SM quiz questions

What is the second line treatment for a patient who presents with mastitis? Doxycycline (Vibramycin) 250mg BID Azithromycin (Z-pak) 250mg BID Cephalexin (Keflex) 500mg QID Dicloxacillin (Dynapen) 500mg QID

Cephalexin (Keflex) 500mg QID

A middle aged female patient presents to the clinic and wants to discuss her family history of breast cancer. She reports that her mother died at the age of 51 from breast cancer and wants to know what her treatment options are if she develops breast cancer herself. Which of the following "If you develop breast cancer, the only option for you would be a mastectomy." "A lumpectomy with radiation therapy can be an option if the breast cancer is caught early." "We will continue your mammogram screenings and will only discuss options if there is a positive finding." "Given your family history, the best option for you would be systemic therapy with chemotherapy if a malignant tumor is detected."

"A lumpectomy with radiation therapy can be an option if the breast cancer is caught early."

An 18-year-old patient comes to the office wanting the human papillomavirus (HPV) vaccine. How should the nurse practitioner describe the vaccine schedule to this patient? "Because you are older than 15, you will need 3 doses of the vaccine over the next 6 months." "This is a two-dose series, so you will need to come back in the next 6 to 12 months to get your second dose." "You are too old to receive this vaccine." "This requires only one injection, so you will not need to come back if you get the vaccine today."

"Because you are older than 15, you will need 3 doses of the vaccine over the next 6 months."

A 45 year old patient was recently diagnosed with Meniere's Disease and would like more education on her treatment plan. Which of the following teaching statements is the most appropriate? "There is no definitive treatment but we can prescribe you medications that might help your symptoms." "There is no definitive treatment or therapy that will help alleviate your symptoms." "We will start you on antibiotics and prescribe them again during flare ups." "We will prescribe you medication to take long term that will prevent this disease from progressing to permanent hearing loss."

"There is no definitive treatment but we can prescribe you medications that might help your symptoms."

A young adult presents to the clinic for a follow up after being treated for a new diagnosis of gastroesophageal reflux disease (GERD) . At his last visit four weeks ago, the patient was prescribed Omeprazole (Prilosec). He reports great relief and is asking if he can continue to take this medicine everyday. Which of the following is the most appropriate response? "Omeprazole is safe for you to take everyday and you can continue to use it long term for relief of symptoms" "You can continue your Omeprazole for four more weeks. After that, we will have to discontinue the drug and refer you to gastroenterology if symptoms persist." "You need to stop the Omeprazole since it has been four weeks now. If you continue to have symptoms after stopping, we will refer you to gastroenterology." We will cut the dose of Omeprazole in half today and you can continue to take the medication long term."

"You can continue your Omeprazole for four more weeks. After that, we will have to discontinue the drug and refer you to gastroenterology if symptoms persist."

A woman comes in for her 35-week prenatal visit. Her urine dipstick is negative for glucose and protein, and she asks if any other testing will be done at today's visit. Which of the following is the most appropriate response? "No, if your first trimester testing was normal and blood pressure is normal, there are no additional tests to do for today's visit." "Yes, you will have your 2-hour oral glucose tolerance testing done at today's visit to assess for gestational diabetes." "You will have a vaginal introitus and rectum swab done today for Group B Streptococcus." "Yes, you will have your second RhoGam vaccine today since your blood type is A-."

"You will have a vaginal introitus and rectum swab done today for Group B Streptococcus."

A 25 year old female patient was previously seen for a routine pap smear, and received a result of atypical squamous cells of undetermined significance, "AS-CUS." How should the nurse practitioner explain this finding to the patient? "This is a very common finding in young adult women, and there is no need to follow up. We will see you again in three years for your next routine pap smear." "You will need to return to the office for HPV testing, just in case. This is an extra precautionary measure." "You will need to return to the office in approximately one year to have another pap smear completed." "This result indicates that you will need a procedure called a colposcopy. We will schedule this for you right away."

"You will need to return to the office for HPV testing, just in case. This is an extra precautionary measure."

A 27-year-old male patient comes into the office for a follow up on an STI screening after recent intercourse with a new partner. All tests are negative except the Nucleic acid amplification test (NAAT) which is positive for chlamydia. What would be the best treatment option for this patient? 500mg IM injection of ceftriaxone (Rocephin) and 1g oral azithromycin 250mg oral azithromycin once a day for 5 days 100mg oral augmentin twice a day for 7 days 100mg doxycycline twice a day for 7 days

100mg doxycycline twice a day for 7 days Chlamydial infections should be treated when detected to avoid longterm complications like pelvic inflammatory disease in females and sterility in males.Chlamydia is typically treated with 1g oral azithromycin, without co-treatment forgonorrhea. Another treatment option for chlamydia is 100mg doxycycline twice a day for7 days.

When considering combined oral contraceptives, which patient would be a candidate for this type of birth control? A 26-year-old who has a personal history of deep vein thrombosis (DVT) A 38-year-old who was recently diagnosed with breast cancer A 30-year-old who smokes ½ pack of cigarettes daily A 42-year-old who has a history with migraines with auras

A 30-year-old who smokes ½ pack of cigarettes daily

Which of the following patients would be the most appropriate to start on a SNRI (serotonin and norepinephrine reuptake inhibitor) for a new diagnosis of depression? A 45 year old male patient with uncontrolled hypertension A 15 year old female patient who is being treated for migraines with Imitrex (Sumatriptan) A 33 year old female patient who is being treated for fibromyalgia with Gabapentin (Neurontin) A 29 year old male patient who was recently also diagnosed with Hepatitis B

A 33 year old female patient who is being treated for fibromyalgia with Gabapentin (Neurontin)

Which of the following patients is the most appropriate to initiate a SGLT-2 inhibitor in for better glycemic control? A 54-year-old female patient with a history of multiple yeast infections A 62-year-old male patient with a history of alcoholism A 36-year-old male patient with a non-healing ulcer on his left foot A 40-year-old female patient with cardiovascular disease

A 40-year-old female patient with cardiovascular disease

Which of the following wounds would the nurse practitioner suture? A. A wound on the leg from a fall 20 hours ago B. A clean, deep wound on the arm 5 hours ago that you cannot visualize the bottom of, but has been x-rayed. C. A laceration on the cheek that the patient got 2 days ago D. A small wound on the hand from a dog bite 5 hours ago

A clean, deep wound on the arm 5 hours ago that you cannot visualize the bottom of, but has been x-rayed.

The nurse is reviewing results of a tuberculosis (TB) skin test which measured 7 mm. In which of the following populations would this result warrant intervention? Select all that apply by choosing five of the following answer choices. A woman living in a homeless shelter A woman undergoing chemotherapy A patient with HIV with a CD4 count of 180 A patient with HIV with a CD4 count of 450 A nurse whose roommate was just diagnosed with TB A man with renal failure

A woman undergoing chemotherapy A patient with HIV with a CD4 count of 180 A patient with HIV with a CD4 count of 450 A nurse whose roommate was just diagnosed with TB A man with renal failure

A patient who is HIV (human immunodeficiency virus) positive is seen in the office today to review his routine laboratory results. Upon reviewing the laboratory results with the patient, it is found that his CD4 count is down to 184 from 225. What education will you provide for this patient? Select all that apply by choosing three of the following answer choices. A. You may not receive live vaccines B. You will receive weekly antiretroviral therapy C. Get a monthly CD4 count drawn for measurement of treatment effectiveness D. Your diagnosis has progressed to AIDS E. You will be started on antibiotics prophylactically to prevent infection

A. You may not receive live vaccines D. Your diagnosis has progressed to AIDS E. You will be started on antibiotics prophylactically to prevent infection A CD4 count of less than 200 indicates the patient is severely immunocompromised and is the diagnostic criteria for AIDS (acquired immunodeficiency syndrome). Since this patient's CD4 count is newly below 200, he will need to be educated on his progressed diagnosis of AIDS. In addition, because he is severely immunocompromised he will be started on prophylactic antibiotics and is unable to receive live vaccines, both of which are new at this stage of the disease and topics he will need to be educated about. Antiretroviral therapy is started at a CD4 count of less than 350, which this patient was previously at. Treatment effectiveness will be evaluated by CD4 count lab draws every six months unless the patient is ill.

A 28 year old pregnant patient presents for a follow up on concerns over the development of a new possible hypertension. The nurse practitioner decides to collaborate with the patient's obstetrician for medication management. Which of the following medications would be inappropriate to prescribe to this patient? Lisinopril (Prinvil) Nifedipine (Procardia) Labetalol (Normodyne) Methyldopa (Aldomet)

Lisinopril (Prinvil)

Which of the following is false regarding the antiviral acyclovir (Zovirax)? Acyclovir (Zovirax) may lower the seizure threshold Acyclovir (Zovirax) commonly causes black, tarry stools Acyclovir (Zovirax) can lead to acute kidney injury and therefore we should check a baseline creatinine Acyclovir (Zovirax) can be given orally, topically, or parenterally

Acyclovir (Zovirax) commonly causes black, tarry stools

A 42 year old male with a past history of hypertension and diabetes is at the clinic today. He is currently managed with 2550mg metformin (Glucophage) per day and insulin glargine (Lantus) before bed. When reviewing his home blood sugar log, the nurse practitioner notices consistently high glucose levels every morning. When asked to check his blood sugar at 3 in the morning, his levels are consistently low. Which of the following treatment plans would be inappropriate? Decrease his insulin glargine (Lantus) dose before bed Instruct the patient to eat a snack before bedtime Tell the patient to not exercise right before bed unless he is compensating with a snack afterwards Add on a rapid acting insulin to take every morning

Add on a rapid acting insulin to take every morning

A 28-week pregnant mother brings her 2-year-old child in for a follow-up visit. The child recently had Varicella and has recovered. The mother had labs drawn to assess immunity to Varicella, but they came back non-immune. When would be the best time to give this pregnant mother her Varicella vaccine to protect both her, her child at home, and her fetus? After the baby is born After 32 weeks gestation At today's visit due to Varicella exposure It would not be appropriate as she has aged out of the Varicella series

After the baby is born Varicella is a live vaccine typically given to children at their 12 month and 4-6 year annual visits. Live vaccines are not safe to administer to pregnant women, so waiting until the baby has been born is the safest course of action.Pregnant women should always be reminded to screen any potential contacts for communicable diseases as they are at a higher risk of complications due to pregnancy.

The nurse practitioner is assessing a 51 year old female and notices her hands shaking slightly upon shaking hands initially, but it disappeared as she rested her hands in her lap. When asked about this she states that this happens frequently. What may help this condition? Levodopa (Dopar) Caffeine Carbidopa-Levodopa (Sinemet) combination Alcohol

Alcohol

A middle aged patient with recurrent bouts of gout states that he is frustrated that he keeps having exacerbations. Which of the following would it be important for the nurse practitioner to educate the patient about to hopefully prevent further attacks? Select all that apply by choosing three of the following answer choices. Alcohol cessation Increase intake of tuna, liver, and mackerel Increase intake of Vitamin D Decrease intake of sardines, bacon, and scallops Avoid use of diuretics

Alcohol cessation Decrease intake of sardines, bacon, and scallops Avoid use of diuretics Risk factors for gout include high purine foods, alcohol, obesity, and diuretics. High purine foods include most shellfish and seafood as well as liver. Increasing intake of Vitamin C has shown some efficacy in reducing gout attacks, not vitamin D.

A patient with a history of atrial fibrillation, hyperthyroidism, and diabetes comes into the office after visiting their cardiologist. They state they are on a new medication forrate control, but can not remember the name of the medication. Of the following medications, which is the least likely to be prescribed to this patient? Metoprolol (Lopressor) Digoxin (Digox) Amiodarone (Pancerone) Diltiazem (Tiazac)

Amiodarone (Pancerone) Patients who have a history of atrial fibrillation may be on a variety of medications, including some for rate control. Some of these medications may include beta blockers like metoprolol, calcium channel blockers like diltiazem, and digoxin. Amiodarone is used for rhythm control, but is contraindicated in patients with thyroid disorders.

A 34 year old African American patient with metabolic syndrome presents to the clinic today with a blood pressure of 141/85 mmHg. Which of the following medications would be the most appropriate medication to initiate for this patient? Lisinopril (Prinivil) Losartan (Cozaar) Metoprolol (Lopressor) Hydrochlorothiazide (Microzide) Amlodipine (Norvasc)

Amlodipine (Norvasc)

Which of the following is not a common medication used to treat a tuberculosis infection? Ethambutol (EMB) Pyrazinamide (PZA) Amodiaquine (AMQ) Rifampin (Rifadin) Isoniazid (INH)

Amodiaquine (AMQ)

A 29 year old female patient was recently diagnosed with hyperthyroidism. She is currently waiting for radioactive iodine treatment, which she has scheduled in two weeks. Which of the following would be the most appropriate medication to prescribe to her for symptom relief during this time? Synthroid (Levothyroxine) Tapazole (methimazole) Propylthiouracil (PTU) Atenolol (Tenormin)

Atenolol (Tenormin)

A 33 year old female patient was recently diagnosed with systemic lupus erythematosus (SLE), and is visiting the clinic today for guidance and education about her new diagnosis. Which of the following statements would be inappropriate to include in the teaching for this patient? A. "SLE may present with a variety of vague signs and symptoms. Therefore, we ask that you follow up anytime a new symptom pops up just in case." B. "SLE is characterized by its swift progression. There are no remissions and exacerbations, and instead symptoms gradually worsen over time." C. "SLE is known to potentially affect many other organ systems, and frequently damages the kidneys. We will monitor your renal function closely." D. "It is recommended for you to utilize sunscreen whenever spending time outdoors to avoid the potential for a SLE exacerbation."

B. "SLE is characterized by its swift progression. There are no remissions and exacerbations, and instead symptoms gradually worsen over time." Sun exposure is known to exacerbate SLE, and it is recommended that SLE patients utilize sunscreen to prevent an exacerbation from occurring. In addition, SLE is known to have various effects on the entire body, but often-times the kidneys. Lupus nephritis occurs in up to about half all of SLE patients. SLE is also characterized by the fact that it goes through remissions and exacerbations. Exacerbations commonly occur in response to factors such as emotional stress.

A patient who was recently diagnosed with Addison's disease is looking for more education about his new condition. Which of the following teaching statements would be incorrect? A. "Until this condition is under better control, it is common to have issues with electrolyte imbalances such as hyperkalemia and hyponatremia." B. "Your symptoms are related to an increase in a substance called cortisol in your blood." C. "If a potential Addisonian crisis goes untreated, it may lead to severe hypotension and organ failure." D. "It is always necessary to carry around your IM Hydrocortisone (Cortef) injection, just in case."

B. "Your symptoms are related to an increase in a substance called cortisol in your blood." Addison's disease is due to an adrenal insufficiency so the body is lacking critical adrenal hormones. It is imperative that the patient have an "emergency kit" of steroids prepared in case an Addisonian crisis were to occur. Addisonian crisis can lead to coma and death, so it is a serious matter that must be treated.

A 47 year male patient presents to the clinic who has a history of chronic obstructive pulmonary disease (COPD) and gout. His chief complaint today is a severe right-sided headache off and on throughout the last 3 days. You notice that he is restless from the pain and his right eye won't stop watering. Which of the following would be the best treatment plan for this patient? A. Recommend he go to the emergency room immediately for a CT scan B. Intranasal sumatriptan (Imitrex) to help lessen the symptoms and a prescription of verapamil (Verelan) for prophylaxis C. 100% oxygen via face mask as these findings are consistent with a cluster headache D. Ketoralac (Toradol) IM injection in the office and a prescription for extra strength acetaminophen to pick up tomorrow

B. Intranasal sumatriptan (Imitrex) to help lessen the symptoms and a prescription of verapamil (Verelan) for prophylaxis This patient is experiencing cluster headaches. While 100% oxygen via a face mask is the typical preferred treatment to improve the symptoms of a cluster headache, that is not our best option in a patient with COPD. Intranasal triptans, as well as intranasal lidocaine, ergotamine, and systemic steroids, can help break the cluster headache cycle. Calcium channel blockers like Verapamil can be used as prophylaxis for cluster headaches. While we may refer some patients with cluster headaches to the ER, this patient does not have an indication for a CT scan.

The nurse practitioner is seeing a 36-weeks-pregnant woman for a routine prenatal visit. It is noted in her chart that she tested positive for Group B Streptococcus at her last visit. The nurse practitioner also notes she has a mild penicillin allergy. She asks what the best plan will be for delivery of her fetus. Which is the most appropriate response? A. Delivering via cesarean section will be safest for the baby as Group B Streptococcus can be deadly B. Intrapartum IV clindamycin (Cleocin) can be administered and she can deliver safely vaginally C. She should be on prophylactic clindamycin (Cleocin) or erythromycin (EES) from now up until she delivers, and it is still safe to deliver vaginally D. Because her allergy to penicillin is mild and the risk to the fetus is so high, she should receive intrapartum IV penicillin G benzathine (Bicillin)

B. Intrapartum IV clindamycin (Cleocin) can be administered and she can deliver safely vaginally Group B Streptococcus is tested for between 35 and 37 weeks gestation. Although Group B Streptococcus is dangerous to a fetus, it is possible to deliver vaginally when IV penicillin is administered intrapartum. If a patient is allergic to penicillin, clindamycin or erythromycin may be used. CAMP

A 35 year old female patient presents to the clinic today with increasing "leg heaviness" bilaterally and a small amount of blood in her urine. Her past medical history includes generalized anxiety disorder as well as systemic lupus erythematosus (SLE). At her last visit three months ago, all of her labs were in normal limits at that time. Which of the following is the most appropriate plan of care for this patient? A. Refer the patient to nephrology as this patient is no longer suitable to be cared for in primary care as her SLE is progressing. B. Order a renal function panel on this patient as this may indicate the development of lupus nephritis. C. Educate the patient that these are normal findings with SLE as frequent complications are to be expected with this diagnosis. D. Refer the patient to the emergency department as this is likely an emergent complication of SLE known as catastrophic antiphospholipid syndrome.

B. Order a renal function panel on this patient as this may indicate the development of lupus nephritis.

Which of the following medication classes can be used for migraine prophylaxis? Calcium channel blockers Selective serotonin reuptake inhibitors (SSRIs) Beta blockers Triptans

Beta blockers

Quadruple therapy is used to treat H. pylori infections in areas where there is high antibiotic resistance. Which of the following medications is included as a part of this therapy? Azithromycin (Z-pak) Pepcid (Famotidine) Ciprofloxacin (Cipro) Bismuth subsalicylate (Pepto-Bismol)

Bismuth subsalicylate (Pepto-Bismol)

A 41 year old female patient was recently diagnosed with diabetes and has been taking metformin (Glucophage) for the last month. At today's visit, the patient states her friend with diabetes has started taking a daily Aspirin (Zorprin) and wonders if she should also be taking one. Which of the following statements is incorrect in regards to this patient's question? A. "Aspirin is typically prescribed to diabetic patients who are older than 50 and have at least one major risk factor for heart disease." B. "Aspirin can be used in diabetic patients who have a history of coronary artery disease, ischemic strokes or angina." C. "Aspirin is routinely prescribed to all diabetic patients once they are 60 years old as the cardiovascular risk increases two fold at that time." D. "Aspirin is no longer routinely prescribed to patients with diabetes unless they are at an increased risk of cardiovascular events."

C. "Aspirin is routinely prescribed to all diabetic patients once they are 60 years old as the cardiovascular risk increases two fold at that time." While Aspirin was once routinely prescribed to those with diabetes, this guidance changed by the American Diabetes Association in 2019. The current recommendation is that diabetic patients can receive Aspirin if they are at an increased cardiovascular risk, typically after the age of 50, as long as they receive education on the risks versus the benefits.

You are seeing a 31 year old patient who is 28 weeks pregnant for a routine check up. She reports doing well, however her routine urine screen came back positive for leukocytes and nitrites. What is the most appropriate plan for this patient? A. Do not initiate treatment day as she is asymptomatic. Advise that she monitor for signs and symptoms and call if she begins to experience any. B. Nitrofurantoin (Macrobid) C. Cephalexin (Keflex) D. Trimethoprim/Sulfamethoxazole (Bactrim)

C. Cephalexin (Keflex) CAMP

A 45 year old female returns to the clinic for a follow up on the clusters of erythematous, warm to the touch pustules. They are tender to palpation on her arm and her trunk. She declined oral antibiotics at the last visit and has been utilizing mupirocin (bactroban) without improvement. Which of the following would be the most appropriate medication for the nurse practitioner to prescribe today? Rifampin (Rifadin) Cephalexin (Keflex) Sulfamethoxazole-Trimethoprim (Bactrim) Clindamycin (Cleocin)

Cephalexin (Keflex) This patient is presenting with persistent folliculitis that has not responded to topical mupirocin (bactroban) treatment. Cephalexin (keflex) or penicillins can be utilized to treat severe cases of folliculitis, especially if the patient is not responding to mupirocin (bactroban).

A middle aged patient was recently diagnosed with a parathyroid adenoma, and subsequently had a parathyroidectomy performed. Due to this recent surgery, the nurse practitioner knows that this patient should now be taking which of the following supplements? Calcium Potassium Phosphorus Levothyroxine (Synthroid)

Calcium

Treatment and management of osteoarthritis can include all of the following except? Weight bearing exercise Calcium Supplements Smoking Cessation Glucosamine Supplements

Calcium Supplements

A 22 year old patient presents today with a well demarcated area of erythema with central clearing on the left cheek and ear. He also reports a mild headache and has a temperature of 100.4 F in the office today. What is the most appropriate treatment plan for this patient? Acyclovir (Zovirax) as this patient is presenting with shingles Metronidazole (Flagyl) as this patient is presenting with rosacea Trimethoprim/sulfamethoxazole (Bactrim) as this patient is presenting with cellulitis Cephalexin (Keflex) as this patient is presenting with erysipelas

Cephalexin (Keflex) as this patient is presenting with erysipelas This patient is presenting with erysipelas. Signs and symptoms of erysipelas may include fever, chills, headache, or malaise. The area affected will be well demarcated and may be raised or have a central clearing. Ear involvement is a common distinguishing symptom when deciding between cellulitis and erysipelas, as cellulitis involves the deeper dermis and the ear does not contain this type of tissue. Treatment options for erysipelas include cephalexin (Keflex) or Penicillin.

A middle aged patient who came in for elevated blood pressure 3 months ago presents today for a follow up. Despite lifestyle modifications, they have not been able to lower their blood pressure. The nurse practitioner decides to initiate a medication regimen. The patient has an ASCVD score of 8%. In addition, he has a past medical history of hospital admission due to hyperkalemia and 3rd degree heart block. Which of the following antihypertensives would be the most appropriate choice for this patient? Losartan (Cozaar) Lisinopril (Prinivil) Verapamil (Verelan) Chlorthalidone (Thalitone)

Chlorthalidone (Thalitone)

An adult patient has 2+ leukocytes, 2+ nitrites, and 2+ blood on a urinalysis. Due to this and their presenting symptoms of urinary frequency, pain with urination, and blood in their urine, the nurse practitioner decides that they likely have a urinary tract infection (UTI). Considering the patient is allergic to sulfas, which of the following treatments would be the most appropriate? Phenazopyridine (Pyridium) BID x 2 days Bactrim (sulfamethoxazole/trimethoprim) BID x 3 days Doxycycline (Vibramycin) BID x 7 days Treatment is not indicated until the results of the culture come back due to antibiotic resistance Ciprofloxacin (Cipro) BID x 3 days

Ciprofloxacin (Cipro) BID x 3 days

A patient comes in with atopic dermatitis on the underside of his chin. He states it isextremely itchy and the nurse practitioner notes some weeping erythematous skin on exam. Which of the following topical steroid options would be the least appropriate to prescribe to this patient? Cortizone 10 (Hydrocortisone 1%) Clobetasol (Temovate) Cortaid (Hydrocortisone <2%) Aclovate (Alclometasone dipropionate)

Clobetasol (Temovate) Knowing the basics of topical steroid treatment is important forpractice and the exam. The low potency steroids like low percentage hydrocortisoneand alclometasone dipropionate are suitable options for the face as they are Class 7 and 6 steroids, respectively. High potency steroids, like clobetasol, should never be used onthe face as they can cause skin sloughing.

A middle aged patient with a history of binge drinking presents with an erythematous and tender left knee joint. The nurse practitioner suspects a possible differential of gout. His past medical history includes taking Ibuprofen (Advil) daily for a recent wrist sprain that occurred two weeks ago. Which of the following would be the most appropriate medication for the nurse practitioner to prescribe? Indomethacin (Indocin) Colchicine (Colcrys) Naproxen (Aleve) Allopurinol (Aloprim) Prednisone (Deltasone)

Colchicine (Colcrys)

A 53-year-old patient presents with worsening symptoms of depression despite trying several different first line antidepressants. After discussing various options with the patient, you both come to the agreement that the best medication to begin at this time is amitriptyline (Elavil). What are some side effects that should be discussed with the patient prior to beginning this medication? Select all that apply by choosing three of the following answer choices. Insomnia Dry mouth Weight gain Delirium Diarrhea

Dry mouth Weight gain Delirium

Which of the following is the first line treatment option for ankylosing spondylitis? Acetaminophen (Tylenol) Non-steroidal anti inflammatory drugs (NSAIDs) Low dose corticosteroids Disease Modifying Antirheumatic Drugs (DMARDs)

Non-steroidal anti inflammatory drugs (NSAIDs)

A 20 year old female presents after she found out her partner tested positive for chlamydia recently. She is requesting a pap smear and STD testing at this visit. What should the nurse practitioner tell this patient? A. I am going to do a wet mount to assess for chlamydia and gonorrhea and we will talk about treatment based on those results B. Even though your gonorrhea is negative, I am going to prescribe you azithromycin (Zithromax) and give you an injection of ceftriaxone (Rocephin). C. I will treat you for the chlamydia and test for other STIs with your pap smear today D. We will test you for sexually transmitted infections at this visit and can treat the chlamydia with Doxycycline (Vibramycin)

D. We will test you for sexually transmitted infections at this visit and can treat the chlamydia with Doxycycline (Vibramycin)

A new mother is at the office for her 6 week postpartum visit and is desiring contraception. Which of the following would be preferred methods of birth control if the mother was breastfeeding? Select all that apply by choosing four of the answer choices. Depo-provera Emergency contraception Barrier methods The transdermal patch (Ortho Evra) The Copper-T Intrauterine Device (IUD) Progestin-only pill (mini-pill)

Depo-provera Barrier methods The Copper-T Intrauterine Device (IUD) Progestin-only pill (mini-pill)

A middle-aged female patient recently presented with headaches, palpitations and sweating for the last three months. After further evaluation, she was diagnosed with severe hyperthyroidism and given a referral to endocrinology for radioactive iodine treatment. Which of the following is not a risk of this treatment plan? Swollen salivary glands Bone marrow suppression Infertility Development of lung fibrosis

Development of lung fibrosis

All of the following are possible outpatient treatment options for community acquired pneumonia for patients with significant comorbidities except: Augmentin (Amoxicillin/Clavulanate) in combination with Azithromycin (Z-pak) Factive (Gemifloxacin) Levaquin (Levofloxacin) Doxycycline (Vibramycin)

Doxycycline (Vibramycin) Combination therapy (Augmentin in addition to a macrolide such as Azithromycin) or monotherapy (a respiratory fluoroquinolone) may be utilized. Doxycycline can be used as treatment for community acquired pneumonia, but is not a preferred treatment for those with comorbidities such as renal disease, heart disease, diabetes, etc.

A 29 year old female patient presents to the clinic today due to nausea and diarrhea after beginning Sertraline (Zoloft) 50 mg approximately two weeks ago. The patient denies fever, vomiting, and does not appear ill at today's visit. Physical exam is benign. Which of the following treatment plans would be appropriate based on this information? Educate the patient to increase their fiber intake over the next several weeks Discontinue the Sertraline (Zoloft) and initiate Paxil (Paroxetine) Order a comprehensive stool study for further evaluation Initiate Ondansetron (Zofran) until the symptoms resolve

Educate the patient to increase their fiber intake over the next several weeks

A patient presents to the clinic complaining of vague left upper quadrant pain, especially after he eats pizza, which he states he eats "about three times a week". He has been taking Tums, which have not seemed to help. What would be an appropriate treatment plan to help this patient with their discomfort? Refer the patient urgently to gastroenterology Educate the patient to stop eating fatty foods, increase hydration and follow up if symptoms do not improve Prescribe a histamine H2- receptor blocker like Famotidine (Pepcid) today Prescribe a proton pump inhibitor like Omeprazole (Prilosec) today

Educate the patient to stop eating fatty foods, increase hydration and follow up if symptoms do not improve

It is imperative to complete a thorough cardiac assessment and electrocardiogram (ECG) prior to prescribing which of the following antidepressant medications? Effexor (Venlafaxine) Phenelzine (Nardil) Elavil (Amitriptyline) Zoloft (Sertraline)

Elavil (Amitriptyline)

A 33 year old female patient presents to the clinic with increasing anxiety and difficulty sleeping. She states that she seems to "worry about everything all the time." Her physical exam is benign, as well as her lab results (CBC, TSH screening, CMP, urine pregnancy test.) Her past medical history includes occasionally uncontrolled hypertension as well as obesity. Which of the following medications would be most appropriate to prescribe to this patient for her symptoms? Escitalopram (Lexapro) Venlafaxine (Effexor) Paroxetine (Paxil) Fluoxetine (Prozac)

Escitalopram (Lexapro) Paxil would not be appropriate for this particular patient as it is frequently known to cause issues with additional weight gain. Prozac may be a potential option for this patient, but it is also known to make patients feel "jittery" so we can trial other medications first. Effexor would be inappropriate as it is known to increase issues with hypertension and she is only sometimes controlled. Therefore, Lexapro has the least side profile of the answer choices listed and would be a solid first option for this patient.

A 28-weeks pregnant patient was diagnosed with gestational diabetes at today's visit after completing her oral glucose tolerance test. She reports that she has a fear of needles and would hate to have to give herself insulin injections multiple times a day. Which of the following is true regarding the treatment of gestational diabetes (GDM)? After diagnosis of GDM, insulin must be started immediately for every patient First line treatment involves lifestyle modifications including healthy diet and frequent physical activity If glucose levels are not controlled with lifestyle modifications, Glipizide (Glucotrol) may be added to the patient's treatment regimen As long as the patient is following their individualized treatment plan, glucose levels may be checked every 2 to 3 days.

First line treatment involves lifestyle modifications including healthy diet and frequent physical activity

Which of the following diagnoses can potentially be treated appropriately with Amoxicillin (Amoxil)? Select all that apply by choosing two of the following answer choices. Group A Strep Throat Syphilis Viral pneumonia Acute otitis media Mastitis

Group A Strep Throat Acute otitis media

A 22-year-old male presents for a follow up after starting Retin-A 0.25% cream. He reports that he feels like he has fewer black heads but has seen an increase in pustules along his jawline. Which of the following would be the next step in his treatment? Increase the Retin-A dosage and follow up in 8 weeks. Instruct him to continue the Retin-A cream and start him on Accutane (Isotretinoin) Instruct him to continue the Retin-A cream and start him on Tetracycline (Sumycin) Instruct him to stop his Retin-A and start him on Doxycycline (Vibramycin)

Increase the Retin-A dosage and follow up in 8 weeks.

When educating a middle-aged patient about how to stay healthy, what suggestions could the nurse practitioner give to help reduce the patient's overall risk of kidney disease? Select all that apply by choosing two of the following answer choices. Initiate measures to lower their blood pressure that was 155/93 today Promote at least 150 minutes of physical activity per week Discuss smoking cessation due to the fact that he smokes 1 pack per day Implement ways to lower his glycosylated hemoglobin (HgbA1c) from 8.4% today Discuss dietary supplements to increase his hemoglobin that was 11.7 mg/dL today

Initiate measures to lower their blood pressure that was 155/93 today Implement ways to lower his glycosylated hemoglobin (HgbA1c) from 8.4% today

A 43 year old African American female with a history of asthma and osteoporosis presents for a follow up today due to a previous blood pressure of 131/92. At her last visit three months ago, you discussed diet modifications, exercise, and implemented a home blood pressure log. Her blood pressure log from the last four days reveals the following: 135/92, 136/86, 140/84, and 139/88. Her ASCVD risk today is 10.6%. What would be the most appropriate plan for this patient? Initiation of Chlorthalidone (Thalitone) Initiation of Lisinopril (Prinivil) Continue lifestyle modifications Initiation of Amlodipine (Norvasc)

Initiation of Chlorthalidone (Thalitone) At this visit, the most appropriate plan is medication initiation. Not only has this patient attempted three months of lifestyle interventions, but her ASCVD (atherosclerotic cardiovascular disease) risk is greater than 10% prompting the need for pharmacologic intervention. Since this patient is Afriacan American, we want to avoid ACE inhibitors (angiotensin-converting enzyme inhibitors) such as lisinopril (Prinivil) and utilize a thiazide diuretic or calcium channel blocker. To note, this patient has a history of osteoporosis making the thiazide diuretic the best option for her.

A patient with type 2 diabetes comes into your office for evaluation. She states she is on a rapid acting insulin sliding scale as well as a long acting insulin, but her glucose keeps spiking between lunch and dinner. Which insulin should you prescribe to stop this from happening? Insulin glargine (Lantus) Neutral protamine Hagedorn (NPH) Insulin aspart (Novolog) Insulin detemir (Levemir)

Insulin aspart (Novolog)

A 63 year old patient diagnosed with COPD has a CAT (COPD Assessment Test) score of 6 and has not had any severe exacerbations in the last year, placing them in treatment Group A. Which medications might this patient be on? Select all that apply by choosing two of the following answer choices. Cromolyn sodium (Gastrocom) Levoalbuterol (Xopenex) Theophylline (Theochron) Fomoterol (Perforomist) Budesonide (Pulmicort) ipatropium bromide and albuterol (Combivent)

Levoalbuterol (Xopenex) Fomoterol (Perforomist)

A 45 year old construction worker comes to the clinic today with a new lesion on his forearm. He is unsure when it appeared, but first noticed it 3 days ago. It has not worsened since then, but has also not improved, and he states it is very itchy. Upon further examination, you note a red, scaly, rough macule on the right forearm. What is the most appropriate plan for this patient? Tazarotene (Tazorac) 1% hydrocortisone cream Salicylic acid Liquid nitrogen cryotherapy

Liquid nitrogen cryotherapy

After initial testing, a 42-year-old female patient is diagnosed with a trichomoniasis infection. What is the treatment for this infection? Metronidazole (Flagyl) PO for both the patient and her partner Metronidazole (Flagyl) PO for the patient Ceftriaxone (Rocephin) IM for the patient Azithromycin (Zithromax) PO for both the patient and her partner

Metronidazole (Flagyl) PO for both the patient and her partner A trichomoniasis infection can be treated with an oral course of metronidazole (Flagyl). Trichomoniasis is a sexually transmitted infection (STI) so the patient's sexual partner should be treated as well. Ceftriaxone (Rocephin) is used to treat gonorrhea, and azithromycin (Zithromax) is used to treat chlamydia.

A 40-year-old female patient complains of recurring episodes where her fingers turn white, then blue, then sometimes red. She states these episodes are seemingly random in nature, and her fingers feel numb at the times of the color changes. What medication might be a good option for this patient? Naproxen Sodium (Anaprox DS) Metoprolol (Lopressor) Sumatriptan (Imitrex) Nifedipine (Adalat)

Nifedipine (Adalat) This patient is experiencing Raynaud's Phenomenon. The classic presentation of this is "American Flag" finger color changes, with numbness and tingling. Along with avoiding triggers such as cold exposure and caffeine, calcium channel blockers like Nifedipine (Aladat) can be used. Patients should avoid medications that vasoconstrict, such as Imitrex, as well as general vasodilators such as Metoprolol. Naproxen sodium has not been shown to help patients with Raynaud's.

A type 1 diabetic patient comes in for a follow-up visit. He has been stable on his medication regimen, but is worried because he is between jobs and will be without health insurance coverage for a few months. He asks if there are less expensive insulin options to get him through this time. Which of the following would be good options for this patient given his circumstance? Select all that apply by choosing two of the following answer choices. Insulin Lispro (Humalog) Insulin Aspart Novolin Regular (Regular) Insulin Detemir NPH

Novolin Regular (Regular) NPH The price of insulin continues to rise in the United States, so patients without insurance may not be able to afford it as readily. The least expensive types include Novolin Regular and NPH. There are often pharmacy-specific coupons that can also be used on insulin, so helping patients apply for and navigate these programs can be instrumental in them managing their diabetes.

Triple therapy for treatment of H. pylori may include which of the following drugs? Select all that apply by choosing four of the following answer choices. Omeprazole (Prilosec) Metronidazole (Flagyl) Pepcid (Famotidine) Amoxicillin (Amoxil) Clarithromycin (Biaxin)

Omeprazole (Prilosec) Metronidazole (Flagyl) Amoxicillin (Amoxil) Clarithromycin (Biaxin)

To confirm a diagnosis of enterobiasis, a patient was instructed to perform a test right upon awakening. They bring in a bagged piece of scotch tape to the office and the nurse practitioner documents a positive test. Which of the following treatments would be the most appropriate for this patient? Topical triamcinolone (Kenalog) 3-4 times a day as needed Permethrin (Nix) cream now and again in one week Oral metronidazole (Flagyl) for 7-10 days Oral mebendazole (Vermox) now and again in two weeks

Oral mebendazole (Vermox) now and again in two weeks A scotch tape test is the diagnostic test for enterobiasis, or pinworms. If positive, the patient should be treated with oral anthelmintics such as albendazole (Albenza) or Mebendazole (Vermox). There is also an over the counter treatment called Pyrantel Pamoate (Pin-X). Treatments for enterobiasis should be given as one dose initially and followed by a second dose in two weeks. Household members should be treated as well.

A construction worker stepped on a nail that went through his boot and into his foot this morning. He removed the nail and is not actively bleeding. The nail was fresh from anew box per him and his co-worker who drove him to the clinic. He has a tetanusbooster 6 years ago and is up to date with all his other health maintenance. Which of the following is the most appropriate plan of care for this patient? Order a TD only booster because the nail was not rusty Refer him to the emergency department for an immunoglobulin because it has been more than 5 years since his last TDaP Educate the patient that he does not need a TDaP booster because the nail was not rusty and it has not been 10 years since his last booster Order a TDap booster because it has been 6 years since his last one

Order a TDap booster because it has been 6 years since his last one The CDC recommends a TDaP booster every 5 years in those over 7 years old who have come into contact with a potentially contaminated object, even aclean nail. Any puncture wound is still a risk for Clostridium tetani, even if the object wasnot rusty. The DTap and DT boosters are not given to those older than 7 years old.

A patient who recently immigrated to the United States is at the clinic to get her purified protein derivative (PPD) test evaluated to gain employment clearance. The induration on her arm measures 12 mm and she is feeling well. What is the best next step by the nurse practitioner? Reassure the patient that this is a normal finding Repeat the purified protein derivative (PPD) Order a sputum culture Order a chest x-ray

Order a chest x-ray

A 39 year old female patient with a past medical history of multiple sclerosis was recently diagnosed with trigeminal neuralgia. Currently, she is trialing the use of Tegretol (carbamazepine) for this condition. Which of the following actions is the most appropriate in regards to this specific medication? Assess for hyperactive deep tendon reflexes due to potential for Tegretol toxicity Educate the patient that this drug often-times takes 8-12 weeks to see its full effect Order a renal function panel as Tegretol must be discontinued if the GFR <46 Order a routine CBC (complete blood count) at today's visit to monitor for possible agranulocytosis

Order a routine CBC (complete blood count) at today's visit to monitor for possible agranulocytosis

Chlamydia is one of the most common sexually transmitted diseases throughout the United States. In females specifically, if Chlamydia is left untreated, which of the following may occur? Select all that apply by choosing four of the following answer choices. Eye infections Pelvic Inflammatory Disease (PID) Ectopic Pregnancy Infertility Urethral strictures

Pelvic Inflammatory Disease (PID) Ectopic Pregnancy Infertility Urethral strictures

The nurse practitioner performs a Lachman test in the office that demonstrates an increase in range of motion. Based on this finding, all of the following are appropriate interventions except: Rest, ice, elevation, and compression Referral to orthopedics Perform range of motion exercises to prevent locking of the knee joint Physical therapy

Perform range of motion exercises to prevent locking of the knee joint

A patient is very concerned about their recent diagnosis of polycythemia vera. The nurse practitioner decides to provide some further anticipatory guidance for this patient. Which of the following would be inappropriate to educate this patient about? Further care is handled oftentimes by hematology or oncology, and they may prescribe Hydroxyurea (Hydrea). Phlebotomy is often initiated until the hematocrit is less than 35%. There is no cure, but there are several avenues available for symptom management such as Aspirin. Continued treatment is necessary throughout the rest of the patient's lifespan.

Phlebotomy is often initiated until the hematocrit is less than 35%.

A patient presents for his annual check up today. While reviewing the past medical history, the nurse practitioner sees that the patient had a biopsy of the temporal artery performed 6 months ago which was positive. What medication, if any, do you anticipate this patient being on? The nurse practitioner does not expect the patient to still be on any new medications Sumatriptan (Imitrex) Atenolol (Tenormin) Prednisone (Deltasone)

Prednisone (Deltasone) This patient has a history of a positive temporal artery biopsy which is associated with temporal arteritis (giant cell arteritis). A positive temporal artery biopsy often shows inflammation and giant cells present in the sample. Temporal arteritis is treated by placing the patient on high dose, long term steroids. Often they are on prednisone for at least a couple years to prevent reoccurance.

A 56 year old male patient presents to the office today for a cough that has been present ever since he came back from a business trip to Europe. A chest x-ray is ordered in the office and there are several small areas of consolidation noted in the left upper lobe of his lung. Which of the following would be an inappropriate action? Collect any potential sputum for culturing Advise him to isolate away from his family Prescribe him Levaquin (levofloxacin) today Notify the Department of Public Health

Prescribe him Levaquin (levofloxacin) today

A healthcare worker accidentally receives a needle stick from an HIV-unknown status patient. She is immediately seen in the emergency room for screening and prophylactic care. What would be the most appropriate course of action with regards to potential HIV exposure? Prescribe pre-exposure prophylaxis (PrEP) immediately as it has a higher rate of prevention when the HIV exposure is unknown Prescribe post exposure prophylaxis (PEP) immediately Only prescribe post-exposure prophylaxis if the needle was determined to break into her epidermal layer, where HIV can be transmitted Wait for the rapid HIV testing to come back on her patient before initiating any potential post exposure prophylaxis

Prescribe post exposure prophylaxis (PEP) immediately

A 16 year old male presents with a left ankle sprain after sustaining a fall. He states that he rolled his ankle as he fell during soccer practice. The patient is unable to bear any weight on the ankle. Which of the following is the most appropriate action by the nurse practitioner? Instruct the patient to rest, ice, compress, and elevate the ankle. In addition, educate about utilizing NSAIDs as needed as this is likely a grade II sprain Refer the patient to an orthopedic specialist as this is likely a grade III sprain Educate the patient to compress the ankle and tell the patient that it should get better on it's own with rest as this is likely a grade I sprain Refer the patient to the emergency department as you are worried about a grade IV sprain

Refer the patient to an orthopedic specialist as this is likely a grade III sprain

The nurse practitioner is reviewing the imaging and lab results of a patient with suspected rheumatoid arthritis. Her sedimentation rate is elevated and her rheumatoid factor is positive. What is the next step in her treatment? Refer the patient to rheumatology Refer the patient to orthopedics for a steroid joint injection Start the patient on Naproxen (Aleve) 500mg every 12 hours Start the patient on a Disease-Modifying Antirheumatic Drug (DMARD) such as Methotrexate (Trexall)

Refer the patient to rheumatology Early referral is important in the diagnosis of rheumatoid arthritis. The goal for these patients is to reduce the overall amount of joint damage by providing early, aggressive treatment. Primary care may prescribe patients medications to aid in pain relief, but it is imperative to refer for further treatment.

A 45 year old female presents to the clinic. As the provider assesses the eyes, it is noted that there are bilateral white reflexes. The patient also has slightly decreased visual acuity. Which of the following is the best plan of care for this patient? Perform the snellen chart Prescribe antibiotic eye drops and request that the patient follows up in approximately one week Refer to the emergency department for retinal detachment Refer to ophthalmology for potential lens surgery

Refer to ophthalmology for potential lens surgery An adult patient with bilateral leukocoria should be assessed for cataracts. The question states visual acuity was already assessed. Cataracts lead to cloudy or foggy vision and decreased visual acuity. These patients should be referred to ophthalmology for treatment which is typically done through lens surgery.

A 32-year-old female presents to the office following a motor vehicle accident. She reports that immediately after the accident she went to the hospital where they completed x-rays of her left wrist/spine and sent her home with a prescription for Flexeril (cyclobenzaprine). The nurse practitioner reviews the hospital imaging of the left wrist which is negative for fractures. However, the patient continues to complain of 7/10 pain in the left wrist and cannot make a tight fist. Which of the following is the most appropriate plan of care for this patient? Advise the patient that the pain/swelling is normal and should resolve in the next 1-2 weeks. Prescribe the patient Ibuprofen (Advil) 600mg every 8 hours for pain and instruct the patient to wear a wrist brace during the day Repeat the x-ray of the left wrist and prescribe Ibuprofen (Advil) 600mg every 8 hours for pain. Refer to orthopedics due to continued pain despite icing and rest

Repeat the x-ray of the left wrist and prescribe Ibuprofen (Advil) 600mg every 8 hours for pain.

The nurse practitioner is trying to determine the best medication option for a patient who has been experiencing flashbacks, increasing anxiety, and increasing aggression. The patient has never taken medication before to help with her condition. Which of the following medications would be the most appropriate to initiate in a patient with this diagnosis? Paroxetine (Paxil) 50mg Sertraline (Zoloft) 25mg Phenelzine (Nardil) 15mg Citalopram (Celexa) 40mg

Sertraline (Zoloft) 25mg

A woman at 18 weeks gestation obtains a urine sample as part of a routine prenatal visit. She denies any pain or burning with urination, but there are positive leukocytes and nitrites present on the urinalysis. Which of the following is true regarding treatment? She should be sent to the hospital for treatment as there is concern for pyelonephritis She should get a 3 day course of Ciprofloxacin (Cipro) for her urinary tract infection Since she does not have any active symptoms, she does not require treatment. She can be treated with Amoxicillin (Amoxil) for her urinary tract infection

She can be treated with Amoxicillin (Amoxil) for her urinary tract infection

A 32 year old female patient comes to the clinic to discuss birth control options. Which item in the patient's history would warrant further investigation prior to prescribing Lo-Loestrin Fe (ethinyl estradiol/norethindrone acetate/ferrous fumarate) for this patient? A family history of breast cancer on her father's side She currently smokes a half pack of cigarettes daily Her current BMI is 35 She recently gave birth 3 months ago

She recently gave birth 3 months ago Women who have recently given birth and are currently breastfeeding should not be given combined oral contraceptives because the estrogen can negatively impact the milk supply. Therefore, the nurse practitioner should investigate further to see if the patient is currently breastfeeding. As long as the patient does not have a current personal history of breast cancer, she should be able to take this medication without caution. Given the patient's age of <35, smoking a half pack per day of cigarettes should not impact the nurse practitioner's decision. Patients with a high body mass index are eligible to take combined oral contraceptives without caution.

A 25-year-old patient comes in complaining of unilateral testicular pain. Upon examination, his scrotum is swollen and hot, and there is relief of pain when elevating the testicle. Which of the following would be the best treatment plan for this patient? Refer to a urologist Start a course of ciprofloxacin (cipro) Start a course of doxycycline (vibramycin) Refer to the ED immediately

Start a course of doxycycline (vibramycin) This is a classic case of epididymitis. The key findings here are the positive Phren's sign and the unilateral, swollen scrotum. For patients under 35,doxycycline is the drug of choice. For patients over 35, we choose ciprofloxacin.

A 68-year-old patient comes in for a follow- up from their annual physical. They had blood work completed, and the following results were noted: Total Cholesterol 250mg/dL, LDL 200mg/dL,, HDL 30mg/dL, Triglycerides 210mg/dL. The patient tells the nurse practitioner he was also recently diagnosed with type 2 diabetes, which he states has been under control. What would be the best treatment plan for this patient? Start atorvastatin (Lipitor) 20 mg/d Initiate lifestyle interventions and encourage the patient to continue to follow up with endocrinology for his diabetes Start simvastatin (Zocor) 10 mg/d Start rosuvastatin (Crestor) 20 mg/d

Start rosuvastatin (Crestor) 20 mg/d

After a chest x-ray, the provider diagnoses a patient with a latent tuberculosis (TB) infection. Which of the following plans would be appropriate for this patient? Educate this patient that they are likely contagious Start this patient on antibiotic therapy Educate the patient to follow up if any symptoms develop Order sputum culture for acid-fast bacilli (AFB)

Start this patient on antibiotic therapy

Which of the following conditions is not able to be potentially treated with the use of Ciprofloxacin (Cipro)? Streptococcus pneumoniae Typhoid fever Genital gonorrhea Cutaneous anthrax

Streptococcus pneumoniae It is preferred that those with a streptococcus pneumoniae infection are treated with a respiratory fluoroquinolone such as Levaquin (levofloxacin). Ciprofloxacin is not considered to be a respiratory fluoroquinolone. As a whole, Ciprofloxacin can be used to treat a wide variety of issues including anthrax, prostatitis, gonorrhea, typhoid fever, salmonella, urinary tract infections, etc.

A patient is requesting treatment for her erythematous facial rash. You note dryness, redness, and a few pimples on her nose and cheekbones, with a few lesions on her nasolabial creases. Which of the following is true regarding treatment of this condition? Select all that apply by choosing three of the following answer choices. Sun protection is an important part of treatment Topical metronidazole (Flagyl) gel is a possible treatment Topical steroids are a mainstay of treatment for flares The patient should be referred to rheumatology The patient should avoid triggers

Sun protection is an important part of treatment Topical metronidazole (Flagyl) gel is a possible treatment The patient should avoid triggers

Which of the following is the preferred treatment option in those with Cushing's disease? Surgical removal of the tumor Medical management with steroids Life-long insulin injections Radiation therapy

Surgical removal of the tumor

After reviewing magnetic resonance imaging (MRI) results revealing a partial rotator cuff tear, the nurse practitioner discusses all of the following treatment options with the patient except: Physical therapy Surgical repair Meloxicam Corticosteroid injections

Surgical repair

A provider has diagnosed a patient with a history significant for falls with benign prostatic hyperplasia. Which medication should the provider prescribe? Alendronate (Fosamax) Tadalafil (Cialis) Terazosin (Hyrtin) Finasteride (Proscar)

Terazosin (Hyrtin)

A 22-year-old-female returns for a follow up after trying Retin-A 0.25% cream and Tetracycline (Sumycin). Unfortunately, she reports her pustules have continued and you notice mild scarring on her chest related to the acne. The nurse practitioner considers a referral to dermatology for Accutane (Isotretinoin). Which of the following is true regarding this drug? Select all that apply by choosing two of the following answer choices. The patient must be continuously monitored for depression and suicide The patient must be on two forms of contraception with monthly pregnancy tests while taking this drug The provider can only prescribe three months of Accutane at one time. The patient can continue her Retin-A and Tetracycline in addition to this medication Any provider can prescribe this medication.

The patient must be continuously monitored for depression and suicide The patient must be on two forms of contraception with monthly pregnancy tests while taking this drug

A 27 year old patient presents to the clinic complaining of worsening nasal congestion after being diagnosed with sinusitis 3 weeks ago. Since finishing his antibiotic he feels much better overall, but everytime he stops using his oxymetazoline (Afrin) nasal decongestant spray, his sinus congestion gets worse. He is requesting another course of antibiotics to help get rid of this sinus infection. What should the provider educate this patient about? Select all that apply by choosing three of the following answer choices. Systemic decongestants are not recommended This patient should avoid going to work as he works around young children The patient needs to take the entire second course of Augmentin. The patient should be educated to slowly stop the nasal decongestant A short course of oral corticosteroids may be indicated The patient can start saline irrigation and fluticasone (Flonase) spray to help

The patient should be educated to slowly stop the nasal decongestant A short course of oral corticosteroids may be indicated The patient can start saline irrigation and fluticasone (Flonase) spray to help

A 19 year old female patient presents with worsening migraines over the last two months. She has tried preventative Metoprolol (Lopressor) in the past without success and is now looking for an alternative treatment. Her past medical history is significant for bulimia recovery as well as major depressive disorder. Which of the following preventative migraine treatments would be the least appropriate to prescribe to this patient? Topiramate (Topamax) Sumatriptan (Imitrex) Amitriptyline (Elavil) Rizatriptan (Maxalt)

Topiramate (Topamax)

When discussing sexually transmitted infection (STI) treatment with a patient, they ask if sexual partners always need to be treated as well. Which of the following require that the partner also receive treatment? Select all that apply by choosing three of the following answer choices. Bacterial Vaginosis Trichomoniasis Herpes simplex virus (HSV) Gonorrhea Chlamydia

Trichomoniasis Gonorrhea Chlamydia

A patient presents after being raped the night before. The nurse practitioner can anticipate which of the following labs will be ordered after evaluation by the sexual assault nurse examiner? Select all that apply by choosing five of the answer choices. Urine sample for chlamydia and gonorrhea testing Blood work for hepatitis B and HIV A drug screen CBC and CMP Swabs collected from the genitals and other pertinent body areas Urine pregnancy test

Urine sample for chlamydia and gonorrhea testing Blood work for hepatitis B and HIV A drug screen Swabs collected from the genitals and other pertinent body areas Urine pregnancy test

A 25 year old female patient presents to the clinic with complaints of intense nail pain on her right fourth finger. She states that it began swelling approximately three days ago, and has become increasingly painful ever since. The nurse practitioner diagnoses the patient with paronychia. Which of the following is the most appropriate treatment? Augmentin (amoxicillin/clavulanate) Warm compresses, antibiotics are not necessary at this time Clindamycin (Cleocin) Doxycycline (Vibramycin)

Warm compresses, antibiotics are not necessary at this time In mild cases of paronychia, warm compresses are appropriate as they will typically eventually release the infection under the skin. This infection usually affects the sides of the nail as well as the cuticle. Antibiotics as well as incision/drainage can be utilized if the warm compresses are unsuccessful or if it worsens in severity.

A patient presents with joint pain and stiffness, especially when she first wakes up in the morning. You notice nodes on both the proximal and distal interphalangeal joints on her hand. The patient is wondering how to improve her symptoms. Which of the following plans will help her the most? Corticosteroids Disease-modifying antirheumatic drugs (DMARDS) such as methotrexate (Trexall) Weight management with low impact exercise Referral to rheumatology

Weight management with low impact exercise

A 23 year old female patient presents to the clinic for continued issues with depression. She has been taking escitalopram (Lexapro) for the last six months with only marginal relief of symptoms. Her past medical history includes migraines with aura in addition to well controlled tonic-clonic seizures. Which of the following medication options for depression would be the least appropriate to prescribe for this patient in replacement of her current medication? Citalopram (Celexa) Venlafaxine (Effexor) Wellbutrin (Bupropion) Sertraline (Zoloft)

Wellbutrin (Bupropion) Wellbutrin would be the least appropriate option for this patient due to her past medical history of tonic-clonic seizures. This medication increases the likelihood of seizures and therefore is contraindicated in these patients.

The nurse practitioner is reviewing the pap-smear results for a 30-year old patient. The report notes that there are atypical squamous cells of undetermined significance with positive HPV. What is the best plan of action for this patient? A. Refer for loop electrosurgical excision procedure B. Reflex HPV (human papillomavirus) DNA testing; repeat in 1 year if not positive for HPV types 16 or 18 C. Refer for colposcopy D. Reflex HPV DNA testing; refer for colposcopy if positive for HPV (human papillomavirus) types 16 or 18

When cytology results come back as atypical squamous cells ofundetermined significance and the patient is 30 years of age or older, it is recommendedto have co-testing for HPV done. This is insurance dependant if we test for it at thesame time as the initial pap-smear, or if it is to be done if the results come backabnormal. If the HPV is positive, referring for colposcopy is appropriate due to the lowerHPV clearance rate in women 30 and older. C. Refer for colposcopy

Your 55-year-old female patient comes in for her annual physical. She is up to date with all immunizations and health prevention, and had a colonoscopy at age 50, which wasnormal. She asks what else she can be doing to screen for colorectal cancer, eventhough her family history is negative. What do you respond with? A colonoscopy every 10 years is sufficient due to the negative family history and a normal colonoscopy at age 50 Since it has been 5 years since her last colonoscopy, she should get another to screen for colorectal cancer Yearly fecal occult blood tests can be used to further screen for colorectal cancer An abdominal CT scan every 5 years is suggested to screen for colorectal cancer in patients with normal colonoscopies

Yearly fecal occult blood tests can be used to further screen for colorectal cancer

A female who is 28 weeks pregnant presents today for her prenatal check up. She is asking if she needs the Tdap vaccine today as she received it a year and a half ago during her last pregnancy. What is the most appropriate response by the nurse practitioner? No, since you have had it within the last 10 years you do not need a booster today Yes, it is recommended to protect your newborn from getting pertussis because baby cannot get vaccinated right away No, since you have had it within the last 5 years you do not need a booster today Yes, it is recommended to protect you as pertussis can cause preterm labor and birth complications

Yes, it is recommended to protect your newborn from getting pertussis because baby cannot get vaccinated right away

A pregnant patient is interested in getting the Copper-T intrauterine device (IUD) for contraception after delivery and would like to learn more information about this method. Which of the following statements is appropriate to tell the patient? Once it is placed, you do not have to do anything for 10 years or until you want it taken out. The Copper-T IUD is slightly more effective than the non-hormonal IUD option. This is not a preferred method of contraception if you are breastfeeding You can have this placed within the first 48 hours after birth The Copper-T IUD is effective for 3-5 years and fertility resumes immediately if removed

You can have this placed within the first 48 hours after birth