APEA

Question 1

A 37-year-old patient has a negative rubella titer. How long after immunization should the patient avoid pregnancy?

Answer 1

28 days

Question 2

The diagnostic criteria for Type 2 diabetes mellitus does NOT include:
* A - a serum glucose of 140 mg/dL or greater after a 2-hour oral glucose tolerance test with 75 g of glucose.
* B - a hemoglobin A1C of >6.5%.
* * c - consecutive fasting glucose levels of 126 mg/dL or greater.
* D - a random serum glucose >200 mg/d plus symptoms of hyperglycemia.

Answer 2

-consecutive fasting glucose levels of 126 mg/dL or greater.

Question 3

The developmental theory that proposes that personality development occurs through the mastery of certain tasks and the ability to handle psychological conflict
* A - Bowlby’s Attachment Theory.
* B - Erikson’s Theory of Psychosocial Development.
* C - Freud’s Psychosexual Development Theory.
* D - Piaget’s Cognitive Developmental Theory.

Answer 3

Erikson’s Theory of Psychosocial Development.

Question 4

A frequent cause of death in patients with anorexia nervosa is:
A - starvation.
B - suicide.
C - sepsis.
* D - renal failure.

Answer 4

Suicide

Question 5

A frail 82-year-old patient is diagnosed with community-acquired pneumonia. The patient is allergic to fluoroquinolones, so the nurse practitioner should prescribe:
* A - azithromycin (Zithromax) 500 mg daily x 5 days.
* B - levofloxacin (Levaquin) 750 mg daily x 7 days.
* c - amoxicillin-clavulanate (Augmentin) 2,000 mg BID x 5 days and azithromycin (Zithromax) dose pack.
* D - cefpodoxime (Vantin) 400 mg po BID and levofloxacin (Levaquin)
750 mg daily x 7 days.

Answer 5

A - azithromycin (Zithromax) 500 mg daily x 5 days.

Question 6

A most significant barrier to the diagnosis and appropriate management of depression in the older adult population is:
* A - the belief that depression is inherent to the aging process.
* B - the serious side effects associated with antidepressant medications.
* c - the risk of drug-drug interactions due to polypharmacy.
* D - poor patient adherence as a result of cognitive impairment.

Answer 6

the belief that depression is inherent to the aging process.

Question 7

A lesion that typically begins as a tiny vesicle or pustule, then ruptures and progresses to a honey-colored crusty lesion with an erythematous base, is most likely:

A - varicella.
B - herpes simplex.
C - impetigo.
* D - herpes zoster.

Answer 7

impetigo

Question 8

A patient with hepatic cirrhosis presents with pedal edema. The patient reports that their partner prepares all meals. A typical day of food consists of: oatmeal and half a small apple for breakfast; a ham-and-cheese sandwich with baked chips and sweetened ice tea for lunch; and a bowl of fresh vegetable soup followed by fresh fruit for dinner. The patient states that they do not salt to their food. The food that is most likely causing the edema is the:
* A - sweetened tea.
B - ham and cheese.
* C - fresh vegetable soup.
*.
D - oatmeal.

Answer 8

ham and cheese

Question 9

The nurse practitioner correctly teaches a patient with B12 deficiency that food sources of B12 include:
* A - fish and cheese.
B - green leafy vegetables.
C - whole grain breads and cereals.
* D - fresh fruits.

Answer 9

Fish and cheese

Question 10

Which of the following is NOT a common symptom of carpal tunnel syndrome?
* A - Nocturnal paresthesia
* B - Weakness in the affected hand
* C - Feelings of tightness or swelling
* D - Numbness in the last two fingers

Answer 10

Numbness in the last two fingers (ring finger and pinky)

Question 11

The assignment of a diagnosis to a patient utilizing the International Classification of Diseases (ICD) codes involves a variety of measures, but does NOT include:
* A - tracking of healthcare statistics and disease burden.
* B - measures of quality outcomes.
*O C - establishing reimbursement and payment rates.
* D - tracking of morbidity and mortality statistics.

Answer 11

• establishing reimbursement and payment rates.

Question 12

To differentiate testicular torsion from epididymitis, the nurse practitioner should
A - a urinalysis.
B - Doppler ultrasound.
* C - a urine Gram stain.
* D - a CT scan.

Answer 12

doppler US

Question 13

A sexually active patient reports vaginal discharge. The cardinal presenting symptom of pelvic inflammatory disease is:
* A - dysuria.
* B - low back pain.
* c - abnormal uterine bleeding.
D - lower abdominal pain.

Answer 13

Lower abdominal pain.

Question 14

A patient with type 2 diabetes mellitus is 22 weeks pregnant and presents with symptoms of vaginal candidiasis. The most appropriate treatment for this patient is to:
A - increase the patient’s subcutaneous insulin.
* B - prescribe oral fluconazole (Diflucan).
* C - prescribe topical miconazole (Monistat) vaginal.
D - advise the patient to purchase hydrocortisone cream to help with itching.

Answer 14

monistat

Question 15

A 65-year-old patient presents with a past medical history of coronary artery disease, temperature 101° F (38.3 degree C), tachypnea (24 breaths per minute), and consolidation in the left lower lobe. A chest X-ray confirms left lower lobe pneumonia. What antimicrobial agents) should the nurse practitioner prescribe?
A - Amoxicillin clavulanate (Augmentin)
B - Levofloxacin (Levaquin)
C - Clarithromycin (Biaxin)
* D - Azithromycin (Zithromax)

Answer 15

B - Levofloxacin (Levaquin)

Question 16

As an alternative to an oral antihistamine for the treatment of allergic rhinitis, the FDA has approved one of the leukotriene receptor antagonists. This medication is:
* A - salmeterol (Serevent).
* B - montelukast (Singulair).
* C - albuterol (Ventolin HFA).
* D - levalbuterol (Xopenex HFA).

Answer 16

• B - montelukast (Singulair).

Question 17

A 28-year-old nonpregnant patient has regular menstrual cycles with 5-6 days of blood flow, but also experiences mild, spotty intermenstrual bleeding. What should be included in the differential diagnosis?
* A - Adenomyosis
* B - Ovulatory dysfunction
* c - Polycystic ovarian syndrome
* D - Endometrial polyp

Answer 17

Ovulatory dysfunction

Question 18

The most accurate measure of diabetes control is:
* A - the absence of micro- and macrovascular complications.
* B - serial fasting and periodic postprandial capillary blood sugars.
C - early morning glucose levels.
* D - glycosylated hemoglobin.

Answer 18

glycosylated hemoglobin.

Question 19

In the United States, occupational licensure is a responsibility of:
A - the states.
B - state and local governments, cooperatively.
C - the federal government.
* D - national professional organizations.

Answer 19

state and local governments, cooperatively.

Question 20

A 35-year-old patient who has a history of injection drug abuse is diagnosed with herpes zoster. Which of the following diagnostic tests should the nurse practitioner now consider?
A - Varicella titer
O B - CD4 count
* C - ELISA for HIV
* D - Polymerase chain reaction (PCR) for HSV

Answer 20

• Polymerase chain reaction (PCR) for HSV

Question 21

In a 75-year-old patient, which one of the following presentations would be inappropriately managed in an outpatient setting i.e., the patient should be referred for hospital admission)?
A - Forgetfulness
B - Unstable angina
C - Syncopal episode
D - Carotid bruit

Answer 21

unstable angina

Question 22

The principal goal of treatment in Kawasaki disease is to prevent coronary artery disease. Therefore, the mainstay of treatment is to initially administer:
* A - high-dose corticosteroids and aspirin.
* B - intravenous immunoglobulin (IVIG) and aspirin.
* c - intravenous immunoglobin (IVIG), aspirin, and high-dose corticosteroids.
* D - intravenous immunoglobin (IVIG) and high-dose corticosteroids.

Answer 22

intravenous immunoglobulin (IVIG) and aspirin.

Question 23

Which of the following findings is MOST consistent with otitis externa?
* A - Purulent drainage and fever
* B - Posterior cervical lymphadenopathy
* C - Middle ear effusion
* D - Tragal pain and hearing loss

Answer 23

Tragal pain and hearing loss

Question 24

Education of patients with fibrocystic breast disease should include which of the following statements?
* A - Fibrocystic breast disease is often a precursor to breast cancer.
* B - Annual mammography is recommended beginning at age 40.
* C - Caffeine may trigger breast pain.
* D - Oral contraceptives are not useful in the treatment of this disease.

Answer 24

Caffeine may trigger breast pain.

Question 25

Which of the following is a human papillomavirus-related risk factor for developing invasive cervical cancer?
* A - Cigarette smoking
* B - Early onset of sexual intercourse
* C - Long-term oral contraceptive use
* D - Low socioeconomic status

Answer 25

Early onset of sexual intercourse

Question 26

Following the finding of prostate gland abnormalities on digital rectal exam, the nurse practitioner orders a prostate-specific antigen. When educating the patient, which statement about PSA levels is NOT true?
* A - A PSA is considered within normal limits if it is 4 ng/mL or less.
* B - A PSA is always elevated in the presence of malignant prostate epithelium.
* C - A PSA may be elevated in the presence of BPH.
* D - A PSA may be elevated, and require repeating, if the patient ejaculated 24 hours before the initial draw.

Answer 26

A PSA is always elevated in the presence of malignant prostate epithelium.

Question 27

During a routine pre-employment screen, a patient is noted to have a positive hepatitis B surface antigen. This finding indicates that the patient:
* A - has been immunized against hepatitis B.
* B - has an active infection with hepatitis B.
* O C - has recovered from a hepatitis B infection.
* D - requires re-immunization for protection from hepatitis B

Answer 27

has an active infection with hepatitis B.

Question 28

A 30-year-old patient started taking bisoprolol (Zebeta) for symptomatic mitral valve prolapse 3 days ago. A common initial and transient complaint among patients who take bisoprolol is:
* A - fatigue.
* B - flushing.
* C - reflex tachycardia.
* D - lower extremity edema.

Answer 28

A - fatigue.

Question 29

The sign of neurofibromatosis (von Recklinghausen disease) that is present in almost 100% of affected patients is:
* A - acoustic neuroma.
* B - infantile hemangiomas.
* c - astrocytoma of the retina.
D - cafe au lait spots.

Answer 29

D - cafe au lait spots.

Question 30

Which of the following statements is NOT correct about the removal of impacted cerumen from a patient’s ear?
* A - A relative contraindication to cerumen removal is the inability to visualize the ear canal.
O B - Topical cerumenolytic agents are contraindicated in children with impacted cerumen.
* C - A contraindication to irrigation is the presence or history of a perforated tympanic membrane.
* D - A relative contraindication to the use of visually directed microsuction is very hard cerumen.

Answer 30

• Topical cerumenolytic agents are contraindicated in children with impacted cerumen.

Question 31

Which of the following statements is true about use of the female condom?
* A - Female condoms can be used multiple times within a 24-hour period.
* B - Female condoms and male condoms may be used simultaneously.
* C - Female condoms do NOT protect against sexually transmitted infections.
* D - Female condoms may be inserted up to 8 hours prior to intercourse.

Answer 31

• Female condoms and male condoms may be used simultaneously.

Question 32

Which of the following psychiatric diagnoses is the LEAST likely to be a risk factor for suicide?
* A - Depression
* B - Bipolar disorder
C - Obsessive-compulsive disorder
D - Substance use disorder

Answer 32

Obsessive-compulsive disorder

Question 33

The nurse practitioner is performing a physical exam on an adolescent patient whose symptoms suggest allergic rhinitis. Expected findings may include:
* A - thin, watery nasal discharge, swollen nasal turbinates, and cobblestoning of the posterior pharynx.
* B - horizontal nasal crease, thick, cloudy nasal discharge, and otitis media.
* c - dark circles around the eyes, erythema of the nasal mucosa, and
yellow nasal discharge.
* D - fever, clear nasal discharge, and facial pain on palpation.

Answer 33

thin, watery nasal discharge, swollen nasal turbinates, and cobblestoning of the posterior pharynx.

Question 34

A patient comes to the health clinic in October for immunization against influenza.
The patient has never had one before and requests information about the influenza vaccine. Which of the following is true about the influenza vaccine?
* A - Getting the influenza vaccine prevents patients from getting influenza infection if exposed to the virus.
* B - Influenza vaccination reduces the risk of mortality associated with influenza.
* C - Influenza season in the U.S. is predictable, and vaccines should be given in September.
D - Administration of the influenza vaccine may make the patient more susceptible to other

Answer 34

Getting the influenza vaccine prevents patients from getting influenza infection if exposed to the virus.

Question 35

Which one of the following diagnoses is NOT commonly associated with Escherichia coli?
* A - Prostatitis
* B - Glomerulonephritis
* C - Pyelonephritis
* D - Cystitis

Answer 35

Glomerulonephritis

Question 36

A pregnant patient at 20 weeks’ gestation complains of pain in the right lower quadrant. The patient is afebrile and reports no nausea and vomiting. The most likely diagnosis is:
* A - appendicitis.
* B - urinary tract infection.
* c - muscle strain.
D - round ligament pain.

Answer 36

round ligament pain.

Question 37

An adult athlete presents with complaints of sharp pain over the right shin that has gradually and subtly worsened over time. The patient has been training for a marathon. In considering the possibility of a stress fracture, which statement by the nurse practitioner is NOT correct?
* A - X-rays may not indicate a stress fracture, even if one is present.
* B - Diagnosis can be made based on a thorough history and physical.
* C - A stress fracture is not likely because the patient is in otherwise good health.
* D - Without point tenderness, a stress fracture is unlikely.

Answer 37

• X-rays may not indicate a stress fracture, even if one is present.

Question 38

A 70-year-old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?
* A - Inflammatory bowel disease
* B - Diverticulosis
C - Diverticulitis
* D - Acute bowel obstruction

Answer 38

C - Diverticulitis

Question 39

The lower urinary tract symptom that is LEAST likely to lead the nurse practitioner to suspect benign prostatic hyperplasia (BPH) is:
A - urinary intermittency.
B - nocturia.
C - incontinence.
D - dysuria.

Answer 39

incontinence

Question 40

A 55-year-old male patient presents with dysuria, urgency, perineal pain, and temperature 101 degree F (38.3C). What is the most likely diagnosis?
* A - Cystitis
* B - Epididymitis
* 0 C - Urethritis
* D - Prostatitis

Answer 40

• Prostatitis

Question 41

A patient who is experiencing daily symptoms of asthma with nocturnal awakenings more than once per week is classified as having:
* A - intermittent asthma.
* B - mild persistent asthma.
* C - moderate persistent asthma.
* D - severe persistent asthma.

Answer 41

moderate persistent asthma

Question 42

Which of the following is NOT an electrocardiogram marker of hypokalemia?
* A - Tachyarrhythmias
* B - ST segment depression
* C - Peaked T waves
* D - Prolonged QT waves

Answer 42

B - ST segment depression

Question 43

When assigning an evaluation and management (E&M) code for reimbursement of services provided, the component that reflects the intensity of the cognitive labor performed by the provider is the:
* A - history.
* B - physical examination.
* c - medical decision making.
D - time.

Answer 43

medical decision making.

Question 44

Enlarged submandibular lymph nodes are MOST likely the result of an infection in the:
A - nasopharynx.
B - teeth.
* c - eyes.
* D - ears.

Answer 44

B - teeth.

Question 45

A 4-year-old male returns for a 6-week follow-up visit after being diagnosed with Kawasaki disease. During the physical examination, the nurse practitioner notes normal vital signs and no rash or edema on the feet. Laboratory results show a normal sedimentation rate. The nurse practitioner documents that this child is in the:
02:03:5
A - acute stage of the illness.
* B - subacute stage of the illness.
* C - prodrome stage of the illness.
* D - convalescent stage of the illness.

Answer 45

subacute stage of the illness.

Question 46

An 8-year-old child presents to the health clinic for evaluation of an acute onset of severe sore throat. The patient exhibits tachypnea and has a respiratory rate of 34 breaths/minute. The child’s history is positive for fever and pharyngitis for the past 2 days. The most likely diagnosis is:
* A - mononucleosis.
* B - peritonsillar abscess.
* C - respiratory syncytial virus (RSV).
* D - epiglottitis.

Answer 46

• epiglottitis.

Question 47

Social determinants of health include:
* A - physical barriers, especially for people with disabilities.
* B - exposure to toxic substances.
* C - safe housing.
D - access to healthcare services.

Answer 47

• C - safe housing.

Question 48

The most prevalent nonviral sexually transmitted infection in the United States is:
* A - bacterial vaginosis (BV).
* B - trichomoniasis.
* c - herpes simplex.
* D - syphilis.

Answer 48

B - trichomoniasis.

Question 49

An adult patient presents to the clinic with a productive cough, mild shortness of breath, and pleuritic pain. Which examination finding may prompt the NP to obtain a chest X-ray?
* A - Green sputum
B - Wheezing
* c - Rales
* D - Mild dyspnea

Answer 49

c - Rales

Question 50

A 3-year-old patient presents with several enlarged, warm, and tender anterior cervical lymph nodes. The nurse practitioner should consider an infectious process of the:
A - throat.
B - maxillary sinus.
* C - ears.
D - eyes.

Answer 50

A - throat.

Question 51

Which of the following medications poses the LOWEST fall risk for an older adult?
* A - Quetiapine (Seroquel)
* B - Oxybutynin (Ditropan)
* C - Metoprolol (Lopressor)
* D - Metformin (Glucophage)

Answer 51

• Metoprolol (Lopressor)

Question 52

Which of the following is NOT true about the S3 heart sound?
* A - It is associated with a ventral septal defect.
* B - It is a low-pitched sound that is auscultated in the mitral area.
* c - It is produced by vibration during rapid ventricular filling.
* D - It is a common finding in right-sided heart failure.

Answer 52

B - It is a low-pitched sound that is auscultated in the mitral area.

Question 53

The nurse practitioner is discussing contraception options during lactation with a pregnant patient. Which of the following methods of contraception would NOT be appropriate for use while breastfeeding?
* A - Levonorgestrel
* B - A low-dose oral contraceptive
* C - An intrauterine device
* D - A diaphragm and spermicide

Answer 53

A low-dose oral contraceptive

Question 54

A patient with a history of mitral valve prolapse is scheduled for routine dental cleaning. According to the American Heart Association’s guidelines for endocarditis prophylaxis, what should the nurse practitioner advise this patient?
* A - The patient should receive prophylaxis on the day of their dental cleaning.
* B - The patient does not need prophylaxis for any dental procedures.
* C - The patient should receive prophylaxis on the day before and the day of their cleaning.
* D - The patient needs prophylaxis only for tooth extraction and deep dental procedures.

Answer 54

The patient does not need prophylaxis for any dental procedures.

Question 55

Which of the following screening scenarios is appropriate when screening a patient for diabetes mellitus?
* A - Screen all adults who are physically inactive and have a body mass index >25 kg/m2 using a fasting serum glucose.
* B - Screen a 35-year-old patient with dizziness using a hemoglobin
A1C.
* C - Screen a 28-year-old nonpregnant patient with a family history of gestational diabetes using an oral glucose tolerance test.
* D - Screen a 40-year-old patient with a history of alcohol abuse and three cousins with Type 2 diabetes mellitus using a urine glucose test.

Answer 55

Screen all adults who are physically inactive and have a body mass index >25 kg/m2 using a fasting serum glucose.

Question 56

The process by which the nurse practitioner requests to be reimbursed for services provided is known as:
* A - empaneling.
* B - certification.
* c - credentialing.
* D - privileging.

Answer 56

• credentialing.

Question 57

A patient is diagnosed with basal cell carcinoma (BCC). The nurse practitioner correctly tells the patient that BCC:
* A - has high rates of morbidity and mortality.
* B - is successfully treated with surgical excision or radiation therapy.
* c - is a rapidly growing lesion and thus spreads quickly.
* D - almost always metastasizes and he should have a PET scan
immediately.

Answer 57

is successfully treated with surgical excision or radiation therapy.

Question 58

The hemoglobin A1C level in a patient with Type 2 diabetes mellitus is 7.2. The patient is taking a sulfonylurea medication. Which of the following medications should be added next to the medication treatment regimen?
* A - Glipizide (Glucotrol)
* B - NPH insulin
* c - Regular insulin
* D - Metformin (Glucophage)

Answer 58

Metformin (Glucophage)

Question 59

Which of the following is LEAST likely to contribute to vitamin B12 deficiency and pernicious anemia?
* A - Administration of proton pump inhibitors
* B - Helicobacter pylori infection
* C - Strict vegan diet
D - Chronic laxative use

Answer 59

Chronic laxative use

Question 60

The nurse practitioner is conducting a routine health assessment on a marathon runner. Which urinalysis finding would be consistent with increased exercise?
* A - Ketones and glucose
* B - Protein and hyaline casts
* C - Albumin and increased pH
* D - Urobilinogen and calcium oxalates

Answer 60

ketones and glucose

Question 61

Which respiratory condition can be effectively treated and shortened in duration with the use of antibiotics?
* A - Acute sinusitis
* B - Acute bronchitis
* C - Bronchiolitis
* D - Lower respiratory infections

Answer 61

• A - Acute sinusitis

Question 62

A patient presents for evaluation of right lower quadrant (RLQ) abdominal pain and nausea for 2 days. On examination, the patient has rebound tenderness, pain in the RLQ on palpation of the left lower quadrant (Rovsing’s sign), and mild leukocytosis.
The most likely diagnosis is:
* A - ulcerative colitis.
* B - cholecystitis.
* c - appendicitis.
* D - renal calculi.

Answer 62

• appendicitis.

Question 63

Patients diagnosed with polycystic ovarian disease are at increased risk of developing:
A - diabetes mellitus.
* B - cervical cancer.
* c - endometriosis.
* D - nephrolithiasis.

Answer 63

A - diabetes mellitus.

Question 64

In order to promote diuresis but reduce the possibility of hypokalemia, the best combination of diuretics is:
* A - furosemide (Lasix) and bumetanide (Bumex).
* B - spironolactone (Aldactone) and hydrochlorothiazide (Hydrazide).
* c - hydrochlorothiazide (Hydrazide) and furosemide (Lasix).
* D - bumetanide (Bumex) and hydrochlorothiazide (Hydrazide).

Answer 64

• spironolactone (Aldactone) and hydrochlorothiazide (Hydrazide).

Question 65

A patient reports right flank pain that began 2 days ago and has progressively worsened. On examination of the area, the nurse practitioner identifies papular fluid-filled lesions that are confluent and linear. The nurse practitioner would appropriately order a(n):
* A - narcotic medication.
* B - topical analgesic.
C - oA patient reports right flank pain that began 2 days ago and has progressively worsened. On examination of the area, the nurse practitioner identifies papular fluid-filled lesions that are confluent and linear. The nurse practitioner would appropriately order a(n):
* A - narcotic medication.
* B - topical analgesic.
C - oral antiviral.
* D - topical steroid cream.
* D - topical steroid cream.

Answer 65

oral antiviral

Question 66

When assessing heart murmurs, it is important to document the timing of the murmur. The nurse practitioner would document a murmur as diastolic if the murmur were audible:
* A - with S1 and extends up to S2.
* B - after S1 and obscures S2.
* C - after S1 and ends before S2.
* D - after S2 and ends before S1.

Answer 66

after S1 and ends before S2.

Question 67

Today, a patient is diagnosed with iron deficiency anemia and started on a daily iron supplement. The nurse practitioner should advise the patient to follow up in:
* A - 2 months for a reticulocyte count.
* B - 6 weeks for measurement of total iron binding capacity (TIBC).
* c - 6 months for a serum ferritin and iron level.
D - 1 month for a CBC.

Answer 67

6 months for a serum ferritin and iron level.

Question 68

A patient presents with complaints of fatigue and mild muscle cramps. The nurse practitioner suspects hypokalemia that is most likely caused by:
* A - furosemide (Lasix).
* B - an angiotensin receptor blocker (ARB).
* C - spironolactone (Aldactone).
* D - heparin.

Answer 68

• spironolactone (Aldactone).

Question 69

When auscultating the heart of a patient with chronic emphysema, the nurse practitioner hears a murmur over the fourth and fifth intercostal spaces along the left sternal edge. The nurse practitioner suspects:
* A - tricuspid regurgitation.
B - mitral regurgitation.
* C - aortic regurgitation.
* D - pulmonic regurgitation.

Answer 69

mitral regurgitation

Question 70

Which of the following therapies is NOT recommended for a patient with degenerative joint disease (DJD)?
* A - Aspirin
* B - Corrective surgery
* C - Weightbearing exercises
* D - Systemic steroids

Answer 70

aspirin

Question 71

A 20-year-old female presents to the emergency department with lower abdominal pain, moderate vaginal bleeding, and right shoulder pain. The patient’s blood pressure is 90/50 mm Hg, pulse 120, respirations 20, and temperature 98 degrees F (36.6 degrees C). The patient has a history of pelvic inflammatory disease. A urine pregnancy test is positive. Which of the following is the most likely diagnosis?
* A - Threatened spontaneous abortion
* B - Abruptio placenta
* C - Ectopic pregnancy
* D - Ruptured corpus luteum cyst

Answer 71

Ectopic pregnancy

Question 72

A 44-year-old patient describes stiffness and soreness in the hands, hips, and knees. Enlargement of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints is noticeable in the patient’s hands. The nurse practitioner suspects arthritis. The question that is LEAST helpful in differentiating between rheumatoid arthritis (RA) and osteoarthritis (OA) is:
A - Do the joints of your fingers ever feel particularly warm or hot?
* B - Tell me about your usual energy level and any other systemic symptoms.
* C - Does the soreness and stiffness get better or worse as the day progresses?
* D - Have you noticed decreased joint movement or flexibility?

Answer 72

Do the joints of your fingers ever feel particularly warm or hot?

Question 73

A patient presents with complaints of bilateral eye irritation and crusting upon awakening. Swelling and inflammation of bilateral lids and conjunctiva are present.
Based on the most probable diagnosis, the best choice of treatment is an ophthalmic:
* A - mast cell stabilizer.
* B - antibiotic drops.
* c - antibiotic-steroid combination.
* D - steroid drops.

Answer 73

• A - mast cell stabilizer.

Question 74

The guardian of a 3-month-old infant diagnosed with tetralogy of Fallot seeks advice on how to assist the infant during cyanotic episodes. The initial and most appropriate intervention would be to instruct the guardian to:
* A - provide oxygen via face mask when the episode begins and for 15 minutes after it ends.
* B - place the child in a knee-chest position until the cyanotic episode resolves.
* C - administer intranasal fentanyl every 6 hours as needed.
* D - administer acetaminophen orally every 4 hours as needed.

Answer 74

• place the child in a knee-chest position until the cyanotic episode resolves.

Question 75

The nurse practitioner is counseling a sexually active male about proper condom use. Which of the following statements is INCORRECT?
* A - Use water-based lubrication to prevent damage to the condom.
* B - The condom should be removed after ejaculation and the erection has resolved.
* C - The condom should be tight against the head of the penis.
* D - Spermicides should not be used because of risk of irritation.

Answer 75

• The condom should be tight against the head of the penis.

Question 76

A child’s mean corpuscular volume (MCV) is 73 fl (normal value 80-100 fl). What type of anemia would the nurse practitioner suspect?
* A - Folate deficiency
* B - B12 deficiency
* C - Iron deficiency
* D - Reticulocytosis

Answer 76

Iron Def anemia

Question 76

A child and their caregiver each have several 10-cm round, reddened skin patches with central clearing. The rash presents on the trunk in a Christmas tree-shaped pattern. The caregiver has been treating the rashes with over-the-counter topical steroid cream without success. The nurse practitioner’s best response is to:
* A - prescribe an antifungal cream and advise continued use for 7 days after symptoms subside.
* B - educate the patient that there is no recommended treatment for this rash. It will spontaneously resolve in 4-8 weeks.
* C - reassure the patient that this is a viral rash and prescribe an oral antiviral to accelerate the healing process.
* D - refer to dermatology for further

Answer 76

educate the patient that there is no recommended treatment for this rash. It will spontaneously resolve in 4-8 weeks.

Question 77

According to existing data on child abuse, which parent characteristics are most closely associated with the use of abusive parenting practices?
* A - Older in age, following the example set by the previous generation
* B - Younger in age, isolated, with low self-esteem
* C - Working full time, feeling pressure to perform multiple duties
D - Single, working part time, and attending trade school

Answer 77

• B - Younger in age, isolated, with low self-esteem

Question 78

An adult patient has chronic gout. He has come to the clinic for a third time in 3 months for treatment of an acute exacerbation. When educating the patient about a low-purine diet to reduce exacerbations, the NP should state food choices that are low in purines. These include:
* A - all alcoholic beverages.
* B - crab and shrimp.
* C - soda, tea, and peanut butter.
* D - wild game and organ meats.

Answer 78

crab and shrimp

Question 79

The recommended patient-delivered expedited partner therapy (EPT) for the treatment of Neisseria gonorrhoeae is:

Answer 79

azithromycin (Zithromax) 1 g orally plus cefixime (Suprax) 400 mg orally.

Question 80

“Hot flashes” that occur during menopause are thought to be related to:

Answer 80

fluctuatin estrogen levels

Question 81

Laboratory testing results for a 40-year-old patient show the following: HBAg, negative; anti-HBc, negative; anti-HBs, positive with >10 mlU/mL. Which statement is the correct interpretation of these results?

Answer 81

The patient is immune to hepatitis B due to vaccination.

Question 82

A 63-year-old woman with type 2 diabetes mellitus is diagnosed with hypertension and has microalbuminuria. She is started on an angiotensin-converting enzyme (ACE) inhibitor. How soon will the antiproteinuric effect of the ACE inhibitor be evident in this patient?

Answer 82

6 weeks

Question 83

the NP is prescribing treatment for acute otitis media in a child with a PCN allergy. The most appropriate anbbiotic is
Amoxicillin–clavulanic acid (Augmentin)
Clindamycin (Cleocin)
Cefdinir (Omnicef)
Ceftriaxone (Rocephin)

Answer 83

Solution: B

Clindamycin (Cleocin).

If the reaction to a medication allergy is unknown, the nurse practitioner should consult with an allergist or avoid prescribing the medication. Clindamycin would be the most appropriate antibiotic for this patient. Amoxicillin–clavulanic acid (Augmentin) is a penicillin-based medication; therefore, it is contraindicated. A cross-sensitivity to cephalosporins may occur when a penicillin allergy is present; thus cefdinir and ceftriaxone should be avoided. Also, ceftriaxone is not a first-line medication and would not be indicated if the patient were able to tolerate oral intake.

Question 84

Which factor indicates that an infant with a urinary tract infection (UTI) may require hospitalization for treatment?

Aged 4 months
Penicillin and sulfa allergies
History of a febrile UTI
Lives on a rural farm 50 miles from office

Answer 84

Solution: D

Lives on a rural farm 50 miles from office.

Indications for hospitalization for an infant with a UTI include age younger than 2 months, signs of sepsis, immunocompromised status, inability to tolerate oral medication, outpatient treatment failure, and a potential lack of appropriate follow up. The infant living on a rural farm raises concern for follow-up due to distance from primary care office. Hospitalization is indicated if follow-up cannot be guaranteed. There are outpatient treatment options that are not in the penicillin or sulfa drug families. History of a previous UTI warrants urology evaluation to rule out structural abnormalities, but this can be done on an outpatient basis.

Question 85

A patient prescribed azithromycin is concerned about taking the medication due to a history of vomiting and diarrhea after taking erythromycin. The appropriate response by the nurse practitioner is:

“I will prescribe an antiemetic if you experience severe vomiting.”
“Azithromycin is prescribed for only 5 days, so the side effects should be tolerable.”
“The same side effects may not occur with azithromycin.”
“The medications are not in the same drug class.”

Answer 85

Solution: C

“The same side effects may not occur with azithromycin.”

While erythromycin and azithromycin are in the same drug class (macrolides), side effect intolerance for one medication does not automatically apply to all medications in that group. In addition, azithromycin is the most well-tolerated macrolide. If severe vomiting occurs, the medication should be changed. The patient should not be asked to tolerate side effects for 5 days.

Question 86

Which drug will the nurse practitioner prescribe to a 5-year-old patient whose stool sample is positive for Enterobius vermicularis?

Permethrin (Elimite)
Atovaquone (Mepron)
Albendazole (Albenza)
Thiabendazole (Mintezol

Answer 86

Solution: C

Albendazole (Albenza).

Enterobius vermicularis, also known as pinworm, is treated with an antiparasitic such as albendazole. Permethrin is an insecticide used to treat lice and scabies. Atovaquone is indicated for the treatment of toxoplasmosis. Thiabendazole is an older anthelmintic that can be used to treat of variety of parasites. It is rarely used due to its significant side-effect profile.

Question 87

Which medication can cause amenorrhea?

Sertraline (Zoloft)
Albuterol (Proair) inhaler
Omeprazole (Prilosec)
Tretinoin (Retin-A) topical

Answer 87

Solution: A

Sertraline (Zoloft).

Medications that increase prolactin production (hyperprolactinemia) can cause secondary amenorrhea. Antipsychotics and selective serotonin reuptake inhibitors (SSRIs; e.g., sertraline) are drug classes associated with this condition. Albuterol and omeprazole do not increase prolactin levels. Tretinoin should be stopped during pregnancy but does not affect menstrual cycles.