reveals no space occupying lesion. Lumbar puncture confirms increased intracranial pressure, but the cerebrospinal fluid is normal.

When educating the parent of a ten-year-old female about the HPV vaccine the NP is correct in saying which of the following? a. The immunization series consists of 4 injections, each spaced 6 months a part. b. The current recommended HPV vaccine is the quadrivalent- protecting against four of the most common cancer-causing types. c. HPV is the third most common sexually transmitted infection in the United States. d. The HPV vaccine is recommended for both females and males between the ages of 9 and 12

D : The HPV vaccine series is given either in 2 or 3 doses depending on the age of the initial injection. Prior to the age of 15- it is two doses 6-12 months apart. On or after age 15- three doses. The second dose should be given 1-2 months after the first dose and the third dose should be given 6 months after the first dose. The quadrivalent HPV vaccine is no longer distributed in the US. Instead, it is the nine-valent HPV vaccine protecting against 16, 18, 31, 33, 45, 52, and 58. HPV is the most common sexually transmitted infection not only in the United States but also worldwide

During a well child visit with a 10-year-old boy, the clinician notes that the child is in the 90thpercentile for weight. Knowing early recognition and intervention is important, which anticipatory guidance would be most appropriate for the clinician to initiate? A. Place the child on a calorie restrictive diet and refer to a dietician immediately. B. There is no concern and the child may continue his regular diet and routine. C. Consult with a multidisciplinary team to discuss behavioral therapy and medication needs. D. Conduct an assessment of the child's dietary habits, activity patterns, and family support.

D According to Hays, early recognition of changes in weight or behaviors that identify them as high risk are important and that it is easier to provide prevention tactics than interventions. Each well child check up should include measurements of height and weight, nutritional status, and activity level. Assessing the patient and family's readiness to learn how to change dietary behaviors will provide the most success in trying to prevent obesity and comorbidities.

A 32-year-old male presents to the clinic today complaining of nausea, fatigue, diarrhea and generalized muscle aches for the past week. The patient reports attending a camping trip in Puerto Rico 3 weeks ago. The patient denies any known exposure to bodily fluids or risky sexual practices previously. Based upon clinical presentation, you suspect acute hepatitis. What type of hepatitis virus is the most likely cause? A. Hepatitis D B. Hepatitis C C. Hepatitis B D. Hepatitis A

D Acute hepatitis A is characterized by anorexia, nausea, vomiting, diarrhea and malaise. Additional clinical symptoms can include fever, jaundice, enlarged and tender liver. Hepatitis A is transmitted by fecal-oral route by ingestion of contaminated food or water sources. Due to the patient's recent camping trip in Puerto Rico, Hepatitis A is the only option that fits the clinical picture. The patient denied exposure to bodily fluids or risky sexual practices which could have transmitted Hepatitis B or C. Hepatitis D requires previous infection hepatitis B to occur.

All the following processes increase fluid requirements and risk for dehydration for pediatric patients except: ' A. GI loss like vomiting or diarrhea B. Fever C. Hyperventilation D. Renal failure

D All these processes create alterations of fluid requirements for pediatric patients. However, in contrast to the others, renal failure decreases requirements. Children with renal failure should restrict to insensible losses plus urine output

A first-time mother comes with her 8-day old male newborn for an urgent visit to the clinic. She states her newborn keeps having seizures while asleep. But the seizures seem to stop once she arouses him. After assessing the baby, the Nurse Practitioner did not find any neuro problems on the newborn. What is the most likely diagnose for this child? A. Epilepsy B. Restless Leg Syndrome C. Narcolepsy D. Benign Neonatal Sleep Myoclonus

D Benign Neonatal Sleep Myoclonus is s benign condition identified by myoclonus jerking movements (Hay et al., 2020). These movements are usually synchronous and bilateral in nature. Occurs during sleep and stop once the newborn is woken. This normal condition's onset happens withing the first 2 weeks of life. It usually resolves by the first month of life. However, can last up to 10 months. The myoclonus jerking movements can last from a few seconds up to 20 minutes

A 65-year-old man is diagnosed with chronic kidney disease. Which of the following dietary recommendations is correct? a) potassium intake less than 1 gram/day b) salt restriction of less than 5 gram/day c) phosphate restriction to 2000mg/day d) protein restriction to 0.6 - 0.8 grams/kg/day

D Correct: potassium restriction less than 2 gram/day to prevent hyperkalemia Correct: salt restriction should be less than 2g/day to prevent hypertension and/or hypervolemia Correct: Phosphate restriction to 800-1000 mg/day to help slow progression of chronic kidney disease Answer: protein restriction to 0.6 - 0.8 grams/kg/day - helps slow progression of chronic kidney disease

15-month-old Morgan is brought to your rural clinic by her father. He tells you that his daughter watching Paw Patrol when she began to stare away from the TV and started shaking. He said he called her name and picked her up, but she would not pay attention to him and did not stop shaking. He says this behavior went on for approximately 1-2 minutes. Morgan is currently sitting quietly in the room on dad's lap. She is not playful but follows most of dad's commands. She has a runny nose and dad says she has had that for a couple of days. Vital signs- temp: 101.9 F, pulse: 146, respirations: 22, Spo2: 99%. She has no medical problems, is up to date on vaccines, and is normally very playful. As the nurse practitioner, you believe Morgan may have had a febrile seizure. What would be your next step? a. Give Morgan benzodiazepines IM b. Tell dad to give Morgan Tylenol and put her to bed. c. Diagnose Morgan with epilepsy and refer them to neurology. d. Send Morgan to the ER for further evaluated of fever.

D Criteria for febrile seizures include ages 3 months to 6 years, with most being between 6 and 18 months, fever greater than 38.8 C, and a non-CNS infection. Febrile seizures typically last less than 5 minutes, are generalized, and associated with acute respiratory illnesses. Children with febrile seizures must be evaluated for the source of the fever, particularly to exclude a CNS infection. Meningitis and encephalitis should always be considered.

NP examines an 11-year-old child with a three-months history of migraines. Which of the following agents represent the best choice of abortive treatment in this patient? a) Almotriptan b) Zolmitriptan nasal c) Ibuprofen 10mg/kg; max dose 1,000mg d) Acetaminophen 15mg/kg; max dose 650mg

D First-line of treatment for headache (abortive) in a child: Give medication as soon as possible after the onset of headache - Acetaminophen 15mg/kg- max.650mg, and Ibuprofen 10mg/kg, max. 800mg.

A 40-year-old with a history of basal cell carcinoma presents for their annual wellness exam. What is the recommended screening you, as an NP, want to ensure they are doing? A) Do nothing! It is not going to come back. B) A head-to-toe skin assessment every 5 years C) A head-to-toe skin assessment every month for the first year then twice a year after that D) A head-to-toe skin assessment at least yearly

D Having a history of skin cancer, it is recommended to have a skin assessment complete at least yearly

Hematuria is a common clinical finding in all the following conditions except: A. Renal calculi B. Membranoproliferative glomerulonephritis MPGN disease C. UTI D. Chronic kidney disease

D Hematuria is a common manifestation in conditions like UTI, renal calculi, MPGH, & genitourinary neoplasms. However, it is not a specific finding associated with CKD.

Which of the following statements is FALSE regarding hypomagnesemia? A. Lowers the amount of parathyroid hormone (PTH) released. B. Renal potassium wasting occurs in relation to hypomagnesemia. C. Hypomagnesemia can cause disorientation tremors, and nystagmus. D. Hypomagnesemia can cause arrhythmias, hypotension, and bradycardia.

D Hypomagnesemia suppresses PTH secretion and increases renal potassium wasting. Just because magnesium is low does not mean that it will show in serum testing. Most common signs and symptoms of hypomagnesemia are CNS hyperirritability and cardiovascular manifestations of arrhythmias, tachycardia, and HTN

Which of the following statements regarding fevers in the pediatric population is FALSE? a. Acetaminophen can be given every 4 hours to treat fever in a 3-year-old. b. A fever lower than 41.7 degrees Celsius (107 degrees Fahrenheit) will not cause brain damage. c. Aspirin is not a safe treatment for fever of child due to the association with development of Reye syndrome. d. Ibuprofen and acetaminophen can be alternated to treat fever in a 3-month old infant.

D Ibuprofen should not be used to treat fever in a child younger than 6 months of age

A 30years old male presents to the clinic complaining of a rash on the arms and legs, mainly at the knees and elbows. On examination, you noticed silvery scales on a bright red plaque and well demarcated. As an NP you would treat this rash as: a. Herpes Zoster virus b. Tinea Corporis c. Sunburn d. Psoriasis

D The characteristic of psoriasis is erythematous papules which will be covered by thick silvery scales and occur mainly over the scalp, knees, and elbows

A 16-year-old patient is brought to the clinic for a well-child visit as he starts his fall semester of school. Which immunizations should be given at this time? A. MMR and Varicella B. DTaP and Influenza C. Varicella and Influenza D. Meningococcal and Influenza

D The correct answer is D. The second dose of Meningococcal vaccine and the annual Influenza vaccine are both recommended at 16 years of age. If the patient is up to date on all recommended immunizations, the final doses of MMR, Varicella, and DTaP were already received between 4 to 6 years of age.

Which child should be referred to an ophthalmologist? A. 3-year-old who is uncooperative with their first formal visual acuity exam B. 7-year-old child with vision 20/30 in left eye and 20/25 in right eye C. 4-year-old with vision 20/40 in left eye and 20/40 in right eye D. 6-month-old infant with Down syndrome

D The minimum acceptable visual acuity in ages 3-5 is 20/40 and in ages 6 or older it is 20/30. Any two line discrepancy in visual acuity between the two eyes in any age warrants an ophthalmology referral, even if the measured acuity is in the passing range. Children with Down syndrome are at increased risk for strabismus, cataracts and refractive error so they should receive an ophthalmology referral at age 6 months.

A patient presents to clinic with suspected acute pancreatitis. Which of the following diagnostic tests would NOT confirm acute pancreatitis? a) ultrasonography, b) CT scan, c) MRI, d) x-rays

D The pancreas can be hard to visualize through imaging because of overlying gas. Initial imaging typically consists of US. A CT scan shows the pancreas with more consistency and is typically better in recognizing pancreatic issues that could be occurring. An MRI can also be used to detect acute pancreatitis due to having superior soft tissue contrast resolution. X-rays are not diagnostic in showing inflammation in the pancreas or other abdominal organs.

How should a patient that presents with eye pain and says they are seeing lights with halos around them be treated? a. Prescribed topical corticosteroids b. Advised to use warm compresses on the eye c. Prescribed artificial tear drops d. Referred emergently to an ophthalmologist

D The patient described above is one that is demonstrating signs of acute angle-closure glaucoma. This condition is a medically emergency that requires a patient to be referred to an ophthalmologist to reduce the intraocular pressure in the eye. Permanent vision loss will occur in patients that are not treated within 2 to 5 days of symptom onset. Timing is crucial for this condition. The usual treatment for acute angleclosure glaucoma is an IV dose of acetazolamide once followed by oral dosages combined with topical medications used to decrease the pressure in the eye. This is usually managed by an ophthalmologist

A 2months old Asian American child is brought to the clinic by her mother for a scheduled well-child visit. On assessment, you notice blue-black "bruises" over the lumbosacral area even extended to the back and shoulder. And mother looks worried. What is your next action as an NP? a. Call child protective service because the child might be physically abused b. Ask the mother if someone in the house hit the child c. Ask the mother if the child fell d. Let the mother know that it is not concerning, it will fade as the child grows and skin darkens

D. 90% of Asian descents, African American, or Native American will have Mongolian spot which looks like a bruise over the lumbosacral area mainly and could also spread to the back and shoulder. It will not need any treatment; it'll fade as they grow or as their skin darkens.

Glenda, a 47-year-old educator, presents today with a 2-month history of daily intermittent mid epigastric burning. The sensation occurs 30 minutes after a meal and is accompanied with increased belching, and a sour sulfuric taste. Pain is relieved with OTC Tums. The patient denies nausea, vomiting, weight loss, or difficulty swallowing. Physical exam is unremarkable. Which of the following is most appropriate? A. Inform Glenda this is a normal finding that occurs with age, continue taking Tums for symptomatic relief. B. Refer to GI for an EGD to rule out esophageal cancer C. Prescribe Omeprazole 20 mg po daily, 30 minutes before meals for 4 weeks. D. Test for H. Pylori by ordering a urea breath test.

D: Intermittent pain that occurs in the mid epigastric region for at least one month is considered dyspepsia. Dyspepsia can present with other symptoms such as belching, nausea and/or vomiting. Diagnostic studies are not indicated for patients under 60 years old unless there are alarm features. While choice C can be correct, you would want to first rule out H. pylori by performing either a urea breath test or fecal antigen assays, due to recent PPI and antibiotic use causing false negatives. If this test is negative than you would start the patient on a PPI for 4 weeks.