Questions 6

A 67-year-old man was brought into your clinic by his daughter. She is very concerned because he has not been eating properly because of pain upon swallowing. She states she noticed his voice changed about 3 weeks ago and he has been persistently hoarse. Yesterday, he coughed up blood. You are concerned he has squamous cell carcinoma of the larynx. What is needed to confirm your suspected diagnosis? 1. Laryngoscopy with biopsy 2. CT scan of the chest 3. CBC and liver biochemical tests 4. PET scan

1 A biopsy is performed during a laryngoscopic procedure which confirms the diagnosis of squamous cell carcinoma of the larynx by evaluating surface tumor extent, arytenoid fixation, and true fold mobility. A chest CT is indicated if there are level IV enlarged nodes along the internal jugular vein or level VI enlarged nodes around the trachea or thyroid gland. Blood work should be included but does not confirm the diagnosis. A PET scan will assess for metastases in advanced disease

A 53-year-old man presents to your clinic complaining of mouth discomfort. He states he has Type 2 Diabetes Mellitus and uses full top and bottom dentures. He denies smoking or drinking. Upon doing your assessment, you note erythema in the oral cavity with creamy-white curd-like patches that are able to be rubbed off with a tongue depressor. What is your diagnosis? 1. Leukoplakia 2. Oral lichen planus 3. Oral cancer 4. Oral candidiasis

4 Oral candidiasis is usually painful. Unlike in leukoplakia or oral lichen planus, the white lesions in the mucosa can be removed by rubbing the surface of the mucosa. Risk factors associated with oral candidiasis include anemia, chemotherapy or radiation therapy, use of corticosteroids, use of broad spectrum antibiotics, poor oral hygiene, use of dentures, or diabetes mellitus. The major risk factors for oral cancer are alcohol and tobacco use

A 55-year-old female patient presents to clinic complaining of weakness, dizziness, tremors, and muscle cramps ongoing for 1 week. Her medications include Lasix 40mg daily, Amlodipine 2.5mg daily and Omeprazole 40mg daily. She reports she had a stomach virus 2 weeks ago. Which of the following set of labs would you expect to find on a basic metabolic panel completed today? A. Mg 1.4, K+ 3.0, Ca 8.2 B. Mg 2.1, K+ 3.5, Ca 9 C. Mg 3, K+ 4.7, Ca 8.5 D. Mg 2.5, K+ 4, Ca 8.7

A .Clinical manifestations of hypocalcemia, hypomagnesemia and hypokalemia include weakness, tremors, and muscle cramps. Common causes of hypokalemia include nausea and vomiting (patient had stomach virus) and use of loop diuretics. Common cause of hypomagnesemia include use of proton pump inhibitors and loop diuretics. Commonly with hypokalemia there is also magnesium depletion.

A 75 year-old female presents to clinic with a chief complaint of short-term memory loss. The most common neurodegenerative age-related cause is? A) Alzheimer dementia B) Vascular dementia C) Lewy body dementia D) Frontotemporal dementia

A : Alzheimer dementia is the most common age-related neurodegenerative disease. Dementia incidence doubles every 5 years after the age of 60

The FNP knows that there are home environment risk factors for childhood obesity. These risk factors include all of the following except which one? a. Family meals every night b. Large portion sizes c. Poor sleep d. Sedentary lifestyle

A : Home environment risk factors are modifiable and easier to control. These risk factors are drinking of sugared beverages, lack of meals as a family, large portions, eating foods that are not prepared at home (take-out, fast-food), watching TV, playing video games, not sleeping well, and little to no activity are all associated with unnecessary weight gain.

Your next patient is a 60-year-old female. At the patient's yearly wellness exam, she mentions that her hands and fingers have started having pain. This pain is usually in the mornings and improve with increased movement as the day goes on. She can hardly open her bottle of water when the pain is more severe, and the joints in her fingers appear swollen. She also says as the months go by, she feels her pain is steadily getting worse. What type of arthritis does the advanced practice nurse suspect? A. Rheumatoid Arthritis B. Old Age C. Psoriatic Arthritis D. Gouty Arthritis

A : Rheumatoid arthritis usually has a slow onset and worsens over time. The pain is most often worse in the mornings. It most often affects the joints of the fingers.

A 40-year-old female presents to your clinic with the complaint of a sudden onset sore throat that began 2 days ago. The patient denies fever, rhinorrhea, difficulty swallowing, or cough. During the exam, you note a temperature of 98.2 F, erythema to the posterior pharynx, white tonsillar exudate, no anterior cervical lymphadenopathy, and no hepatosplenomegaly. According to the Centor Criteria, what is your next action? A. Order a Rapid Strep Test. B. Write a prescription for Amoxicillin twice daily for 10 days. C. Order a throat culture. D. Order a Monospot test.

A : The Centor Criteria is utilized in clinical practice to guide the diagnostic course for Group A Strep (GAS). 1 point is awarded for each criteria marker met. The criteria consist of (1) Lack of Cough, (2) Fever > 38 C, (3) Anterior Cervical Adenopathy, and (4) Tonsillar Exudate. If a patient presents with 0 or 1 criteria marker, then GAS is not likely, and neither Rapid Strep Test nor Throat Culture are indicated. If the patient presents with 2-3 criteria markers, then further testing via Rapid Strep Test is indicated. If the patient meets all 4 criteria markers, GAS is likely, and you may treat the patient empirically for GAS without testing. In this scenario, the patient meets 2 of the 4 criteria; therefore, the correct answer is A. Prescribing an antibiotic at this time is not warranted until you receive the results of the Rapid Strep Test. A throat culture may be ordered if the initial Rapid Strep test is negative. A Monospot Test to detect Epstein-Barr Virus is also not warranted at this time.

You are performing a 1 week follow up on a 50-year-old male who went to the ER last week for nausea, vomiting and diarrhea. He was diagnosed with gastroenteritis and sent home with a prescription for antiemetics. His only complaints today are slightly decreased urine output and mild nausea. Upon reviewing his lab results, you notice that his creatinine has increased from 0.8 mg/dL in the ER to 1.6 mg/dL today. His most likely diagnosis is: A. Acute Kidney Injury B. Chronic Kidney Disease C. Interstitial Nephritis D. Glomerulonephritis

A AKI is a rapid increase in creatinine. AKI of prerenal cause is typically due to volume depletion from GI loss and hemorrhage. Oliguria and nausea are symptoms of AKI. The patient's creatinine was normal 1 week ago, so this rules out CKD. Interstitial nephritis is ruled out due to the lack of fever and rash. Hematuria and edema are not mentioned, so glomerulonephritis is also ruled out

A mother presents to the clinic for a well child visit with her 2 year-old son, Michael. When asked about Michael's diet, you learn that he does not consume a balanced diet. Michael's BMI is in the 95th percentile. What patient/caregiver education would you discuss? A. Encourage the mother to incorporate more nutrient rich foods into Michael's diet and engage in active play time daily. B. Tell the mom Michael is a healthy boy, and no changes are needed. Michael will grow into his body shape. C. Counsel the mother to start Michael on a structured meal plan with a daily exercise routine. D. Refer to Nutritionist/Dietician

A According to Haemer & Diab (2020), obesity in childhood can be managed by considering the extent of the problem and age of the child, but also is largely dependent on the caregiver's acceptance and ability to make changes (p.297). Body mass index in pediatrics is divided into percentiles. Between the fifth and 85th percentile is considered healthy weight (CDC, 2020)

A toddler with a history of being admitted to NICU for prematurity and renal disease presents to your clinic for a 2 year old well-child visit. What vital signs would be appropriate for this visit? A. Temperature, Heart Rate, Blood Pressure, Respirations, Pulse Oximeter B. Temperature, Heart Rate, Respirations C. Temperature, Heart Rate, Respirations, Pulse Oximeter D. Temperature, Blood Pressure, Respirations, Pulse Oximeter

A Although most well visits do not include a BP measurement until the age of 3; this child has a history of renal disease and was admitted to NICU for prematurity. Both factors would indicate the need for a BP measurement prior to the age of 3.

A 28-year-old male recently established care with your clinic after a 5-year incarceration. The patient's laboratory findings indicate HBsAg negative, anti-HBc positive, and anti-HBs positive. The nurse practitioner knows this means: A. the patient is immune to the hepatitis B virus due to a natural infection B. the patient is fully vaccinated against the hepatitis B virus C. the patient will need to be started on Interferon alfa 180 mcg via subcutaneous injection weekly for 48 weeks D. the patient will need 3 doses of a hepatitis B vaccine

A HBsAg, a protein found on the surface of the hepatitis B virus, is only found during an acute or chronic infection. Anti-HBc indicates a current or past infection from the hepatitis B virus. Anti-HBs indicates recovery or immunity from infection of the hepatitis B virus. The patient is immune due to natural immunity because his HBsAg is negative, anti-HBc is positive, and anti-HBs is positive. If the patient was susceptible to the hepatitis B virus, all 3 results would be negative. If the patient was fully vaccinated his HBsAg and anti-HBc would be negative and his anti-HBs would be positive. If the patient was actively infected HBsAg and anti-HBc would be positive while anti-HBs would be negative.

Sydney is a 5-year-old patient who presents to the office with complaints of a stomach bug and diarrhea for several days. Her pulse is slightly increased, has mild oliguria, and her skin turgor is normal. She is not showing any signs of respiratory distress or altered mental status. What would be the best course of treatment for this level of dehydration? A. Oral rehydration with an electrolyte solution B. Emergent IV therapy C. Admission to the hospital D. Oral rehydration with broths and apple juice

A If a patient is showing signs of mild (normal turgor, mucous membranes, hemodynamic signs, and mild oliguria) to moderate (decreased turgor, slight increase in pulse, oliguria) dehydration, oral rehydration with solutions that are fortified with electrolytes are the best option versus solutions that do not contain repletion of electrolytes.

Upon reviewing labs on a new 58-year-old male patient with chronic kidney disease you notice a potassium of 6.0 mEq/L. You know that EKG changes may reveal which of the following? A. Peaked T waves B. Presence of pathologic Q waves C. Shortened QRS complexes D. Presence of a delta wave

A Peaked T waves may be present with an elevated potassium (below 6.5) may have peaked T waves, QRS widening, and PR interval prolongation (p. 912, McPhee). Incorrect answers: Q wave can indicate previous MI. QRS widens not shortens with hyperkalemia. Delta waves are present in WolfParkinson White syndrome

1. A 50-year-old female patient diagnosed with Primary Biliary Cholangitis (PBC) is complaining of worsening pruritus that is not relieved by Benadryl. The NP understands that A. Pruritus is an expected finding and prescribes Cholestyramine. B. Pruritus is an expected finding and prescribes Colestipol. C. Pruritus is an unexpected finding and prescribes Cholestyramine. D. Pruritus is an unexpected finding and prescribes Colestipol.

A Primary Biliary Cholangitis affects females of middle age between 40-60 years. Cholestyramine is the preferred and first line medication for the treatment of PBC pruritus because it is the most effective. Colestipol is not as effective for PBC pruritus even though it is better tolerated.

The nurse practitioner is holding a vaccine clinic administering influenza vaccines. The nurse practitioner is demonstrating what level of prevention? A. Primary Prevention B. Secondary Prevention C. Tertiary Prevention D. Health Promotion

A Primary prevention aims to remove or reduce the risk factors of decreases by stopping the disease or injury prior to it occurring. Immunizations are an example of primary prevention

The fundoscopic examination of your 3-month-old patient reveals leukocoria of the right eye. The best treatment option for your patient at this time is: A. Immediate referral to the ophthalmologist as this is a serious condition requiring prompt evaluation. B. Have patient return to clinic in 1 month for another evaluation as this is common for an infant and normally self-resolves. C. Have the parents begin practicing tracking exercises with the infant as this finding often precedes strabismus. D. Do nothing—this is an expected finding with infants

A The correct answer is A. Leukocoria is associated with serious disease and requires ophthalmologic evaluation. This may be caused by retinoblastoma, cataracts, retinal detachment, and retinal vascular disorders.

Rebecca is a 45 y/o woman with PMH of CAD presents with migraine, which treatment should the nurse practitioner avoid to prescribe for this patient? A. Triptans B. Short-term systemic corticosteroid C. Opioids D. NSAIDs

A Triptans. Triptans are contraindicated in patients with coronary or peripheral vascular disease and Prinzmetal angina.

The NP is conducting a wellness assessment on a 5-month-old infant and the parents want to know around what age the child is supposed to develop all their primary teeth. Between what ages can you expect to see a complete set of primary teeth (20 teeth) erupt? a. 30 to 36 months of age b. 6 to 7 years of age c. 6 to 7 months of age d. 3 to 4 years of age

A. complete set of primary teeth is usually set to erupt between the ages of 30 to 36 months. Primary teeth begin to erupt around 7 months of age and between the ages of 6 to 7, the first permanent molars erupt.

A patient with congestive heart failure is routinely taking furosemide daily. Which electrolyte abnormality is most likely to occur? a. hypokalemia b. hyperkalemia c. hyponatremia d. hypernatremia

A. Loop diuretics can cause a substantial loss in potassium and cause hypokalemia

You are performing an ophthalmoscopic exam on a 6-month-old during her well child exam. You notice that one of her pupils appears white in color. Your treatment plan for this child includes which of the following A. Steroid eye drops for 7-10 days B. Referral to Ophthalmology C. No treatment, this will self-correct by 24 months of age D. A corrective patch for 6-12 months

B Checking the patient's red reflex is important at every pediatric exam from birth to 36 months. An abnormal red reflex can signify abnormality in the retina, refractive errors, glaucoma, Peter anomaly, infections, anterior segment dysgenesis, cataracts and retinal detachment retinoblastoma. The red reflex should be orange-yellow in color to dark red. Any difference in quality of the red reflex between eyes requires a referral to ophthalmology

A 7 day old full term male presents for an initial newborn visit. He is exclusively breast fed and his mother reports he seems to be feeding enough with an adequate number of wet diapers and bowel movements. Bilirubin level was 11 mg/dL at discharge. He is now back at his birth weight. Upon exam, he is noted to have jaundice on his trunk as well as his sclera. What response by the NP is appropriate at this time? A. "You should stop breast feeding and switch to formula." B. "Jaundice is common in breast fed infants and usually resolves within 2-3 months." C. "He needs to be readmitted for phototherapy." D. "He needs additional labs to evaluate the cause of his hyperbilirubinemia."

B : B is the correct answer. Elevated indirect bilirubin occurs in 35% of breastfed infants. Jaundice peaks before the 3rd week of life and clears by 3 months in almost all infants Phototherapy is not indicated unless bilirubin meets high risk level criteria. Supplementing formula is sometimes suggested in those with moderate-high bilirubin levels but should be suggested as an adjunct to breastfeeding

A 3 year old healthy male with no known allergies presents to clinic with father for left ear pain. The father states the child has been rubbing his left ear since yesterday morning. He also reports the child is irritable and was unable to sleep last night. Upon assessment you notice bulging of the left TM and the canal is erythematous without any drainage and you diagnose the patient with AOM. Which of the follow is not a treatment recommendation? A. Encourage the use of acetaminophen or ibuprofen to relieve ear discomfort B. Prescribe Azithromycin for 5 days as first line treatment C. Discuss the benefits of considering delayed antibiotic therapy using the "watch and wait" method D. Educate parent if symptoms do not improve in 2-3 days to contact clinic for follow up

B : High dose amoxicillin is considered first line treatment for acute otitis media in children with mild to moderate symptoms that have not recently had amoxicillin in the past 30 days. The patient also has no known allergies.

42 year old Caucasian female presents to Urgent Care for otalgia. She reports she went swimming 4 days ago at a local lake. She states her ear is very painful and has been draining yellow drainage since swimming in the lake. Upon examination, the nurse practitioner observes an edematous, erythematous external canal with crusted yellow drainage. The tympanic membrane is unable to be visualized. What is the best way to treat this illness? A. Attempt to debride ear canal with irrigation to visualize tympanic membrane B. Insert ear wick into auditory canal. Start Ofloxacin otic solution. C. Debride ear canal with forceps. Start Neomycin/Polymyxin B otic solution. D. Insert ear wick into auditory canal. Start Neomycin/ Polymyxin B/ hydrocortisone otic solution.

B : Irrigation should not be performed when it is unknown if the tympanic membrane is intact. The practitioner can attempt to clear any debris with forceps, however, aminoglycosides are ototoxic and unsafe to prescribe if the tympanic membrane is perforated. This also deems D incorrect treatment as well. Ofloxacin is safe to prescribe with a perforated tympanic membrane.

A 4-week-old male infant presents to the clinic today with the chief complaint of vomiting. The mother states that the infant projectile vomits blood-streaked emesis after every feeding. The mother also denies any changes in the infant's bowel movements. Upon assessment of the abdomen, the nurse practitioner palpates an "olive" size mass in the right upper quadrant. Based on these findings what would be the nurse practitioner's presumptive diagnosis? A. Gastroesophageal reflux B. Pyloric stenosis C. Intussusception D. Duodenal ulcer

B : Pyloric stenosis is present predominantly in males. Signs and symptoms such as postprandial projectile vomiting usually begin between 2 and 12 weeks. The emesis is rarely bilious but may be blood streaked. An olive sized mass is often palpated in the right upper quadrant of the abdomen (

You are examining a patient who you suspect may have acute cholecystitis. During the physical exam, the patient demonstrates a positive Murphy's sign. Which of the following best describes this clinical finding? A.) Pain in RLQ caused by right leg extension B.) RUQ pain upon palpation which causes the patient to cease inspiration C.) Palpation of LLQ produces pain in RLQ D.) Pain in RLQ upon internal rotation of right hip

B A clinical feature of acute cholecystitis is a positive Murphy's sign which is the inhibition of inspiration by pain on palpation of the right upper quadrant

A 4-week-old newborn is brought by mom with concerns of a new "rash" on his face. Upon assessment, you observe inflammatory papules and pustules with scattered comedones over baby's cheeks, forehead, and chin. Which of the following is the appropriate clinical diagnosis and education? A. Neonatal cephalic pustulosis; treat with topical antifungal, ketoconazole 2% cream. B. Neonatal acne; reassure mom it will spontaneously resolve within 6 months to 1 year. C. Milia; reassure mom the cysts eventually rupture and exfoliate their contents. D. Sebaceous gland hyperplasia; reassure mom this is a remnant of maternal androgens and will resolve within the first several months of life.

B A. Neonatal cephalic pustulosis is rare and characterized by red papules and pustules on the head and neck, which appear in the first month. B. Neonatal acne can be present at birth but typically show up around 2-4 weeks of age. Neonatal acne has inflammatory papules and pustules with some comedones, largely on baby's face. This takes 6 months to 1 year to clear up without intervention. C. Milia are 1-2 mm epidermal cysts filled with keratinous debris; present in newborns. D. Sebaceous gland hyperplasia; prominent white/yellow papules at the opening of pilosebaceous follicles without erythema, common atop the nose.

A 39-year-old male presents to the clinic with episodes of severe unilateral periorbital pain. The episodes awaken the patient from sleep and lasts roughly 1hr. The practitioner knows that the patient is most likely experiencing which of the following? A: Migraine B: Cluster Headache C: Tension-Type Headache D: Giant Cell Arteritis

B Cluster headaches affect predominantly middle-aged men. These headaches present as episodes of severe unilateral periorbital pain occuring daily for several weeks. They occur typically at night, awaken the patient, and last between 15 minutes and 3 hours.

A 13-year-old female presents to your clinic. 4 days ago, she was seen by another provider and was tested for acute strep pharyngitis and the strep test result was negative. The provider treated her with Amoxicillin because of their assessment of the patient. The patient stopped the antibiotic yesterday because she started getting a rash and began feeling worse. She now reports that she still has a sore throat and coughing that has gotten worse. She has a fever of 102 degrees Fahrenheit, her throat is very erythematous, and exudate is present. What would be the appropriate next step? a. Prescribe Penicillin V for 10 days and have patient follow up as needed. b. Obtain a throat culture and consider serological testing for mononucleosis. c. Send the patient to the local hospital for a chest x-ray for assess for possible pneumonia. d. Prescribe the patient Ibuprofen for throat pain and Fluconazole for Candida infection of the throat

B According to Hay et al. (2020), over 90% of sore throats and fever in children are due to viral infections. You must differentiate a viral infection from a bacterial infection because the treatment will be different. In this case, the previous provider treated this patient as a bacterial case of pharyngitis when it was not. This is a case of infectious mononucleosis which usually presents as exudative tonsillitis, generalized cervical adenitis and fever, and more often presents in patients greater than 5 years of age (Hay et al., 2020). The proper treatment for this patient would be to perform a throat culture and mono-spot test to confirm mononucleosis diagnosis.

A 32-year-old male presents to the clinic complaining of headaches with sinus pressure and congestion with increasing green purulent nasal drainage for 2 weeks. Patient reports symptoms improved for a couple of days with over-the-counter cold/allergy medications and now have worsened. Patient reports fever >101 for the past 2 days. Your physical exam also reveals frontal and maxillary sinus tenderness. What is the best presumptive diagnosis? A. Allergic Rhinitis B. Acute Bacterial Rhinosinusitis C. Non-Allergic Rhinitis D. Viral Sinusitis

B Acute Bacterial Rhinosinusitis can be distinguished from viral rhinitis with symptoms presenting greater than 10 days after onset or worsening of symptoms after initial symptoms improvement. Symptoms present as nasal obstruction, congestion, purulent nasal drainage, facial pain/pressure within sinus areas, cough, and fever.

A 68-year-old man presents to your primary care clinic with reports of flashes of light and visual "floaters" over several hours followed by a curtain-like shadow obstructing his view. As the Nurse Practitioner you know: A. This is a common condition experienced by the elderly and is associated with hypertension. B. To refer this patient immediately as this is consistent with retinal detachment, a medical emergency requiring surgical intervention to preserve vision. C. Is consistent with macular degeneration. D. The patient is likely hallucinating.

B B is the correct answer. Visual disturbances and curtain-like shadows are hallmark signs of retinal detachment.

Mr. Davis is a 43-year-old man that presents to you with CKD. His current vitals are 150/93, HR 90, O2 sat 96%, temp 36.8 and his labs show that he is proteinuric. He is already on a HCTZ, and you decide to start him on Lisinopril. Which two labs should be obtained within the next 7-14 days to provide a baseline? A. Serum creatinine and sodium B. Serum creatinine and potassium C. Serum potassium and BUN D. GFR and sodium

B BP control is essential in proteinuric patients and adding an ACE or ARB offers renal protection. However, these medications can cause increases in serum creatinine and potassium. If serum creatinine or potassium increase by more than 30%, the ACE/ARB should be prescribed at a lower dose or discontinued

Which vertigo is classic for lasting seconds to minutes with recurrent spells? A. Labyrinthitis B. Benign Paroxysmal Positioning Vertigo C. Meniere Syndrome D. Vestibular Neuronitis

B Benign Paroxysmal Positioning Vertigo is classic for having recurrent spells of "spinning" lasting seconds up to minutes. It is provoked by movement or changes of head position. It is also known as "positional vertigo." It is best treated with Epley maneuvers that you can teach in office and provide printed education to give your patient to do at home. The other 3 vertigo types usually have a longer lasting spell (20min, days, or a week), which can be treated initially with diazepam or meclizine (p. 225).

What annual lung cancer screening intervention is recommended by the USPSTF for those that are 55- 80 years old and are current smokers with a 30 pack-year history or are former smokers who have quit within the last 15 years? A- chest X-ray B- low dose CT scan C- lung biopsy D- bronchoscopy

B Evidence supports the use of low dose chest CT which is substantially more precise than a chest X-ray in recognizing asymptomatic small lung cancers. This screening should not be regarded as a substitute for smoking cessation. This screening can be ceased when the individual has not smoked for more than 15 years, or a health issue arise would limit their life expectancy. A lung biopsy would be completed after results from CT scan. A bronchoscopy would be completed to view the lungs, obtain biopsy samples, & bronchial brushing sample

A 55-year-old male presents to the clinic with complaints of malaise, anorexia, nausea, vomiting, and mild, epigastric abdominal pain. He reports his symptoms began about 8 days ago after he began staying at crowded shelter due to a hurricane damaging his home. His vital signs are the following: T 100.4, HR 94, RR 20, BP 128/86. Which lab findings would the practitioner expect to find with this patient? a. Elevated WBC, positive IgM anti-HAV, mild proteinuria b. Elevated ALT & AST, positive IgM anti-HAV, normal WBC c. Decreased ALT & AST, positive IgG anti-HAV, mild bilirubinuria d. Normal ALT & AST, positive IgG anti-HAV, decreased WBC

B Hepatitis A is a virus transmittable through the fecal-oral route. A common mode of transmission is through contaminated food or water. Prodromal phase includes anorexia, nausea, vomiting, malaise, low-grade fever, and mild, epigastric abdominal pain. Laboratory findings include normal-to-low WBC, mild proteinuria and bilirubinuria, and elevated aminotransferase levels. Serum IgM anti-HAV is detectable soon after viral onset indicating active Hepatitis A infection. IgG anti-HAV is also detectable soon after onset but also can persist for years.

1. A 3-year old male presents to the clinic with honey-crusted erosions localized around his nose. Based on the characteristics of these erosions, the Nurse Practitioner would know that these are characteristic of what diagnosis? What would be the appropriate treatment? A. Folliculitis; wet and warm compress B. Impetigo; Bacitracin ointment applied to affected area TID C. Tinea Corporis; Griseofulvin D. Impetigo; Amoxicillin/Clavulanate

B Honey-crusted lesions are diagnostic for impetigo. While D could also be correct, the first-line treatment for localized infection is bacitracin. Widespread infection that is suspicious for MRSA infection should be treated with Amoxicillin-Clavulanate.

A 47-year-old male presents to your clinic with complaints of intense itching, right upper quadrant pain, tea colored urine, clay colored stool, and malaise. On exam the nurse practitioner notes the presence of jaundice and a palpable gallbladder (Courvoisier sign). The nurse practitioner suspects a biliary obstruction. The nurse practitioner's next action will be to: A. Obtain kidney function tests and order a CT of the abdomen B. Obtain liver biochemical tests and order an ultrasound of the abdomen C. Order an MRI of the abdomen and refer the patient to a gastroenterologist D. refer the patient to a nephrologist

B Initial evaluation of suspected biliary obstruction should include serum total bilirubin, unconjugated bilirubin, alkaline phosphatase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalized ratio (INR), and albumin as well as an ultrasound. Together these tests are known as liver biochemical tests. An ultrasound is the preferred initial imaging diagnostic due to its lower cost. CT and MRI are significantly more expensive and therefore are not used for first line screening.

The NP is providing new medication education to a patient. Which of the following medications place the patient at risk for ototoxicity? A. Calcium Channel Blockers B. Loop Diuretics C. Fluroquinolones D. Potassium Sparing Diuretics

B Ototoxic medications may cause irreversible hearing loss even at therapeutic doses. Common ototoxic medications are aminoglycosides, loop diuretics, and antineoplastic agents.

A patient is diagnosed with Hemochromatosis and has questions regarding treatment. All of the following general treatment measures would be appropriate except? A. Avoid foods high in iron, alcohol, vitamin C, and raw fish B. Phlebotomy therapy is not suggested C. Administration of a PPI can help reduce intestinal iron absorption D. Deferoxamine can be taken for patients with hemochromatosis and anemia

B Phlebotomy therapy for hemochromatosis has shown to help change the course of the disease by increasing survival rates, regressing hepatic fibrosis, and preventing cirrhosis in precirrhotic patients. This also helps to correct insulin requirements and cardiac conduction defects.

The FNP is correct in choosing to prescribe dental prophylactic antibiotics for which child? A) A 5 year old with Type I DM going for a routine dental cleaning. B) A 10 year old who previously recovered from infective endocarditis having a tooth extraction. C) A 3 year old with a feeding tube needing fluoride treatments. D) A 6 year old with a family history of heart valve replacement having a periodontal procedure

B Prophylactic antibiotics are prescribed for high risk patients undergoing dental procedures that may predispose them to bacteria. High risk conditions include children with: prosthetic heart valves, previous recovery from infective endocarditis, vascular grafts (placement less than 6 months) unrepaired congenital heart disease, total joint replacements, indwelling vascular catheters, neurosurgical shunts.

13 year old Jessica presents to the Emergency Department with her mother, stating that she cannot breathe, can't feel her fingers and thinks she is having a panic attack. Vital signs are: T-98.9, HR-115, RR-32, BP-136/90, O2-100% RA. ABG results were pH 7.47, pCO2 25, HCO3 21. What is the likely cause for her respiratory alkalosis? A. Hypoventilation B. Hyperventilation C. Diarrhea D. Hyperemesis

B Respiratory alkalosis occurs when hyperventilation results in a decrease in Pco2 and an increase in systemic pH. Hypoventilation results in respiratory acidosis due to increase of Pco2. Diarrhea would cause loss of buffering bicarbonate, resulting in metabolic acidosis. Hyperemesis would result in metabolic alkalosis due to the loss of strong acid (gastric juice) from excessive vomiting.

A 72-year-old female presents to your clinic with mild nausea, headache, and fatigue. She was recently diagnosed with a brain tumor. Her CMP reveals a serum sodium of 130 mEq/L. You recognize she most likely has: A. Elevated sodium levels requiring oral rehydration therapy B. Syndrome of inappropriate antidiuretic hormone requiring fluid restriction (500-1,000mL/day) C. Low sodium level requiting rapid hypotonic fluid infusion D. Normal sodium levels with no intervention required

B SIADH is the appropriate diagnosis related to the brain tumor and limiting fluid can help regulate the sodium level. Wrong answers: 130 is not an elevated sodium level. C is correct in saying it is a low sodium level, but rapid correction of hypotonic hyponatremia can cause cerebral osmotic demyelination syndrome (p. 906, McPhee). D is wrong because this is not a normal sodium level

A 2 year old female presents to clinic with mother with complaints of cough, nasal congestion, sore throat and fever of 100.8F that started 2 days ago. The rapid COVID and flu tests were negative. What is the best course of treatment? A. Prescribe Amoxicillin 90 mg/kg/day for 10 days B. Educate and reassure parent that it is likely a viral infection and should improve within 7-10 days C. Encourage use of OTC antihistamine for treatment of cough D. Start antitussive with codeine to help with cough

B Symptoms are less that 10 days in duration and therefore should be treated as acute viral rhinitis. Treatment is conservative and includes medication for fever reduction, humidified air, and saline nasal drops. Consideration for antibiotic therapy can be made once symptoms have not improved after 10-14 days.

A 65-year-old female presents to the clinic for her wellness exam. The patient reports that she is up to date on her vaccines. After reviewing her records, you recommend the Shingrix vaccine. The patient states "I already took the Zostavax vaccine, do I still need this?" As an NP, your best response would be. a. No, you are currently up to date on your vaccines b. Yes, you should receive the Shingrix vaccine despite prior vaccination with the Zostavax vaccine c. You can wait another year to receive the Shingrix vaccine since you took the Zostavax vaccine. d. Yes, the Shingrix vaccine is a booster of the Zostavax vaccine.

B The Advisory Committee on Immunization Practices recommends that individuals 50 and older receive the Shingrix vaccine to prevent the herpes zoster infection. Despite, receiving the Shingrix vaccine it is recommended by the Advisory Committee on Immunization Practices that the Zostavax still be administered. The patient is not up to date at this time and the Shingrix vaccine is not a booster and has been replaced by the Zostavax vaccine.

A 4-year old patient presents to the pediatric clinic with his mother who reports yellow eye drainage. She reports the drainage is worse in the morning and it is crusted over when he wakes in the morning. Upon exam you note injected sclera and mucopurulent drainage bilaterally. These findings are consistent with: A. Viral conjunctivitis B. Bacterial conjunctivitis C. Allergic conjunctivitis D. Acute dacryocystitis

B The correct answer is B, bacterial conjunctivitis and manifests with mucopurulent drainage. Viral conjunctivitis presents with clear drainage and allergic presents with clear watery drainage. Dacryocystitis presents with inflammation, swelling, and tenderness over the lacrimal sac.

A 23-year-old male presents to your clinic with the complaint of watery eyes, clear rhinorrhea, sneezing, and an occasional cough. He reports his symptoms have occurred intermittently for the last 2 months since becoming employed as a landscaper. During the exam, you note that the patient's conjunctiva is erythematic, and the nasal turbinates are pale and swollen. What is your diagnosis and treatment plan for this patient? A. Nonallergic Rhinitis; Prescribe Ipratropium (Atrovent) intranasally. B. Allergic Rhinitis; Prescribe Fluticasone (Flonase) intranasally and Cetirizine (Zyrtec). C. Acute Rhinosinusitis; Prescribe Amoxicillin-Clavulanate (Augmentin). D. Allergic Rhinitis; Prescribe Ipratropium (Atrovent) intranasally and Loratadine (Claritin).

B The correct answer is B. A patient with Allergic Rhinitis typically presents with watery and irritated eyes, rhinorrhea, sneezing, cough, and/or recent allergen exposure. Pale, swollen nasal turbinates are a common exam finding. Treatment options for Allergic Rhinitis include intranasal corticosteroids and antihistamines. In Nonallergic Rhinitis, a patient may complain of cigarette smoke or other strong odor as a symptom trigger and sneezing is not a common complaint. Ipratropium intranasally is a first line treatment option in Nonallergic Rhinitis. In Acute Rhinosinusitis, a patient typically presents with additional symptoms such as purulent rhinorrhea, fever, and/or sinus pain, plus red and swollen nasal turbinates.

When evaluating a patient with potential appendicitis what is the gold standard imaging study to support appendicitis would be which of the following: A.HIDA scan B.Abdominal CT scan C.Abdominal MRI D.Abdominal US

B The gold standard for diagnosing appendicitis is abdominal CT scan.

Mr. Smith presents to your clinic with a known history of DM Type 2 and Chronic Kidney Disease. His lab work today shows eGFR 25, urine albumin-to-creatinine ratio 450, and HgbA1C 7.8. He is currently taking Metformin 1000 mg BID. Your next immediate action as the NP is to: a. Refer to nephrology for further management b. Discontinue Metformin c. Reduce dose of Metformin and add a SGLT-2 inhibitor for glycemic control d. Do nothing, these are normal lab results for a patient with CKD and DM Type 2.

B While referral to nephrology would be appropriate, you first immediate action would be to discontinue Metformin which is contraindicated in patients with an eGFR less than 30. Adding an SGLT-2 inhibitor would be appropriate, but you would need to discontinue Metformin completely rather than reduce the dosage

A 58 year old female patient presents to your office with complaints of fatigue and unintended weight loss over the past two months. Her laboratory results reveal a serum calcium of 14.2 mg/dL. Follow up lab work reveals a normal parathyroid hormone level. What disease process must be ruled out in this patient? A. Nephrolithiasis B. Neoplasm C. Cushing Syndrome D. Gout

B [A] While hypercalciema can cause uroliths, the patient with a kidney stone will typically complain of severe flank pain, nausea and vomiting (Papadakis & McPhee, 2020, p. 981). [B] The correct answer is neoplasm. Severe hypercalcemia (greater than 14 mg/dL) is usually the result of a neoplastic process. Further, this patient also complains of fatigue and weight loss (Papadakis & McPhee, 2020, p. 916). [C] The principal electrolyte derangement of Cushing syndrome is hypokalemia (McPhee, 2020, p. 1192). [D] Serum uric acid is the principal laboratory test used in the diagnosis of Gout

Hallmark sign of a patient with Ulcerative Colitis? A. RUQ pain B .bloody diarrhea C.LLQ pain D heartburn

B. Bloody diarrhea is the hallmark sign of UC, LLQ pain is diverticulitis, heartburn is GERD, and RUQ pain would be related to the patients gallbladder.

When educating a patient on the different level of prevention, which statement made by the nurse practitioner is true? A. Routine cervical pap smears screening is a form of primary prevention B. Annual pneumonia vaccine is a form of secondary prevention C. Radiation therapy in cancer diagnosis is a form of tertiary prevention D. Avoiding alcohol consumption is a form of secondary prevention

C

What secondary prevention strategy for osteoporosis is recommended for women over the age of 65? A- bisphosphonates B- calcium & vitamin D supplementation C- dexa scan D- weight bearing exercise

C - Inadequate bone mineral density or osteoporosis is correlated with a profound risk of fracture which can lead to substantial discomfort, impairment & disability. Women have a lifetime risk of 50% for osteoporotic fracture. Screening for osteoporosis related to low bone density can be identified via Dexa scan. It is also recommended in younger women with increased risk factors. Primary prevention strategies include calcium & vitamin D supplementation, & weight bearing exercise. Bisphosphonates are included as treatment (tertiary prevention intervention) of osteoporosis

A 3-month-old girl is brought to the clinic with her mother for a well child visit. The mother is concerned that her daughter may have thrush because she has noticed a "whitish film in her mouth". After examining the child, the nurse practitioner decides the white film is biofilm not thrush. What education should the nurse practitioner provide? a. Reassure the mother this a normal finding in children this age b. Teach the mother to use salt water irrigation to remove the biofilm daily c. Teach the mother how to clean the intra-oral cavity with a warm soft cloth daily d. Advise the mother to purchase fluoride toothpaste and rub all over the baby's gums to prevent cavities.

C .: Dental caries is the most predominate disease of childhood. It is mostly a disease of poverty and affects 80% of children and adolescents living in poverty. Establishing good oral hygiene habits early in a child's life helps to prevent early childhood caries. Therefore, it is important for pediatric offices to assess for caries risk and provide anticipatory guidance on good oral health

A 3 y/o female presents with mom for fever and decrease in wet diapers x 48 hours. The patients' weight is 3% less than it was at her wellness check one month prior. Blood pressure and HR are within normal limits and mucous membranes are dry. Oral rehydration is recommended for mild-moderate dehydration. Which beverage is appropriate for at home treatment of dehydration? a) Whole milk b) Warm broth c) Pedialyte d) Lemon-lime powerade/water mix

C : Rehydrating with oral fluids may be appropriate with in children who have mild to moderate dehydration. According to Table 23-5, a 3% decrease in body weight, dry mucous membranes, Normal BP and HR, and mild oliguria are all signs of MILD dehydration. Items found at home such as broth and juice are not appropriate for rehydration. Table 23-7 names Pedialyte and Enfalyte as appropriate oral rehydration solutions. (Hay et al., 2020)

A nurse practitioner, who is caring for a 3-year-old that has missed several routine exams, explains to the child's mother that establishing a medical home is important and should be: A. decided at birth by the doctors and other family members B. only used for urgent care visits to decrease the number of emergency room visits C. accessible, family-centered, and culturally effective D. used only for children with special health care needs

C : The medical home is a concept in which all children and their families have an identified, easily accessible primary care provider or group of providers within an office. The seven components include: accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.

A 45 year old male with a history of hypertension presents to your clinic. He is currently taking amlodipine 10mg daily. His BP today is 168/98 with a HR of 80. You note that his potassium level on his lab draw from 2 weeks ago was 4.9. You decide to add an additional antihypertensive to his current regime. What is the most appropriate selection? A. Eplerenone B. Spironolactone C. Hydrochlorothiazide D. Metoprolol

C : [A] & [B]: Eplerenone and spironolactone are both potassium-sparing diuretics and are not suitable for this particular patient with a potassium level on the upper end of normal. [C] Hydrochlorothiazide is the correct answer. HCTZ can minimize hyperkalemia. [D] Beta blockers can increase the risk of hyperkalemia and should be avoided in this patient (

A mother presents with her 10 month old daughter stating they were notified of a Hepatitis A outbreak that occurred on a cruise ship they returned from 1 week prior. After a detailed history and exam is obtained, the infant does not present with any symptoms suggesting an acute Hepatitis A infection. What is the FNP's best action? A. Draw Hepatitis Panel and LFT labs today. B. Administer initial dose of Hepatitis A vaccine C. Schedule administration of immune globulin. D. Reassure mother that her daughter seems fine and no further action is needed.

C C is the correct answer. Children younger than 12 months, adults greater than 40 years old, and those who are immunocompromised are recommended to receive immune globulin within 2 weeks of exposure. Children are unable to receive the Hepatitis A vaccine until 12 months of age (Hay et al., 2020). Labs are not needed if she is not showing clinical signs of Hepatitis A.

A new mother presents to clinic with her son for his 3 month checkup. She is concerned because her milk production is decreasing, her baby has become irritable, signaling to nurse every hour and is only producing 2-3 wet diapers per day. Upon assessment of the child, you should expect the following: A. Bounding pulses B. Swollen anterior fontanel C. Heart rate of 158 D. BP 110/54

C Children generally respond to a decrease in circulating volume with a compensatory increase in pulse rate and may maintain their blood pressure in the face of severe dehydration. Fast, thready pulses and sunken fontanels are indicative of dehydration.

The nurse practitioner knows the following patient is most at risk for developing cholelithiasis: A. An Ethiopian female drinking 3 cups of caffeinated coffee daily and taking Atorvastatin nightly B. A Nigerian male training for his third half marathon C. A Mexican American female with recent intentional 60lb weight loss following the keto diet D. A Caucasian male compliant the Mediterranean diet for the past 4 years

C Cholelithiasis is more common in females, Mexican Americans, and those who rapidly lose weight. Cholelithiasis is less common in males and individuals from Africa. Physical activity, a Mediterranean diet, and caffeinated coffee are protective against cholelithiasis. Statins are protective against cholecystectomy

.The mother of a 2-month-old male infant is concerned about some pimple-like nodules growing on her infant's gums. Upon assessing the infant, the NP notices some smooth, white, and yellow cyst-like nodules on the alveolar mucosa that are about 2mm and non-tender. The NP explains that A. This is a common sign for early growth of teeth in male children. B. This is not a common occurrence and refer the infant to an oral surgeon. C. This is a common occurrence in infants and should disappear by 3 months of age. D. This an infection and prescribe some antibiotics.

C Dental lamina cysts smooth, round 1-3mm cysts are white, gray, or yellow nodules, non-tender, self-limiting and disappear by the age of 3 months. These cysts are remains of the dental lamina and are usually found on the alveolar mucosa

52-year-old male patient presents for follow up of lab work. His labs revealed Potassium 3.4, Magnesium 2.1, Phosphorous 3.2 and Calcium 8.1. Which of the following findings would you not expect to find on this patient? A. Positive Chvostek sign B. Muscle cramps and spasms C. Negative Chvostek sign D. Laryngospasms with stridor

C Hypocalcemia causes excitation of muscle and nerve cells resulting in laryngospasms with stridor, convulsions, spasms of muscles with cramps and tetany, positive Chvostek and positive Trousseau signs and QT prolongation

The FNP is seeing a 72-year-old female who has been diagnosed with stage 3 chronic kidney disease. When educating the patient about her disease and general recommendations to follow, you recommend which of the following: A. Taking ibuprofen as needed for headaches B. Following a high protein diet C. Restricting sodium and water D. Using Milk of Magnesia as needed for constipation

C. Nephrotoxic medications such as ibuprofen should be avoided in patients with CKD. These patients should also restrict protein and avoid medications that contain magnesium. Restricting salt and water are important to prevent volume overload and hypertension.

A 62-year-old male presents to his primary care clinic for a refill on his medications. He was diagnosed with Parkinson Disease five years ago. Given his history which of the following symptoms would you NOT expect to be present? A. Tremor present at rest B. Rigidity C. Tremor present with voluntary activity D. Fatigue

C Parkinson Disease most often occurs between 45 and 65 years of age and is a progressive disease. Tremor, rigidity, bradykinesia, and postural instability are the cardinal features of parkinsonism and may be present in any combination. The tremor of about four to six cycles per second is most conspicuous at rest and is often less severe during voluntary activity

A 10 y/o male presents to clinic with his mother. Mom states he has been febrile (up to 103 degrees F) off and on for 2 days with sweating. He has had nausea with vomiting and diarrhea. Mom has tried to force fluids, but states patient hasn't been able to keep much down. Which would NOT be included in priority testing for fluid and electrolyte management? a) Daily weights b) BUN/Cr c) Stool sample d) Na/K

C Patient's weight and I/O's should be monitored daily for fluid and electrolyte management. For imbalance of fluid and electrolytes, serum electrolyte concentrations should also be monitored closely. This includes blood urea nitrogen and creatinine. (Hay et al., 2020)

A patient presents to the clinic with complains of vomiting, severe abdominal pain, and fever of 101.2F. The NP suspects acute cholecystitis. What is an expected finding on assessment? A. Periumblical pain that moves to the right lower quadrant. B. Epigastric pain that occurs after eating worse when lying down. C. Right upper quadrant pain that radiates to the area between shoulders worsens with palpation. D. Severe epigastric pain that radiates to the back and worsens in supine position.

C Right upper quadrant pain that radiates to the right shoulder or in between shoulders correlates with acute cholecystitis. The pain is worse with palpation and elicits rebound tenderness, a positive Murphy's sign.

When assessing a mass to the neck, what findings would be of most concern? A. 1cm, soft, nontender mass B. 2.5 cm, soft, mobile, tender mass C. 2.5 cm, hard, nontender mass D. 1cm, hard, tender mass

C Soft, tender masses are more likely caused by inflammation such as pharyngitis. They are also usually rapid growing. While hard, nontender, slow growing masses greater than 2cm are more concerning and likely malignant (p. 252).

A 63-year-old male presents to the clinic for evaluation. Over the past 7 month he has had worsening balance. His wife has noticed a decline in short term memory. He cannot seem to remember what he ate for breakfast or what instructions she has given him for the day. He has also started to have urinary incontinence. His blood pressure is 132/78, heart rate of 85, respirations 20, temperature 98.2 degrees Fahrenheit, and oxygen saturation is 98% on room air. The advanced nurse practitioner suspects which neurological disorder as her first differential diagnosis. A. Alzheimer's B. Cerebrovascular accident C. Normal Pressure Hydrocephalus D. Dementia

C Symptoms of off balance, short term memory loss, and urinary incontinence in an older male patient may be suspicious for normal pressure hydrocephalus. This brain disorder would be confirmed with a thorough assessment and history, along with a CT brain or MRI brain scan. The diagnostic imaging would look for excess cerebrospinal fluid collecting in the brain's ventricles.

A 33-year-old male presents to the clinic with the following: diaphoresis, vomiting, and tremors. Vitals signs are as follows BP 160/90, RR 22, HR 98, Temp 98.9. The patient reports heavy alcohol use. As an NP, which tool is the most appropriate for assessing this patient? a. GAD-7 b. Mini-Cog c. AUDIT d. PHQ-9

C The Alcohol Use Disorder Identification Test (AUDIT) screening tool is used to assess for signs of alcohol abuse due to the presenting symptoms and vital signs the patient is likely going through withdrawals. The PHQ-9 is a screening tool used for depression. The mini cog is used to assess for cognitive impairment. The GAD 7 is used to assess for anxiety

A 46 year-old woman presents to your Urgent Care Clinic with reports of a painful bump on her eyelid which appeared 1 week ago. She states she has uses OTC eye drops and warm compresses, but the area has become more swollen and painful. Upon examination you note a red, tender, swollen area with dried discharge on her right upper eyelid consistent with a external hordeolum. As the nurse practitioner you instruct the patient A. This is a self-limiting condition and will improve without treatment B. This is generally non-infective and symptoms may be relieved with warm compresses. C. This condition is most likely caused by a bacteria and should resolve with the use of a prescription antibiotic ointment. D. To go to the ER for antibiotic IV infusion.

C The correct answer is D. Hordeolum is an infection of the upper or lower eyelid most commonly caused by staphylococcus aureus. The treatment is optical erythromycin or bacitracin. Emergency treatment of an external hordeolum is not indicated.

Molly is currently receiving treatment with Isoniazide, Rifampin, and Ethambutol and she wants to know if she can continue breast feeding her daughter. As her NP, you tell Molly: A. Advise Molly she can continue breastfeeding. B. Clarify to Molly if she pumps, instead of baby to breast, she can continue breastfeeding. C. Tell Molly breastfeeding is contraindicated and provide alternative options for infant nutrition. D. Inform Molly breastfeeding and supplementing with formula is recommended

C The text suggests that active tuberculosis infection and undergoing treatment are "absolute contraindications" for breastfeeding (Hay et al. 2020, p. 284

The FNP is teaching a mother of a toddler about prevention of dental caries. Which statement made by the mother indicates an understanding of the teaching? A) I can give my toddler a sippy cup of milk at bedtime. B) I can give my toddler 100% fruit juice to drink. C) When brushing my toddler's teeth, I should use fluoridated toothpaste. D) When brushing my toddler's teeth, I will use non-fluoridated toothpaste.

C Toddlers should only be given water at bedtime to prevent dental caries. Drinks that contain sugar may expose the child's enamel to fermentable carbohydrates leading to periodontal disease. Incorporating the use of fluoride in oral care by using fluoridated toothpaste can help prevent dental caries.

A 5-year-old African American male presents to the clinic for a new patient/well child visit. On assessment the nurse practitioner notices an umbilical hernia. Which action is best for the nurse practitioner to include in the patient's plan of care? A. No abnormal findings; follow-up in 1 year. B. Order and administer a barium enema. C. Refer to general surgery. D. Refer to pulmonology

C Umbilical hernias are most common in African American. If they persist beyond the age of 4 should be treated surgically

Which of the following is true regarding café au lait macules? A. Characterized by a black-blue macule typically found in darker-skinned infants. B. Patients with McCune-Albright syndrome often have small café au lait macules present over their entire body. C. Café au lait macules decrease in number and do not persist past puberty. D. The presence of six or more lesions with a diameter greater than 0.5 cm prior to puberty or 1.5 cm postpuberty or adulthood are significant criteria in the diagnosis of neurofibromatosis type 1 (NF-1).

D A. These are Mongolian spots. B. Patients with McCune-Albright syndrome have a large, unilateral café au lait macule. C. Café au lait macules persist throughout the lifetime and increase with age. D. The presences of six or more café au lait macules with diameters above are diagnostic criteria concerning NF-1. *

A 21-year-old college student presents to the clinic with complaint of epigastric abdominal pain since awakening about four hours ago. His pain level is a 6/10. He also reports nausea and vomiting and admits to heavy alcohol intake for the past 48 hours. Which of the following lab values would you expect to be significantly elevated? A.) Calcium and creatinine B.) Sodium and potassium C.) Magnesium and ALT D.) Amylase and Lipase

D Serum amylase and lipase are usually three times the upper limit of normal within 24 hours in 90% of cases of acute pancreatitis

A 2-year-old female patient presents to the clinic with her mother for a well child visit. Upon obtaining a thorough history from the mother, the NP learns that the mother was a heavy cigarette smoker during her pregnancy with the child and delivered at 32 weeks gestation. The mother also stated that the child had to have tubes placed in her ears at 8 months of age for recurrent ear infections. Which of the following conditions would warrant blood pressure screening at this visit? A. Tube placement in ears B. Mother's smoking status C. Recurrent ear infections D. History of prematurity

D : Blood pressure screening at well child visits starts at age 3 years, but some conditions warrant blood pressure monitoring at an earlier age. These conditions include history of prematurity, very low birth weight, or other neonatal complication requiring intensive care, congenital heart disease (repaired or nonrepaired), recurrent urinary tract infections, hematuria, or proteinuria, known renal disease or urologic malformations, family history of congenital renal disease, solid organ transplant, malignancy or bone marrow transplant, treatment with drugs such as steroids or oral contraceptives which are known to raise blood pressure, other conditions such as neurofibromatosis and tuberous sclerosis that are associated with hypertension, and evidence of elevated intracranial pressure.

The new FNP is assessing an 11 year-old, pediatric patient for childhood obesity. The child has a BMI of >95%. The NP knows that the following labs should be obtained except which one? a. Fasting lipids b. Fasting glucose c. Fasting Hgb A1C d. AST

D : In an obese, pediatric patient over the age of 10 or the onset of puberty, recommended labs are fating lipid panel, glucose and/or Hgb A1C, and ALT as well as other studies as needed. 10-25% of obese youth have NAFLD which can be evidenced by an elevated ALT.

Which statement about Bells Palsy is NOT true? A) It can be triggered by recent varicella zoster infection B) Treatment with corticosteroids increases recovery C) Inflammation of the facial nerve is involved D) Aphasia is often an associated symptom

D A) True: Can be triggered by reactivation of herpes simplex or varicella zoster virus infection B) True: Treatment with corticosteroids increases probability of a complete recovery at 9-12 months by 12- 15% C) True: has been attributed to inflammation of the facial nerve (IIV) D) False: Aphasia is not an associated symptom of Bell Palsy

has been hypertensive for his last two visits and the NP needs to consider initiating a blood pressure medication. Which medication would be the best choice for this patient? a. Lisinopril b. Losartan c. Spironolactone d. Hydrochlorothiazide

D ACE inhibitors, ARBs, and spironolactone can cause hyperkalemia, especially in a patient with renal disease. These should be used cautiously. A thiazide diuretic will help lower the potassium as well as blood pressure

What is the initial treatment plan for Blephritis, Chalazion, & Hordeolum? A. Topical antibiotic ointment to eye lid B. Topical corticosteroids to eye lid C. Incision & curettage affected lid D. Warm compress to eye lid

D All three disorders are inflammation of the eye lid. They each may affect different areas of the lid but all three can respond with initial treatment of warm compresses. If warm compresses don't improve the lid disorder the other options to this question are specific to worsening cellulitis, conjunctivitis, and swelling

Anticipatory guidance on injury prevention and management for a 1 year old well-child office visit should include all the following except: A. Placing chemicals out of reach and having the poison control phone number saved into family member's phones B. Prevention of drowning and water safety and benefits of swim lessons C. Choking hazards, food safety and recommending CPR training for parents D. Concussion prevention and concussion protocol for safe return to sports activity

D Anticipatory guidance should be specific for age and development. Concussion prevention and safe return to sports is more appropriate for a school aged child.

A 40-year-old female presents to the clinic with complaints of "stomach issues". She reports that she has been having sharp, epigastric abdominal pain, nausea, and vomiting after eating large meals. She denies history of GERD, PUD, or irritable bowel disease. Upon physical examination, she reports pain upon palpation of the RUQ of the abdomen. This is consistent with which of the following: a. Rovsing's sign b. McBurney's sign c. Obturator sign d. Murphy's sign

D Cholecystitis presents with severe pain of the epigastrium or RUQ, nausea, vomiting, often in association with ingestion of fatty or large meals. A physical exam finding typically present in this condition is Murphy's sign which is the induction of pain upon palpation of the patient's right upper quadrant.

A father presents to your clinic stating his 4-year-old son woke up this morning with his eyes matted shut and itching. Upon examination you find the child's eyes are red with a boggy conjunctiva and a stringy discharge. With these signs and symptoms, you know: A. This condition is very contagious and the child should stay out of school for until redness and tearing resolve. B. Decreasing exposure to allergens will not aid in the preventions of this condition. C. This condition is typically caused by bacteria and should be treated with a topical antibiotic. D. Antihistamines and mast cell stabilizers are very effective in treating this condition

D Conjunctivitis can be caused from bacteria, virus, allergens, or trauma. It usually presents as redness of one or both eye and a boggy conjunctiva. Bacterial conjunctivitis is usually differentiated by a purulent discharge. Viral and allergic conjunctivitis usually have a stringy discharge. Allergic conjunctivitis can be differentiated from viral by the presence of itching. Allergic conjunctivitis is not contagious and can be effectively treated with topical ophthalmic solutions that combine antihistamine and mast cell stabilizers.

A 35 y/o man came to clinic with recurrent headache for about 4 weeks. He reports it typically occurs at night with severe pain behind his right eye, it awakes him for 45 minutes to an hour. He also experiences lacrimation along with the headache. Based on his presentation, what diagnosis could the FNP suspect? A. Migraine without aura B. Increased ICP C. Tension-type headache D. Cluster headache

D Correct answer: D. Cluster headache. Cluster headache usually affects mid-age men with severe unilateral periorbital pain accompanied with nasal congestion, rhinorrhea, lacrimation. It lasts about 45 minutes to 3 hours typically occurs at night

A 30yom visits your office today after waking this am with severe bilateral eye pain and photophobia. He denies having eye pain upon going to bed. He states he is a welder at the local art studio. Physical exam with a slit lamp and 2 drops of ophthalmic anesthetic with sterile fluorescein reveals only dimple veiling to both corneas. What is the best course of treatment? A. Administer 2 drops of ophthalmic anesthetic to each eye once & prolonged saline solution irrigation B. Prescribe Tobramycin 0.3% 1-2 drops each eye Q4hrs & 2 drops of ophthalmic anesthetic to each eye PRN C. Prescribe ophthalmic anesthetic 2 drops to each eye Q4hr PRN & apply binocular patching D. Administer Cyclopentolate 1% 1-2 drops to each eye & apply binocular patching

D Cyclopentolate dilates the pupil and reduces ciliary spasming. Binocular patching allows for both eye rest. This can also be accomplished with use of cool clean wash cloth. Also educate the patient on importance of where eye protective gear. And in this patient's case always wearing his welding goggles or hood. Typical recovery is 24-48hrs. Ophthalmic anesthetic to be used while doing PE and administering fluorescein, but do not prescribe or send home with patient, 1st it can delay corneal healing and 2nd frequent use can impair the eye from knowing if a FB is in eye, thus causing possible increased damage with now an ulceration or abrasion (p. 208)

58 year old African American male presents to clinic for sore throat. He states his daughter is being treated for strep throat. He reports painful swallowing, loss of appetite, and fever but denies cough. Upon examination, the nurse practitioner notices a large area of leukoplakia on the lateral inferior surface of his tongue, which cannot be rubbed off. Which part of the patient's history is the least important to inquire about? A. Social history B. Last dental examination C. Sexual history D. Surgical history

D Leukoplakia is an alarming feature during an examination. Alcohol and tobacco use is a key risk factor for oral cancer. The last dental examination can guide the nurse practitioner to see if this area of concern has been present or biopsied in the past. HIV can be a factor in hairy oral leukoplakia due to the weakened immune system. Surgical history can be important if there was a biopsy, but that would be covered during the dental history.

A parent is bringing their 18-month-old child to the clinic today for follow up of recurrent otitis media. The child is also behind on their 12-month and 15-month vaccinations and screenings. Which of the following statements would represent the most effective advice to give the parent to help prevent Acute Otitis Media (AOM)? a. Your child should be scheduled for surgery to have tympanostomy tubes placed to prevent recurrent AOM. b. Try to find a day care that has many children in attendance so your child can be exposed to more diseases to build their immune system. c. Smoking is not a problem for AOM if you smoke outside the home. d. It is beneficial to bring your child in for routine screening and immunizations to help prevent disease such as Acute Otitis Media.

D Primary prevention is the goal. According to Hay et al. (2020), prevention of Acute Otitis Media consists of discouraging antibiotic use if not indicated, modifying certain lifestyle habits such as smoking, referral to surgery only if indicated, completing immunologic evaluation and allergy testing if the child has an atopic history, and immunization. The most effective advice to give this parent would in fact be to bring the child in for routine immunizations because according to Hay et al. (2020), the use of PCV13 vaccine has resulted in a decline of AOM in children younger than 2 years of age

The mother of a five-month-old baby boy expresses concerns about her baby developing dental caries. What advice should you give her to reduce the chances of developing dental caries in the infant? a. Her baby should be weaned from the bottle between 6 and 12 months of age b. Her baby should only drink from a bottle and no uncovered cups c. She should only offer milk for the baby to drink d. She should give only water in the bottle at bedtime

D Rationale: Water reduces the chances of developing dental caries. Soda, juice, and powdered beverages should be avoided because they can increase the risk of developing dental caries. Infants between 12 to 18 months should be weaned from the bottle as well as drink from an uncovered cup to reduce the chance of developing dental caries.

A 73-year-old patient presents for his annual exam. He tells you that he has been taking six extra strength acetaminophen tablets (500 mg each) every morning before sunrise and four extra strength acetaminophen tablets every evening after sunset for his chronic lower back pain since Ramadan started 2 weeks ago. The nurse practitioner will: A. praise the patient for managing his pain without the use of narcotics B. encourage the patient to continue this dosing regimen until the end of Ramadan but then resume dosing two extra strength tabs every 4 hours C. instruct the patient to stop the acetaminophen immediately and start Oxycontin 30 mg PO BID D. educate the patient that his maximum daily dosage of acetaminophen should not exceed 2 grams daily and that his current dosing regimen puts him at an elevated risk of liver failure

D The maximum daily recommended dose of acetaminophen is 4 grams daily for short term use, 3 grams daily for long term use, and only 2 grams daily for the elderly or those with liver disease. Nearly 50% of all acute liver failure cases in the US are due to acetaminophen overdose. Chronic alcohol use, bariatric surgery, type 2 diabetes, and fasting can all decrease the toxic dosage threshold of acetaminophen. Muslims observe Ramadan by fasting from sunrise to sunset during the ninth month of the Islamic calendar. Option A and B are incorrect due to acetaminophen overdose. Option C is incorrect because narcotics are not indicated, and the dosage is inappropriate.

A male patient comes into the office complaining of abrupt abdominal pain. He conveys the pain is constant and radiates across the upper abdomen around to his back. The pain is worse when walking and laying down. The pain is alleviated with sitting and leaning forward. Other symptoms include nausea/vomiting, weakness, and temperature of 101. The NP knows that this best describes. A. Acute gastroenteritis B. Cholecystitis C. Peptic ulcer disease D. Acute pancreatitis

D The patient presents with common symptoms of acute pancreatitis. Upon examination the patient is likely to present with sudden constant abdominal pain that does not subside, abdominal distention, absent bowel sounds, and abdominal tenderness with palpation. Other symptoms include weakness, clammy skin, fever, tachycardia and hypotension. Acute gastroenteritis presents with N/V, diarrhea, and cramping abdominal pain that is not severe and not localized to the epigastric region. Characteristics of pain associated with PUD include a burning, gnawing, hunger like pain that is not severe and is not changed by laying, sitting, or leaning forward. Characteristics of pain associated with cholecystitis includes sudden pain that is constant gradually subsiding over 12-18 hours. The pain is located in the epigastrium or right hypochondrium with rebound tenderness and muscle guarding.

A 7-year-old girl is brought to the clinic by her father for complaints of swelling under her right eye, cheek, and across the bridge of her nose. He reports that she has not felt well for the last three days. She reportedly spiked a fever of 101.7 yesterday, was sent home from school and treated with Tylenol x 1. This morning she does not have a fever but has facial swelling and will not eat or drink because her mouth hurts. She denies difficulty swallowing or breathing. Upon examination you note an upper abscessed back molar. What should your next step be? a. Immediately refer to the ER for IV antibiotics b. Immediately refer her to her dentist for treatment c. Tell her father he can go home and pull her tooth since it is a baby tooth and she does not need it d. Immediately start her on penicillin and schedule an appointment with her dentist 24 hours from now*

D When odontogenic infections are present, they may invade the facial spaces causing facial cellulitis. When an infection involves the midface including the bridge of the nose and lower eyelid a patient should be evaluated for an oral infection. Since the patient is not experiencing any difficulty in swallowing or breathing, first line treatment should be immediately starting antibiotics and referring to a dentist. Treating the infection prior to an extraction or other treatment allows the infection to properly drain. If the girl had presented with ongoing fever, lethargy, difficulty breathing or swallowing an ER referral for IV antibiotics would have been appropriate.

Mrs. Anderson is a 50-year-old patient that you are seeing with CKD III with a GFR of 51. She has not been to the practice in quite a while and does not follow any particular diet. Analysis of her labs might show which combination of mineral abnormalities? A. Hypercalcemia, Hyperphosphatemia, High Vitamin D B. Hypocalcemia, Hypophosphatemia, Low Vitamin D C. Hypercalcemia, Hypophosphatemia, High Vitamin D D. Hypocalcemia, Hyperphosphatemia, Low Vitamin D

D Within the body, phosphorous and calcium have an inverse relationship. With the destruction of kidney mass in CKD and lowering of GFR, phosphorous levels can increase, while calcium and vitamin D levels decrease. This can lead to Hyperparathyroidism and damage to the cardiovascular system. A diet restricting phosphorous can reduce phosphorous levels early on, but phosphorous binders may be a necessary addition

An 8-year old male presents with multiple flesh-flesh colored lesions that are shaped like a dome and have a waxy appearance. A diagnosis of Molloscum Contagiosum is made. The nurse practitioner knows that all of the following are treatments for this diagnosis EXCEPT: A. Allowing lesions to resolve spontaneously B. Liquid nitrogen C. Curettage D. Topical Mupirocin applied to affected area twice daily

D. : Answers A-C can all be treatments for Molloscum Contagiosum. Lesions usually resolve on their own within 13 months. Mupirocin ointment is used for bacterial infections and would not be effective against a viral lesion