Exam study Flashcards
The most commo cancer found on the aurcle is Actinic keratosis Basal cell carcinoma Squamous cell carcinoma Acral-lentiginous melanoma
Basal cell carcinoma
Which of the following medication classes should be avoided in patients with acute or
chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the
patient?
Xanthines
Antihistimine
Steroids
Anticholinergics
Antihistimines
A 47 year old male patient presents to the clinic with a single episode of a moderate
amount of bright red rectal bleeding. On examination, external hemorrhoids are noted.
How should the nurse practitioner proceed?
Instruct the patient on measures to prevent hemorrhoids such as
bowel habits and diet.
Order a topical hemorrhoid cream along with a stool softener.
Refer the patient for a barium enema and sigmoidoscopy.
Refer the patient for a surgical hemorrhoidectomy.
Refer the patient for a barium enema and sigmoidoscopy.
Which of the following patient characteristics are associated with chronic bronchitis?
Overweight, cyanosis, and normal or slightly increased
respiratory rate
Underweight, pink skin, and increased respiratory rate
Overweight, pink skin, and normal or slightly increased
respiratory rate
Normal weight, cyanosis, and greatly increased
respiratory rate
Overweight, cyanosis, and normal or slightly increased
respiratory rate
A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and
polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain.
Her current medications include omeprazole 20 milligrams po daily, lisinopril 20
milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po
daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The
most appropriate diagnostic test for this patient at this time is
CBC/diff
Erythrocyte
sedimentation rate
Abdominal ultrasound
CT scan
CT Scan
A patient reports “something flew in my eye” about an hour ago while he was splitting
logs. If there were a foreign body in his eye, the nurse practitioner would expect to find
all except:
Purulent drainage
Tearing
Photophobia
A positive fluorescein
stain
Purulent drainage
A 21 year old college student presents to the student health center with copious,
markedly purulent discharge from her left eye. The nurse practitioner student should
suspect
Viral conjunctivitis
Common pink eye
Gonococcal
conjunctivitis
Allergic
conjunctivitis
Gonococcal Conjuctivitis
A 35 year old man presents with radicular pain followed by the appearance of grouped
vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He
complains of pain, burning, and itching. The nurse practitioner should suspect:
A common case of shingles and prescribe an analgesic and an antiviral
agent
A complicated case of shingles and prescribe acyclovir, an analgesic,
and a topical cortisone cream
Herpes zoster and consider that this patient may be
immunocompromised
A recurrence of chickenpox and treat the patient’s symptoms
Herpes zoster and consider that this patient may be
immunocompromised
Which type of lung cancer has the poorest prognosis?
Adenocarcinoma
Epidermoid
carcinoma
Small cell
carcinoma
Large cell
carcinoma
Small cell
carcinoma
An 83-year-old female presents to the office complaining of diarrhea for several days.
She explains she has even had fecal incontinence one time. She describes loose stools 3–
4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The
history suggests that the patient has:
Acute diarrhea
Chronic diarrhea
Irritable bowel
Functional bowel
disease
Chronic Diarrhea
Margaret, age 32, comes into the office with painful joints and a distinctive rash in a
butterfly distribution on her face. The rash has red papules and plaques with a fine scale.
What do you suspect?
An allergic reaction
Relapsing
polychondritis
Lymphocytoma cutis
Systemic lupus
erythematosus
Systemic lupus
erythematosus
Antibiotic administration has been demonstrated to be of little benefit to the treatment of
which of the following disease processes?
Chronic sinusitis Acute bronchitis Bacterial pneumonia Acute exacerbation of chronic bronchitis
Acute bronchitis
Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2
agonist daily. Her exacerbations affect her activities and they occur at least twice weekly
and may last for days. She is affected more than once weekly during the night with an
exacerbation. Which category of asthma severity is Lisa in?
Mild
intermittent
Mild persistent
Moderate persisent
Moderate persistent
Which of the following is the most appropriate therapeutic regimen for an adult patient
with no known allergies diagnosed with group A B-hemolytic strep?
Penicillin V 500 milligrams PO every 8 hours
for 10 days
Ampicillin 250 milligrams PO twice a day for
10 days
Clarithromycin 500 milligrams po daily for 7
days
None of the above
Penicillin V 500 milligrams PO every 8 hours for 10 days
A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by
leg elevation. She occasionally has edema in her lower legs at the end of the day. What is
the most likely cause of these problems?
Congestive heart
failure
Varicose veins
Deep vein
thrombosis
Arterial
insufficiency
Varicose veins
Which statement below is correct about pertussis?
It is also called whooping cough
It begins with symptoms like strep throat
It lasts about 3 weeks
It occurs most commonly in toddlers and
young children
It is called whooping cough
Which of the following is the most important diagnosis to rule out in the adult patient
with acute bronchitis?
Pneumonia
Asthma
Sinusitis
Pertussis
Pneumonia
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?
Diverticulitis
Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This
morning she noticed a rash with erythematous papules in that site. What do you suspect?
Varicella
Herpes
zoster
Syphilis
Rubella
Herpes zoster
A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows
that the most common cause of pancreatitis is:
Alcohol
Gallstones
Medications
Pregnancy
Gallstones
When a patient presents with symptoms of acute gallbladder disease, what is the
appropriate nurse practitioner action?
Order abdominal x-rays
Order an abdominal ultrasound
Refer the patient to a surgeon for
evaluation
Prescribe pain medication
Order an abdominal ultrasound
A false-positive result with the fecal occult blood test can result from:
ingestion of large amounts of
vitamin C
a high dietary intake of rare
cooked beef
colonic neoplasm that is not
bleeding
stool that has been stored
before testing
a high dietary intake of rare
cooked beef
A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and
pain. Physical findings include an abdominal mass and stool positive for occult blood. The
nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test
for this patient is
Colonoscopy
Small bowel follow through
Barium enema
CT abdomen
Small bowel follow through
A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity
edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner
knows that these findings are consistent with:
Mitral
regurgitation
Systolic heart
failure
Cardiac myxoma
Diastolic heart
failure
Systolic heart failure
Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is
an indication that she should be hospitalized?
Multilobar involvement on chest x-ray with the inability to take oral
medications
Alert and oriented, slightly high but stable vital signs, and no one to
take care of her at home
Sputum and gram positive organisms
A complete blood count showing leukocytosis
Multilobar involvement on chest x-ray with the inability to take oral
medications
A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner
correctly tells him:
“It is the most common cause of death in patients with skin
cancer.”
“It can be cured with surgical excision or radiation therapy.”
“It is a slow growing skin cancer that rarely undergoes
malignant changes.”
“It can be cured using 5-flurouracil cream twice daily for 2
to 4 weeks.”
“It can be cured with surgical excision or radiation therapy.”
Expected spirometry readings when the patient has chronic emphysema include:
Decreased residual volume (RV)
Increased vital capacity (VC)
Increased forced expiratory volume
(FEV-1)
Increased total lung capacity (TLC)
Increased total lung capacity (TLC)
An 80-year-old male admits to difficulty swallowing during the review of systems. The
nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:
Esophageal
cancer
Chest pain
GERD
A and C
All of the
above
A and C
A 40 year old female with history of frequent sun exposure presents with a multicolored
lesion on her back. It has irregular borders and is about 11mm in diameter. What should
the nurse practitioner suspect?
Squamous cell
carcinoma
Malignant
melanoma
A common nevus
Basal cell
carcinoma
Malignant melanoma
Which of the following is not a goal of treatment for the patient with cystic fibrosis?
Prevent intestinal obstruction Provide adequate nutrition Promote clearance of secretions Replace water-soluble vitamins
Replace water-soluble vitamins
The nurse practitioner is performing a physical exam on a middle-aged African-American
man. Which of the following areas is a common site for melanomas in African-Americans
and other dark-skinned individuals?
Scalp Nails Feet B and C All of the above
B and C
An adult presents with tinea corporis. Which item below is a risk factor for its
development?
topical steroid use
A patient has experienced nausea and vomiting, headache, malaise, low grade fever,
abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a
shift to the left. He is requesting medication for diarrhea. What is the most appropriate
response?
Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours.
Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and
symptom management.
Offer an anti-emetic medication such as ondansetron (Zofran) and
provide oral fluid and electrolyte replacement instruction.
Order stool cultures.
Prescribe a broad-spectrum antibiotic such as ciprofloxacin and symptom management
Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed
with urticaria. What do you order?
Aspirin
NSAIDs
Opioids
Antihistamines
Antihistamine
Of the following signs and symptoms of congestive heart failure (CHF), the earliest
clinical manifestation is:
Peripheral
edema
Weight gain
Shortness of
breath
Nocturnal
dyspnea
Weight gain
A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical
adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what
drug would be least appropriate to prescribe?
Ibuprofen
Erythromyci
n
Amoxicillin
Acetam
Amoxicillin
A 70 year old man who walks 2 miles every day complains of pain in his left calf when he
is walking. The problem has gotten gradually worse and now he is unable to complete his
2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans?
“Are you wearing your usual shoes?”
“Do you also have chest pain when you
have leg pain?”
“Is your leg pain relieved by rest?”
“Do you ever have the same pain in the
other leg?”
Is your leg pain relieved by rest
Which of the following statements about malignant melanomas is true?
They usually occur in older adult males
The patient has no family history of melanoma
They are common in blacks
The prognosis is directly related to the thickness of the lesion
The prognosis is directly related to the thickness of the lesion
Sheila, age 78, presents with a chief complaint of waking up during the night coughing.
You examine her and find an S3 heart sound, pulmonary crackles that do not clear with
coughing, and peripheral edema. What do you suspect?
Heart failure
Which antibiotic would be the most effective in treating community acquired pneumonia
(CAP) in a young adult without any comorbid conditions?
Erythromycin
Clarithromycin
(Biaxin)
Doxycycline
(Vibramycin)
Penicillin
Clarithromycin
Biaxin
Which of the following dermatologic vehicles are the most effective in absorbing moisture
and decreasing friction?
Powders
Gels
Creams
Lotion
Powders
A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her
forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects
actinic keratosis. This lesion is a precursor to:
Squamous cell
carcinoma
Basal cell
carcinoma
Malignant
melanoma
Acne vulgaris
Squamous cell Carcinoma
An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by
sitting or lying down. How should the nurse practitioner proceed with the physical
examination?
Assist the patient to a standing position and take her blood
pressure.
Assess the patient’s cranial nerves.
Compare the patient’s blood pressure lying first, then sitting,
and then standing.
Compare the amplitude of the patient’s radial and pedal pulses.
Compare the patient’s blood pressure lying first, then sitting,
and then standing.
`
What oral medication might be used to treat chronic cholethiasis in a patient who is a
poor candidate for surgery?
Ursodiol
Ibuprofen
Prednisone
Surgery is the only
answer
Ursodiol
A 46-year-old female with a past medical history of diabetes presents with a swollen,
erythematous right auricle and is diagnosed with malignant otitis externa. The nurse
practitioner knows that the most likely causative organism for this patient’s problem is:
Staphylococcus aureus
Group A beta hemolytic
streptococcus
Haemophilus influenza
Pseudomonas aeruginosa
Pseudomonas aeruginosa
Which of the following is not a symptom of irritable bowel syndrome?
Painful diarrhea
Painful constipation
Cramping and
abdominal pain
Weight loss
Weight loss
A patient comes in complaining of 1 week of pain in the posterior neck with difficulty
turning the head to the right. What additional history is needed?
Any recent trauma
Difficulty swallowing
Stiffness in the right
shoulder
Change in sleeping
habits
Any recent trauma
Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive.
Which of the following drugs has the potential to cause the development of bronchial
asthma and inhibit gluconeogenesis?
ACE Inhibitor
Beta Blocker
Calcium channel
blocker
Diuretic
Beta Blocker
The differential diagnosis for a patient complaining of a sore throat includes which of the
following?
Gonococcal
infection
Thrush
Leukoplakia
B only
A, B, and C
A,B and C
A patient presents to the primary care provider complaining of a rash on his right
forehead that started yesterday and is burning and painful. The physical exam reveals an
erythematous, maculopapular rash that extends over the patient’s right eye to his upper
right forehead. Based on the history and examination, the most likely cause of this
patient’s symptoms is:
Rhus
dermatitis
Ophthalmic
zoster
Chemosis
Optic neuritis
Opthalmic zoster
Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse
practitioner orders liver function studies. The patient’s aminotransferase (ALT) is
elevated. What laboratory test(s) should be ordered?
Serologic markers for hepatitis
Serum bilirubin
Serum cholesterol with HDL
and LDL
A liver biopsy
Serologic markers for hepatitis
A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he
calls to report generalized muscle aches. The nurse practitioner should suspect:
A drug interaction
Hepatic dysfunction
Hypersensitivity to
lovastatin
Rhabdomyolysis
Rhabdomyolysis
Treatment of acute vertigo includes:
Bedrest and an
antihistamine
Fluids and a
decongestant
A sedative and
decongestant
Rest and a low sodium
diet
Bedrest and an
antihistamine
Treatment of H.pylori includes which of the following?
Proton pump
inhibitor
Antibiotic
therapy
Bismuth
subsalicylate
A and B
A, B, and C
A, B, and C
Carl, age 78, is brought to the office by his son, who states that his father has been
unable to see clearly since last night. Carl reports that his vision is “like looking through a
veil.” He also sees floaters and flashing lights but is not having any pain. What do you
suspect?
Cataracts
Glaucoma
Retinal
detachment
Iritis
Retinal detachment
In order to decrease deaths from lung cancer:
All smokers should be screened annually
All patients should be screened annually
Only high risk patients should be
screened routinely
Patients should be counseled to quit
smoking
Patients should be counseled to quit smoking
John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened
for hypercholesterolemia?
Every 5 years
Every 2 years
Every year
Whenever blood work is
done
Every 5 years
Mort is hypertensive. Which of the following factors influenced your choice of using an
alpha blocker as the antihypertensive medication?
Mort is black
Mort also has congestive heart
failure
Mort has benign prostatic
hyperplasia
Mort has frequent migraine
headaches
Mort has benign prostatic
hyperplasia
John, age 59, presents with recurrent, sharply circumscribed red papules and plaques
with a powdery white scale on the extensor aspect of his elbows and knees. What do you
suspect?
Actinic keratosis
Eczema
Psoriasis
Seborrheic
dermatitis
Psoriasis
Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her
hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and
Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC
VIII guidelines, what should you do next to control Harriet’s blood pressure?
Increase her Lisinopril to 20mg daily
Add a thiazide diuretic to the Lisinopril 5mg daily
Discontinue the Lisinopril and start a combination of ACE Inhibitor and
calcium channel blocker
Discontinue the Lisinopril and start a diuretic
Add a thiazide diuretic to the Lisinopril 5mg daily
An active 65-year-old man under your care has known acquired valvular aortic stenosis
and mitral regurgitation. He also has a history of infectious endocarditis. He has recently
been told he needs elective replacement of his aortic valve. When he comes into the
office you discover that he has 10 remaining teeth in poor repair. Your recommendation
would be to:
defer any further dental work until his valve replacement is completed
instruct him to have dental extraction done cautiously, having no more
than 2 teeth per visit removed.
suggest he consult with his oral surgeon about having all the teeth
removed at once and receiving appropriate antibiotic prophylaxis
coordinate with his cardiac and oral surgeons to have the tooth
extractions and valve replacement done at the same time to reduce the
risk of anesthetic complications.
suggest he consult with his oral surgeon about having all the teeth
removed at once and receiving appropriate antibiotic prophylaxis
Appropriate therapy for peptic ulcer disease (PUD) is:
Primarily by eradication of infection
Based on etiology
Aimed at diminishing prostaglandin
synthesis
Dependent on cessation of NSAID
use
Based on etiology
Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than
her diabetes medications, what would you prescribe today during her routine office visit?
A calcium channel
blocker
A beta blocker
An ACE Inhibitor
No hypertension
medication
An ACE Inhibitor
Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices?
It is important to “undercode” so that one does not get charged with Medicare fraud
The practice of “overcoding” is essential in this age of decreasing reimbursements
Failing to bill for billable services will lead to unnecessarily low revenues
Time spent with the patient is a very important determinant of billing
Failing to bill for billable services will lead to unnecessarily low revenues
A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?
Viral conjunctivitis
Glaucoma
Corneal abrasion
Retinoblastoma
Retinoblastoma
Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?
Pharmacological therapy
A labyrinthectomy
A vestibular neurectomy
Wearing an earplug in the ear with the most hearing loss
A Vestibular neurectomy
Which of the following is not a risk factor for coronary arterial insufficiency?
Hyperhomocysteinemia
Smoking
Genetic factors
Alcohol ingestion
Alcohol ingestion
An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms?
Allergic conjunctivitis
Bacterial conjunctivitis
Gonococcal conjunctivitis
Viral conjunctivitis
Allergic conjunctivitis
A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?
A long-acting bronchodilator
An inhaled corticosteroid and cromolyn
Theophylline and a short acting bronchodilator
A bronchodilator PRN and an inhaled corticosteroid
A bronchodilator PRN and an inhaled corticosteroid
Acute rheumatic fever is an inflammatory disease which can follow infection with:
Group A Streptococcus
Staphlococcus areus
Β-hemolytic Streptococcus
Streptococcus
Β-hemolytic Streptococcus
A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to:
Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days
Order mandibular x-rays and question the patient about physical abuse
Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic
Initiate a parenteral antibiotic and consider hospital admission
Initiate a parenteral antibiotic and consider hospital admission
If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:
Iritis
Allergic conjunctivitis
Viral conjunctivitis
Bacterial conjunctivitis
Iritis
The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:
160 mg/dL
130 mg/dL
100 mg/dL
70 mg/dL
100 mg/dL
A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is:
Referral for surgical intervention such as a partial or complete fundoplication
Dependent upon how sever the practitioner believes the condition
To repeat the 8 week course of drug therapy while continuing lifestyle modifications
Investigation with endoscopy, manometry, and/or pH testing
Investigation with endoscopy, manometry, and/or pH testing
Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?
Under 3 years of age
Preschool children
6 to 12 years of age
Adolescents
6 to 12 years of age
The most appropriate treatment for a child with mild croup is:
A bronchodilator
An antibiotic
A decongestant
A cool mist vaporizer
A cool mist vaporizer
A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?
Peritonsillar abscess
Thyroiditis
Mononucleosis
Epiglottitis
Peritonsillar abscess
Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?
It is not effective during an acute asthma attack.
It may take 2 to 3 days to begin working.
This drug works within 10 minutes.
This drug may be used by patients 6 years and
It is not effective during an acute asthma attack.
Which intervention listed below is safe for long term use by an adult with constipation?
Stool softeners
Laxatives
Osmotic agents
Bulk-forming agents
Bulk-forming agents
A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:
Apply a topical antibiotic and warm compresses.
Apply cool compresses and avoid touching the hordeolum.
Use an oral antibiotic and eye flushes.
Apply light palpation to facilitate drainage.
Apply a topical antibiotic and warm compresses.
Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?
An antihistamine intranasal spray
A decongestant nasal spray
Ipratropium
Omalizumab
A decongestant nasal spray
What is the Gold standard for the diagnosis of asthma?
Patient’s perception of clogged
airways
Validated quality-of-life questionnaires
Bronchoscopy
Spirometry
Spirometry
A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough?
Methyldopa
Enalapril
Amlodipine
Hydrochlorothiazide
Enalapril
Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:
Aphthous ulcers
Candidiasis
Oral cancer
Herpes simplex
Candidiasis
Risk factors for acute otitis media (AOM) include all of the following except:
Household cigarette smoke
Group daycare attendance
Sibling history of acute otitis media
African-American ethnicity
African-American ethnicity
Which of the following can result from chronic inflammation of a meibomian gland?
A chalazion
Uveitis
Keratitis
A pterygium
A chalazion
What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?
You must initiate the plan of care for the patient
The physician must be on-site and engaged in patient care
You must be employed as an independent contractor
You must be the main health care provider who sees the patient
The physician must be on-site and engaged in patient care
Of the following choices, the least likely cause of cough is:
Asthma
Gastroesophageal reflux
Acute pharyngitis
Allergic rhinitis
Acute pharyngitis
The most common correlate(s) with chronic bronchitis and emphysema is(are):
Familial and genetic
factors
Cigarette smoking
Air pollution
Occupational environment
Cigarette smoking
Which choice below is least effective for alleviating symptoms of the common cold?
Antihistamines
Oral decongestants
Topical decongestants
Antipyretics
Antihistamines
When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?
Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control
Sodium restriction can cause serious adverse effects
A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable
Seventy-five of sodium intake is derived from processed foods
Seventy-five of sodium intake is derived from processed foods
Which of the following heart murmurs warrants the greatest concern?
Systolic murmur
Venous hum murmur
Diastolic murmur
Flow murmur
Diastolic murmur
A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?
Hordeolum; treat with a topical antibiotic and warm compress
Conjunctivitis; treat with topical antibiotic and warm compresses
Blepharitis; treat with warm compresses and gentle debridement with a cotton swab
Chalazion; refer to an ophthalmologist for incision and drainage
Blepharitis; treat with warm compresses and gentle debridement with a cotton swab
A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?
Inferior wall
Anterior wall
Apical wall
Lateral wall
Inferior wall
The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is:
Acute otitis media (AOM)
Otitis media with effusion
Mucoid otitis media
Serous otitis media
Acute otitis media (AOM)
Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:
epigastric hernia
umbilical hernia
incisional hernia
inguinal hernia
epigastric hernia
A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?
Omeprazole
Ranitidine
An antacid
None of the above
Omeprazole
Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:
Quit smoking
Maintain aggressive hypertension therapy
Stick to a low-fat, low-sodium diet
Continue with his exercise program
Quit smoking
Risk factors for acute arterial insufficiency include which of the following?
Recent myocardial infarction
Atrial fibrillation
Atherosclerosis
All of the above
All of the above
Impetigo and folliculitis are usually successfully treated with:
Systemic antibiotics
Topical antibiotics
Topical steroid creams
Cleansing and debridement
Topical antibiotics
What are signs & symptoms of SIADH (Syndrome of inappropriate antidiuretic hormone)?
Increased production of ADH (antidiuretic hormone), hyponatremia, concentrated urine (from excess water resorption), elevated urine osmolality, mental status changes from cerebral edema.
Diabetes insipidus is associated with what sodium level?
Hypernatremia
Psychogenic polydipsia results in urine that is:
diluted with low osmolality and hyponatremia
How would you determine the cause of a patient’s AKI who presents with decreased urine output, history of neurogenic bladder, chronic foley, dark urine, and Cr increase from 1.3 to 2.1 over 3 months?
Flush the foley catheter to see if urine comes out and assess the patency of the catheter. This action will unblock clogged sediment or biofilm from chronic bacteriuria.
When a female patient presents to the ER after sexual assault, what medications should be offered prior to discharge?
Ceftriaxone, azithromycin, Plan B, and Metronidazole.
Manifestations of Conn syndrome (hyperaldosteronism)?
hypernatremia, hypokalemia, and hypertension
What causes Cushing syndrome?
Increased levels of glucocorticoids, can be exogenous (from therapy) or endogenous (from adenoma or neoplasm).
Manifestations of Cushing syndrome?
hypertension, truncal obesity, osteoporosis, skin fragility, and hyperglycemia.
What differentiates primary adrenocortical insufficiency from secondary adrenocortical insufficiency?
Skin hyperpigmentation is present in primary adrenocortical insufficiency
What is Trousseau’s sign?
A carpal spasm elicited by compression of the upper arm with a BP cuff that indicates hypocalcemia.
What is Chovstek’s sign?
A hemifacial tic that is induced by tapping the facial nerve below the maxilla that indicates hypocalcemia.
What is Babinski’s sign?
An upward response (extension) of the hallux when the sole of the foot is stimulated with a blunt instrument. Can identify spinal cord disease in adults.
What is Romberg’s sign?
Loss of balance in standing when eyes are closed. Usually indicating a loss of proprioception or lesion in the cerebellum.
What is Homan’s sign?
pain on passive dorsiflexion of ankle, associated with DVT.
What is the clinical presentation of Goodpasture’s syndrome?
Urinalysis: Specific gravity: 1.020. pH 5.5, 1+ albumin and large blood present. Chest XR positive for bilateral diffuse infiltrates.
BUN 30, Cr 3.0
Symptoms: dyspnea with hemoptysis
What is Goodpasture syndrome?
Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody.
Initial treatment for Goodpasture’s syndrome?
Hospitalization, pulse dose of steroids, begin plasmapheresis and cyclophosphamide therapy.
Characteristics of Grave’s disease
Ophthalmopathy (lid retraction, scleral show, proptosis) and hyperthyroidism
What organism causes the formation of a staghorn calculus?
Proteus mirabilus
What organism causes Toxic shock syndrome?
Staphylococcus aureus
What electrolyte disturbance is most likely to lead to tetany and neuromuscular irritability?
Hypocalcemia
Features of hypercalcemia include?
“Stones, groans, moans, and bones.” Delirium and renal stones
When you see hypochloremia, the patient may have?
Metabolic Alkalosis
Hyperkalemia is associated with what cardiac abnormalities?
peaked T-waves, wide QRS, and ventricular arrhythmias.
A patient presents with arcus cornea, LDL 285, TG 110, HDL 45, and father died of an MI at age 45. What is his most likely diagnosis?
Heterozygous familial hypercholesterolemia
A fasting blood glucose level of 130 mg/dL indicates:
Diabetes
What are risk factors for ectopic pregnancy?
smoking, previous tubal surgery, previous ectopic pregnancy, exposure to diethylibestrol, current IUD, PID, advanced maternal age, infertilitiy for more than 2 years.
What hormones are most critical to replace in a patient at risk for anterior pituitary insufficiency?
Glucocorticoids, and thyroid hormone
What is diabetes insipidus?
a disorder caused by inadequate amounts of ADH which causes excessive water loss
CKD Stage 1
GFR >90 with evidence of renal damage, as indicated by proteinuria.
CKD Stage 2
GFR 60-89
CKD Stage 3a
GFR 45-59
CKD Stage 3b
GFR 30-44
What is the diagnosis and initial treatment of a patient with history of nonfunctional pituitary macroadenoma with severe retro-orbital headache, nausea, vomiting, mental status change, right third nerve palsy with stiff neck, and pituitary adenoma (enlarged) hemorrhage?
Pituitary apoplexy
dexamethasone 2mg IV q 6hr then surgery if mental status change present.
What causes hypocalcemia in patients with end stage renal disease?
Decreased conversion of Vitamin D.
What condition is associated with recurrent nephrolithiasis?
Primary hyperparathyroidism
What stabilizes the cardiac membrane in treatment of hyperkalemia?
Calcium gluconate
What medication acts rapidly to antagonize the membrane effects of potassium in hyperkalemia?
Calcium is cardioprotective
What is the most common cause of euvolemic hyponatremia?
SIADH (syndrome of inappropriate antidiuretic hormone secretion)
What causes are associated with hypervolemic hyponatremia?
Cirrhosis and CHF
What is a long-term complication of radio-active iodine therapy?
Hypothyroidism
80% of acute pyelonephritis cases in women are caused by what pathogen?
E coli
Most common cause of acute scrotal pain in adults?
epididymitis
What are predisposing factors for hypocalcemia?
hypoparathyroidism, pancreatitis, vitamin D deficiency, chronic alcohol use disorder, and medications such as phenytoin, cisplatin, and estrogen.
What are prerenal causes of AKI?
decrease in extracellular fluid volume, decreased renal blood flow, or altered intrarenal hemodynamics.
Post-renal causes of AKI
benign prostatic hyperplasia, bladder cancer, nephrolithiasis, neuromuscular disorders, prostate cancer, strictures, trauma
What is are intrinsic causes of renal failure?
Acute glomerulonephritis, ischemic injury, nephrotoxins, malignant hypertension
What classification of drugs cause urinary retention?
anticholinergics (ipratropium)
Common secondary causes of nephrotic syndrome
lupus and diabetes
Presenting symptoms of nephrotic syndrome
loss of appetite, fatigue, ascites, lower extremity edema, proteinuria, low blood albumin, and hyperlipidemia.
What is the initial insulin loading dose for a patient in DKA?
0.1 to 0.15 units/kg/hr
with hourly glucose monitoring
What is Hashimoto’s thyroiditis?
autoimmune destruction of thyroid gland, Anti-thyroid stimulating hormone (TSH) receptor antibodies inhibit release of thyroid hormone.
What would you do first for an incidental finding of an adrenal mass?
Overnight dexamethasone suppression test.
Clinical signs of PCOS
oligomenorrhea, infertility, hirsutism, obesity, and 2/3 Rotterdam criteria: oligo-ovulation or anovulation
clinic of biochemical signs of hyperandrogenism polycystic ovaries on US
Treatment for simple cystitis
5 days of nitrofurantoin
Define the acronym MUDPILES
Acronym for identifying a high anion gap metabolic acidosis: Methanol Uremia Diabetic ketoacidosis Paraldehyde Iron, isoniazid Lactate Ethanol, ethylene glycol Salicylates
First-line evaluation of vulvovaginal candidiasis
wet mount
Prolonged nausea and vomiting can result in:
Metabolic alkalosis loss of gastric acid
Clinical signs/symptoms of uremic pericarditis
worsening anemia, absence of diffuse ST-segment T-wave elevations, fever, pleuritic chest pain, pain that increases in recumbent position.
Hemodialysis treatment should be heparin free.
What is hepatorenal syndrome?
chronic or acute renal disease with advanced hepatic failure and portal hypertension.
What complaint is common with patients who have acute on chronic urinary retention?
urinary incontinence
For a patient who is lethargic and hyperkalemic, what is the first line therapy?
Calcium gluconate or calcium chloride
Priapism is a known side effect of what medication?
Trazodone
What is the maximum compensation of PaCO2 in metabolic acidosis?
26
signs of preeclampsia
BP > 140/90 proteinuria >300 mg of protein in urine in 24 hours headache visual changes 2+ pitting edema
Which of the following is a potential acquired cause of thrombophilia
Homocysteinuria
Protein C deficiency
Factor V Leiden
Antiphospholipid antibodies
Antiphospholipid antibodies
Phalen’s test, 90°wrist flexion for 60 seconds, reproduces symptoms of:
Ulnar tunnel syndrome
Carpal tunnel syndrome
Tarsal tunnel syndrome
Myofascial pain syndrome
Carpal tunnel syndrome
Which patient would benefit most from screening for type 2 diabetes?
A 30 year old female with unintended weight loss.
A 25 year old male with family history of type 1 diabetes
An obese female with recurrent vaginitis
A 50 year old hyperlipidemic male
An obese female with recurrent vaginitis
A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis?
Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Lupus
Peripheral neuropathy
Osteoarthritis (OA)
A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be:
Trimethoprim-sulfamethoxazole for 3 days
Ciprofloxacin for 7-10 days
Trimethoprim-sulfamethoxazole for 14 days
Ciprofloxacin for 3 days
Trimethoprim-sulfamethoxazole for 3 days
A thymectomy is usually recommended in the early treatment of which disease?
Parkinson’s disease
Multiple sclerosis
Myasthenia gravis
Huntington’s chorea
Myasthenia gravis
The diagnosis of human papilloma virus (HPV) infection in males is usually made by
Clinical appearance
Viral culture
Tzanck smear
KOH prep
Clinical appearance
The most effective intervention(s) to prevent stroke is (are):
81 mg of aspirin daily
Carotid endarterectomy for patients with high-grade carotid lesions
Routine screening for carotid artery stenosis with auscultation for bruits
Smoking cessation and treatment of hypertension
81 mg of aspirin daily
What is the most common cause of Cushing’s syndrome?
Excessive ACTH production
Administration of a glucocorticoid or ACTH
Pituitary adenoma or a non-pituitary ACTH-producing tumor
Autonomous cortisol production from adrenal tissue
Administration of a glucocorticoid or ACTH
Diagnostic radiological studies are indicated for low back pain:
Routinely after 3 weeks of low back pain symptoms.
To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain
When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection
As a part of a pre-employment physical when heavy lifting is included in the job description.
When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection
After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured?
An enzyme-linked immunosorbent assay titer
A urea breath test
A rapid urease test
A repeat endoscopy
A urea breath test
Which appropriate test for the initial assessment of Alzheimer’s disease provides the performance ratings on 10 complex, higher order activities?
MMSE
CAGE questionnaire
FAQ - Functional Activities Questionnaire
Holmes and Rahe social readjustment scale
FAQ - Functional Activities Questionnaire
Major depression occurs most often in which of the following conditions?
A. Myocardial infarction
Parkinson’s disease
Stroke
Alzheimer’s disease
Stroke
Which of the following statements about multiple sclerosis (MS) is correct?
MS is a chronic, untreatable illness that is almost always fatal.
MS is a disease of steadily progressive and unrelenting neurologic deterioration.
MS is a chronic, treatable illness with unknown cause and a variable course.
Patients with MS who take active steps to improve their health have the best cure rate.
MS is a chronic, treatable illness with unknown cause and a variable course
Diagnostic evaluation of hypothyroidism reveals:
Elevated TSH and decreased T4
Decreased TSH and increased T4
Decreased TSH and decreased T3
Elevated TSH and increased T4
Elevated TSH and decreased T4
Risk factors for prostate cancer include all of the following except:
Family history
Benign prostatic hypertrophy
African American race
Age
Benign prostatic hypertrophy
What information should patients with diabetes and their families receive about hypoglycemia?
Hypoglycemia is a rare complication.
Hypoglycemia requires professional medical treatment.
Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly.
Hypoglycemia occurs only as a result of insulin overdose.
Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly.
Which history is commonly found in a patient with glomerulonephritis?
Beta-hemolytic strep infection
Frequent urinary tract infections
Kidney stones
Hypotension
Beta-hemolytic strep infection
Which of the following is characteristic of a manic episode?
weight loss of gain
insomnia or hypersomnia
diminished ability to think or concentrate
grandiose delusions
grandiose delusions
Central obesity, “moon” face, and dorsocervical fat pad are associated with:
Metabolic syndrome
Unilateral pheochromocytoma
Cushing’s syndrome
None of the above
Cushing’s syndrome
Which of the following is the most common cause of low back pain?
Lumbar disc disease
Spinal stenosis
Traumatic fracture
Osteoporosis
Lumbar disc disease
A middle-aged female presents complaining of recent weight loss. The physical exam reveals an enlarged painless cervical lymph node. The differential diagnosis for this patient’s problem includes:
Infection Toxoplasmosis Mononucleosis All of the above None of the above
Infection
An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects?
Weight gain
Fracture risk
Hypoglycemia
Weight loss
Hypoglycemia
A patient has HIV infection and is having a problem with massive diarrhea. You suspect the cause is
cryptococcosis
toxoplasmosis
cryptosporidiosis
cytomegalovirus
cryptosporidiosis
Which of the following is the most common causative organism of nongonococcal urethritis?
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Trichonomas vaginalis
Chlamydia trachomatis
The most common symptoms of transient ischemic attack (TIA) include
Nausea, vomiting, syncope, incontinence, dizziness, and seizure.
Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes.
Headache and visual symptoms such as bright spots or sparkles crossing the visual field.
Gradual onset of ataxia, vertigo, generalized weakness, or lightheadedness
Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes.
What is the first symptom seen in the majority of patients with Parkinson’s disease?
Rigidity
Bradykinesia
Rest tremor
Flexed posture
Rest tremor
A 21-year-old female presents to the office complaining of urinary frequency and urinary burning. The nurse practitioner suspects a urinary tract infection when the urinalysis reveals
1-4 red blood cells per high-powered field
Specific gravity 1.012
Urobilinogen
10- white blood cells per high-powered field
10- white blood cells per high-powered field
A 26 year old female presents with elbow pain that is described as aching and burning. There is point tenderness along the lateral aspect of the elbow and painful passive flexion and extension. She reports she has been playing tennis almost daily for the past month. The most likely diagnosis is:
Radial tunnel syndrome
Ulnar collateral ligament sprain
Olecranon bursitis
Lateral epicondylitis: Tennis Elbow
Lateral epicondylitis: Tennis Elbow
Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis?
Depression
Panic disorder
Anxiety
Post-traumatic stress disorder
Post-traumatic stress disorder
An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient’s pain is:
Trauma
Tight shoes
Arthritis flare
Hydrochlorothiazide
Hydrochlorothiazide
Which of the following is a contraindication for metformin therapy?
Insulin therapy
Creatinine > 1.5
Edema
None of the above
Creatinine > 1.5
A positive drawer sign supports a diagnosis of:
Sciatica
Cruciate ligament injury
Meniscal injury
Patellar ligament injury
Cruciate ligament injury
Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?
Apples
Peppermint
Cucumbers
Popsicles
Peppermint
A patient taking levothyroxine is being over-replaced. What condition is he at risk for?
Osteoporosis
Constipation
Depression
Exopthalmia
Osteoporosis
Diabetes screening recommendations for asymptomatic adults age 45 and over include which of the following:
HbA1C
2-hour 75 gram oral glucose tolerance test
C-peptide level
A and B
All of the above
A and B
Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action?
Prescribe systemic antibiotics
Prescribe antibiotic ear drops
Prescribe nasal steroids and oral decongestants
Refer him to an ear, nose, and throat specialist
Prescribe nasal steroids and oral decongestants
Josh, age 22, is a stock boy and has an acute episode of low back pain. You order and NSAID and tell him which of the following?
Maintain moderate bed rest for 3-4 days
Call the office for narcotics if there is no relief with the NSAID in 24-48 hours
Begin lower back strengthening exercises depending on pain tolerance
Wear a Boston brace at night
Begin lower back strengthening exercises depending on pain tolerance
Risk factors for Addison’s disease include which of the following?
Tuberculosis
Autoimmune disease
AIDS
All of the above
All of the above
Urine cultures should be obtained for which of the following patients?
Suspected urinary tract infection in pregnancy
Febrile patients
Young men
All of the above
All of the above
Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?
“Caffeine has not effect on osteoporosis.”
“A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.”
“Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix.”
“Caffeine increase bone resorption.”
“A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.”
The diagnosis which must be considered in a patient who presents with a severe headache of sudden onset, with neck stiffness and fever, is:
Migraine headache
Subarachnoid hemorrhage
Glaucoma
Meningitis
Meningitis
What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?
You must initiate the plan of care for the patient
The physician must be on-site and engaged in patient care
You must be employed as an independent contractor
You must be the main health care provider who sees the patient
The physician must be on-site and engaged in patient care
The most commonly recommended method for prostate cancer screening in a 55 year old male is:
Digital rectal examination (DRE) plus prostate specific antigen (PSA)
Prostate specific antigen (PSA) alone
Transrectal ultrasound (TRUS) alone
Prostate specific antigen (PSA) and transrectal ultrasound (TRUS)
Digital rectal examination (DRE) plus prostate specific antigen (PSA)
The primary goals of treatment for patients with alcohol abuse disorder are:
Reduction in withdrawal symptoms and reduction in desire for alcohol
Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol
Abstinence or reduction in use, relapse prevention, and rehabilitation
Marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment
Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol
You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the:
Lateral meniscus
Cruciate ligament
Medical meniscus
Collateral ligament
Cruciate ligament
Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia?
Musculoskeletal pain
Difficulty sleeping
Depression
Fatigue
Musculoskeletal pain
Differential diagnosis of proteinuria includes which of the following?
Orthostatic proteinuria
Nephrotic syndrome
Infection
Trauma
A and B
A and B
A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as:
Underweight
Normal weight
Overweight
Obese
Overweight
Reed-Sternberg B lymphocytes are associated with which of the following disorders:
Aplastic anemia
Hodgkin’s lymphoma
Non Hodgkin’s lymphoma
Myelodysplastic syndromes
Hodgkin’s lymphoma
A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects:
Arthritis Ulnar
neuritis
Septic arthritis
Olecranon bursitis
Olecranon bursitis
Establishment of a definitive diagnosis of osteomyelitis requires:
A known causative injury such as a puncture wound, bite, or decubitus ulcer.
Biopsy of culture of the pathogen from blood or bone aspirate.
Visualization of purulent material draining into soft tissue.
Lucent areas identified on plain x-ray.
Biopsy of culture of the pathogen from blood or bone
The most accurate measure of diabetes control is:
Avoidance of micro- and macro-vascular complications.
Insulin sensitivity.
Early morning glucose levels.
HgbA1c
HgbA1c
A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder?
Alprazolam or diazepam
Venlafaxine or buspirone
Trazodone or sertraline
Venlafaxine or hydroxyzine pamoate
Alprazolam or diazepam
The most common presentation of thyroid cancer is:
Generalized enlargement of the thyroid gland.
A solitary thyroid nodule.
A multinodular goiter.
Abnormal thyroid function tests.
Generalized enlargement of the thyroid gland.
Which of the following accounts for half of the bladder tumors among men and one-third in women?
Cigarette smoke, both active and passive inhalation
Chemicals from plastic and rubber
Chronic use of phenacetin-containing analgesic agents
Working long hours and not voiding often
Cigarette smoke, both active and passive inhalation
You have a new patient that presents with generalized lymphadenopathy. You know that this is indicative of:
Sjogren’s syndrome
Pancreatic cancer
Disseminated malignancy of the hematologic system
Cancer of the liver
Disseminated malignancy of the hematologic system
Sally, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to:
Refer her to a hand surgeon
Take a more complete history
Try neutral position wrist splinting and oral NSAID
Order a nerve conduction study such as am electromyography
Try neutral position wrist splinting and oral NSAID
Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
Corticosteroids
Inhaled beta-2 agonist bronchodilators
Inhaled anticholinergic bronchodilators
Xanthines
Inhaled beta-2 agonist bronchodilators
Potential causes of septic arthritis include which of the following?
Lyme disease
Prosthetic joint infection
Reiter’s syndrome
A and B
All of the above
A and B
The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is:
Oral ciprofloxacin (Cipro)
Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
Oral trimethoprim-sulfamethoxazole (Bactrim DS)
Intramuscular penicillin
Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is:
Oral ciprofloxacin (Cipro)
Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
Oral trimethoprim-sulfamethoxazole (Bactrim DS)
Intramuscular penicillin
Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
A patient has been taking fluoxetine (Prozac) since being diagnosed with major depression, first episode, 2 months ago. She reports considerable improvement in her symptoms and her intention to discontinue the medication. What should be the nurse practitioner’s recommendation?
Advise the patient to stop the antidepressant medication
Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication
Recommend that the patient continue the antidepressant medication for at least 4 more months
Discuss with the patient the need to take the antidepressant medication indefinitely
Recommend that the patient continue the antidepressant medication for at least 4 more months
A patient has been taking fluoxetine (Prozac) since being diagnosed with major depression, first episode, 2 months ago. She reports considerable improvement in her symptoms and her intention to discontinue the medication. What should be the nurse practitioner’s recommendation?
Advise the patient to stop the antidepressant medication
Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication
Recommend that the patient continue the antidepressant medication for at least 4 more months
Discuss with the patient the need to take the antidepressant medication indefinitely
Recommend that the patient continue the antidepressant medication for at least 4 more months
Your patient has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis?
Iron-deficiency anemia
Hemolytic anemia
Lead poisoning
Liver disease
Liver disease
Which of the following medications increase the risk for metabolic syndrome?
Antihistamines
Proton pump inhibitors
Protease inhibitors
A and C
All of the above
All of the above
The hallmark of neurofibromatosis (von Recklinghausen’s disease) present in almost 100% of patients is
Acoustic neuroma
Astrocytoma of the retina
Distinctive osseous lesions
Café au lait spots
Café au lait spots
The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:
Acetaminophen or an NSAID
A muscle relaxant as an adjunct to an NSAID
An oral corticosteroid and diazepam (Valium)
Colchicine and an opioid analgesic
Acetaminophen or an NSAID
Legal authority for advanced practice nursing rests with:
The Health Care Financing Administration
Federal statutes
State laws and regulations
Certifying bodies
State laws and regulations
Which of the following physical modalities recommended for treatment of rheumatoid arthritis provides the most effective long term pain relief?
Superficial and deep heat
Application of cold
Transcutaneous electrical nerve stimulation (TENS)
Exercise
Transcutaneous electrical nerve stimulation (TENS)
A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take?
Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
Obtain a diet history and check CBC and FBS.
Provide nutritional guidance and have the patient return in 1 month.
Consult home health for intravenous administration of fluids and electrolytes.
Obtain a thorough history and physical, and check serum cortisol and ACTH levels
Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be?
Start him on an ACE Inhibitor
Start him on a diuretic
Have him monitor his blood pressure at home
Try nonpharmacological methods and have him monitor his blood pressure at home
Try nonpharmacological methods and have him monitor his blood pressure at home
Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is:
Parkinson’s disease
Epilepsy
Multiple sclerosis
Diabetes mellitus
Diabetes mellitus
Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?
Hypertriglyceridemia and low high-density lipoprotein (HDL)
Gestational diabetes and polycystic ovarian syndrome
Hispanic, African-American, Native-American, and Pacific Islander ethnicity
Postprandial hypoglycemia
Postprandial hypoglycemia
A 28-year-old female presents to the office requesting testing for diagnosis of hereditary thrombophilia. Her father recently had a deep vein thrombosis and she is concerned about her risk factors. The nurse practitioner explains that:
The patient should start anticoagulant therapy immediately.
Hereditary thrombophilia does not always require anticoagulation therapy. Women of childbearing age cannot take anticoagulant therapy.
Genetic and risk management counseling are recommended.
B and D
B and D
The 4 classic features of Parkinson’s disease are
Mask-like facies, dysarthria, excessive salivation, and dementia.
Tremor at rest, rigidity, bradykinesia, and postural disturbances.
Depression, cognitive impairment, constipation and shuffling gait.
Tremor with movement, cogwheeling, repetitive movement, and multi-system atrophy.
Mask-like facies, dysarthria, excessive salivation, and dementia.
Which of the following set of symptoms should raise suspicion of a brain tumor?
Recurrent, severe headaches that awaken the patient and are accompanied by visual disturbances.
Vague, dull headaches that are accompanied by a reported sense of impending doom.
Periorbital headaches occurring primarily in the evening and accompanied by pupillary dilation and photophobia.
Holocranial headaches present in the morning and accompanied by projective vomiting without nausea.
Holocranial headaches present in the morning and accompanied by projective vomiting without nausea.
The most common cause of elevated liver function tests is:
Hepatitis
Biliary tract obstruction
Chronic alcohol abuse
A drug-induced injury
Hepatitis
The physiological explanation of syncope is:
Accelerated venous return and increased stroke volume resulting in deactivation of the parasympathetic nervous system.
A cycle of inappropriate vasodilation, bradycardia, and hypotension.
A sudden rise in blood pressure due to overly efficient vasoconstriction.
Emotional stress resulting in hypertension, tachycardia, and increased venous return.
A cycle of inappropriate vasodilation, bradycardia, and hypotension
A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem?
Thiazide diuretic
Insulin
Famotidine (Pepcid)
Albuterol
Thiazide diuretic
The cardinal sign of infectious arthritis is:
Affected joint is painful at rest, with movement and weight bearing
Rapid onset that wakes the patient during the night
Long history of severe pain with associated joint swelling
None of the above
Affected joint is painful at rest, with movement and weight bearing
A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains:
Primary hyperparathyroidism is treated with Vitamin D restriction
Primary hyperparathyroidism is treated with parathyroidectomy
Primary hyperparathyroidism is treated with daily magnesium
Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)
Primary hyperparathyroidism is treated with parathyroidectomy
Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis?
Doxycycline 100 mg qd
Nitrofurantoin 100 mg qd
Bactrim DS qd
Erythromycin qd
Erythromycin qd
Who is at a higher risk for developing nephrolithiasis?
Jack, who exercises every day and drinks copious amounts of water
Mary, who watches her weight and eats a low-sodium diet
Harvey, a “couch potato” who drinks a lot of no-sodium soda
Bill, who runs every day and takes excessive amounts of vitamin C
Bill, who runs every day and takes excessive amounts of vitamin C
Potential side effects of levofloxacin include which of the following?
Confusion
Hypoglycemia
Achilles tendon rupture
All of the above
All of the above
A patient has just been diagnosed with Bell’s palsy. He is understandably upset and has questions about the prognosis. You response should be:
Although most of your symptoms will disappear, some will remain but can usually be camouflaged by altering your hairstyle or growing a beard
Unfortunately there is no cure but you have a mild case
The condition is self-limiting and most likely complete recovery will occur
With suppressive drug therapy you can minimize the symptoms
The condition is self-limiting and most likely complete recovery will occur
A diabetic patient is taking low-dose enalapril for hypertension. A record of the patient’s blood pressure over 4 weeks ranges from 130 to 142 mmHg systolic and 75 to 85 mmHg diastolic. How should the nurse practitioner respond?
Change to a different class of antihypertensive medication to get better control.
Increase the dosage of the current BP medication.
Continue the current medication and dosage for 4 more weeks.
Add a beta-blocker to the current medication regimen.
Increase the dosage of the current BP medication.
What diabetic complications result from hyperglycemia?
- Retinopathy
- Hypertension resistant to treatment
- Peripheral neuropathy
- Accelerated atherogenesis
1, 2, 3
Diagnostic confirmation of acute leukemia is based on:
Bone marrow aspiration and biopsy
Pancytopenia
Hyperuricemia
All of the above
Bone marrow aspiration and biopsy
The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy:
A dipstick strip done during routine urinalysis in the office
A 24-hour urine collection
An early morning spot urine collection
A serum albumin test
A serum albumin test
Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester?
Trimethoprim-sulfamethoxazole
Erythromycin
Cefuroxime
Levofloxacin
Trimethoprim-sulfamethoxazole
Martin, a 58 year old male with diabetes, is at your office for his diabetes follow up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Martin receive today regarding the care if his feet?
Wash your feet with cold water daily
See a podiatrist every 2 years, inspect your own feet monthly, and apply lotion to your feet daily Go to a spa and have a pedicure monthly
See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes;
inspect your feet daily for lesions; apply lotion to dry areas
See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes;
The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is:
Psychotherapy
Electroconvulsive therapy (ECT)
A selective serotonin reuptake inhibitor (SSRI)
A tricyclic antidepressant (TCA)
Electroconvulsive therapy (ECT)
The initial clinical sign of Dupuytren’s contracture is:
Pain with ulnar deviation
Painless nodule on palmer fascia
Pain and numbness in the ring finger
Inability to passively extend finger
Painless nodule on palmer fascia
Which of the following is the most common complication of the myelodysplastic syndromes
Fatigue
Cardiomyopathy
Falls
Bleeding
Bleeding
What information should a 42 year old patient with newly diagnosed diabetes receive about exercise?
Buy good walking shoes with support and a flexible sole.
Exercise at least 5 days per week.
Snack before exercise.
Do not exercise if your blood sugar is greater than 180 mg/dL
Snack before exercise.
What is the most commonly abused substance?
Heroin
Cocaine
Alcohol
Marijuana
Alcohol
Sam, age 67, is a diabetic with worsening renal function. He has frequent hypoglycemic episodes, which he believes means that his diabetes is getting “better.” How do you respond?
“You’re right; it seems like your diabetes is improving.”
“Because your kidneys are not functioning well, your insulin is not being metabolized and excreted as it should, so you need less of it.”
“You have watched your diet for all these years and as a result, your body is using less insulin.”
“I will have to change your oral hyperglycemic agents as it seems your body is making more insulin.”
“Because your kidneys are not functioning well, your insulin is not being metabolized and excreted as it should, so you need less of it.”
A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition?
Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am.
Instruct the child’s parents on physical activities to help weight loss.
Increase the evening insulin dose and check CBG at 2:00 am.
Refer the child for instruction on a strict diabetic diet.
Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am
At what age is screening most likely to detect scoliosis?
4 to 6 years
8 to 10 years
12 to 14 years
18 to 20 years
12 to 14 years
The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are)
Patient report of bladder dysfunction, saddle anesthesia, and motor weakness of limbs.
History of significant trauma relative to the patient’s age.
Decreased reflexes, strength, and sensation in the lower extremities.
Patient report of pain with the crossed straight leg raise.
Decreased reflexes, strength, and sensation in the lower extremities.
A patient who has had a swollen, nontender scrotum for one week is found to have a mass within the tunica vaginalis that transilluminates readily. The family nurse practitioner suspects:
a. ) a hydrocele.
b. ) a varicocele.
c. ) an indirect inguinal hernia.
d. ) carcinoma of the testis.
a.) a hydrocele
A client had excessive blood loss and prolonged hypotension during surgery. His postoperative urine output is sharply decreased, and his blood urea nitrogen (BUN) is elevated. The most likely cause for the change is acute:
A) Prerenal inflammation
B) Bladder outlet obstruction
C) Tubular necrosis
D) Intrarenal nephrotoxicity
B) Bladder outlet obstruction
Mr. S. comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are normal. Which of the following conditions outside of the scrotum may present as scrotal pain?
A. Inguinal herniation and peritonitis
B. Renal colic and cardiac ischemia
C. Pancreatitis and Crohn ‘ s disease
D. Polyarteritis nodosa and ulcerative colitis
A. Inguinal herniation and peritonitis
The most common type of hernia is a(n): A. indirect inguinal hernia. B. direct inguinal hernia. C. femoral hernia. D. umbilical hernia.
A. indirect inguinal
Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months. He states that it is not painful, but it is annoying. You note that the origin of swelling is above the inguinal ligament directly behind and through the external ring. You diagnose this as a(n):
A. indirect inguinal hernia.
B. direct inguinal hernia.
C. femoral hernia.
D. strangulated hernia.
direct inguinal hernia.
A 35 year old sexually active man presents with a 1 week history of fever and pain over the left scrotum. It is accompanied by frequency and dysuria. The scrotum is edematous and tender to touch. He denies flank pain, nausea, and vomiting. He reports that eh pain is lessend when he uses scrotal-support briefs. The urinalysis shows 2 + blood and a large number of leukocytes. What is the most likely diagnosis?
A. Acute urinary tract infection
B. Acute pyelonephritis
C. Acute orthitis
D. Acute epididymitis
D. Acute epididymitis
Orchitis is caused by which of the following?
A. Mumps virus
B. Measles virus
C. Chlamydia trachomatis
D. Chronic urinary tract infections that are not treated adequately
A. Mumps virus
A 10 year old boy complains of sudden onset of scrotal pain upon awakening that morning. He is also complaining of severe nausea and vomiting. During the physical examination, the nurse practitioner finds a tender, warm, and swollen left scrotum. The cremastic reflex is negative and the urine dipstick is negative for leukocytes, nitrites, and blood. The most likely diagnosis is:
A. Acute epididymitis
B. Severe salmonella infection
C. Testicular torsion
D. Acute orchitis
C. Testicular torsion
What type of follow up should this patient receive?
A. Refer to a urologist within 48 hours
B. Refer him to the emergency department as soon as possible
C. Prescribe ibuprofen (advil) 600 mg QID for pain
D. Order a testicular ultrasound for further evaluation
B. Refer him to the emergency department as soon as possible
A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having
intermittent unilateral testicular pain in the past but not as severe as this current episode. Confirmation of testicular torsion would include all of the following findings except:
A. unilateral loss of the cremasteric reflex.
B. the affected testicle held higher in the scrotum.
C. testicular swelling.
D. relief of pain with scrotal elevation.
D. relief of pain with scrotal elevation.
In assessing a man with testicular torsion, the NP is most likely to note:
A. elevated PSA level.
B. white blood cells reported in urinalysis.
C. left testicle most often affected.
D. increased testicular blood flow by color-flow Doppler ultrasound.
C. left testicle most often affected.
Anticipated organ survival exceeds 85% with testicular decompression within how many hours of torsion?
A. 1
B. 6
C. 16
D. 24
B. 6
To prevent a recurrence of testicular torsion, which of the following is recommended?
A. use of a scrotal support
B. avoidance of testicular trauma
C. orchiopexy
D. limiting the number of sexual partners
C. orchiopexy
Jordan appears with a rapid onset of unilateral scrotal pain radiating up to the groin and flank. You
are trying to differentiate between epididymitis and testicular torsion. Which test to determine whether swelling is in the testis or the epididymis should be your first choice?
A. X-ray
B. Ultrasound
C. Technetium scan
D. Physical examination
B. Ultrasound
The nurse practitioner recognizes that the most common cause of epididymitis in a young man is:
A chlamydia
B E. coli
C mycoplasma
D Proteus species
A chlamydia
Your 25-year-old male patient has had a fever, dysuria, low back pain, and scrotal edema. Which of the following is likely the diagnosis?
A acute bacteria prostatitis
B acute pyelonephritis
C epididymitis
D urinary tract infection
C epididymitis
The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to:
reduce action of androgens in the prostate.
The action of a 5 alpha-reductace inhibitor in the treatment of BPH is to:
reduce action of androgens in the prostate.
Milton, a 72 year old unmarried, sexually active white man presents to your clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although you suspect benign prostatic hypertrophy, what else should your differential diagnosis include?
Urethral stricture (may develop as a result of sexually transmitted diseases and should be considered in a sexually active individual no matter what the age)
Harry has BPH and complains of some incontinence. Your first step in diagnosing overflow incontinence would be to order a:
Post void residual urine measurement
Lower urinary tract symptoms in males can present as a constellation of storage or voiding symptoms. Storage symptoms include:
urgency and nocturia
A 63-year-old man presents to you with hematuria, hesitancy, and dribbling. DRE reveals a moderately enlarged prostate that is smooth. The client’s PSA is 1.2. What is the most appropriate management strategy for you to follow at this time?
Prescribe an alpha adrenergic blocker, which will relax bladder and prostate smooth muscle to improve flow and relieve symptoms.
According to the AUA guideline on the management of BPH, when is referral for invasive surgery automatically warranted?
With the presence of refractory retention and bladder stones.
What differentiates prostate cancer symptoms from BPH?
Symptoms of prostate cancer in general tend to progress more rapidly than those of BPH.
The most common gram-negative bacteria that causes both acute and chronic bacterial prostatitis is
A. Staphylococcus aureus
B. Klebsiella
C. Escherichia coli
D. Enterobacteriaceae
C. Escherichia coli
A history of urinary tract infections in males is often seen in men with chronic bacterial prostatitis. Other signs and symptoms of chronic bacterial prostatitis includes
A. irritative voiding symptoms, low back pain, and perineal pain.
B. nausea and vomiting, as well as fever.
C. loss of appetite and weight loss.
D. irritative voiding symptoms, inability to ambulate, and fever.
A. irritative voiding symptoms, low back pain, and perineal pain.
When performing a prostate examination, you note a tender, warm prostate. What do you suspect?
A. Benign prostatic hypertrophy
B. Prostatic abscess
C. Prostate cancer
D. Bacterial prostatitis
D. Bacterial prostatitis
Gerard is complaining of a scrotal mass; however, the scrotum is so edematous that it is difficult to assess. How do you determine if it is a hernia or a hydrocele?
Bowel sounds may be heard over a hernia.
Mr. S comes to you with scrotal pain. The examinations of his scrotum, penis, and rectum are normal. Which of the following conditions outside of the scrotum may present as scrotal pain?
Inguinal hernia and peritonitis
A 17 year old boy reports feeling something on his left scrotum. On palpation, soft and movable
blood vessels that feel like a “bag of worms” are noted underneath the scrotal skin. It is not swollen or reddened. The most likely diagnosis is
A. Chronic orchitis
B. Chronic epididymitis
C. Testicular torsion
D. Varicocele
D. Varicocele
What risk factors contribute to varicocele?
A. Younger age
B. Current cigarette smoker
C. Multiple sex partners
D. None of the above
D. None of the above
Treatment options for varicocele repair include all of the following except: A. Open surgery B. Laparoscopic surgery C. Treatment with a thrombolytic agent D. Percutaneous embolization
C. Treatment with a thrombolytic agent
There is a higher risk of balanitis in which of the following conditions?
A. Renal Insufficiency
B. Diabetes Mellitus
C. Graves’ disease
D. Asthma
B. Diabetes Mellitus
Balanitis is caused by:
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Candida albicans
D. Trichomonads
C. Candida albicans
Balanitis is a symptom of which one of the following diseases
A. Psoriatic arthritis
B. Reactive arthritis
C. Alkylosing Spondylitis
D. Rheumatoid arthritis
B. Reactive arthritis
The average American man has an approximately % lifetime risk of prostate cancer and an approximately % likelihood of clinical disease.
A. 15, 5
B. 25, 8
C. 40, 10
D. 60, 15
C. 40, 10
All of the following can cause an elevated PSA level except:
A. Current prostate infection
B. Recent cystoscopy
C. BPH
D. Prostatectomy
D. Prostatectomy
According to recent epidemiologic studies, prostate cancer is the number cause of cancer death in men residing within the US. (B)
A. 1
B. 2
C. 3
D. 4
B. 2
You perform a DRE on a 72-year old man and find a lesion suspicious for prostate cancer. The findings are described as:
A. a rubbery, enlarged prostatic lobe.
B. an area of prostatic induration
C. a boggy gland.
D. prostatic tenderness
B. an area of prostatic induration
A 54 year old white man with no obvious risk for prostate cancer opted to undergo PSA screening and DRE testing. The DRE findings are normal and his PSA is 3..7ng/ml. You recommend:
A. Repeating the PSA test immediately.
B. Repeat screening in 1 yr.
C. Repeat screening in 2 yrs.
D. Repeat screening in 5 yrs.
B. Repeat screening in 1 yr.
Which of the following mediations is associated with the highest incidence of erectile dysfunction?
a. Lamotrigine (Lamictal)
b. Clonazepam (Klonopin)
c. Paroxetine (Paxil)
d. Doxepin (Sinequan)
c. Paroxetine (Paxil)
Which of the following is not a common risk factor for erectile dysfunction (ED)?
A. diabetes mellitus
B. hypertension
C. cigarette smoking
D. testosterone deficiency
testosterone deficiency
When taking a phosphodiesterase-5 (PDE-5) inhibitor, concomitant use of which medication must be avoided?
A. statins
B. sulfonylurea
C. angiotensin-converting enzyme (ACE) inhibitors
D. nitrates
D. nitrates
What percent of patients with genital warts have spontaneous regression of the lesions? a. A. 10%
B. 50%
C. 25%
D. 75%
B. 50%
Which HPV types are the most likely to cause genital warts or condyloma acuminatum?
A. 1,2, & 3
B. 16 & 18
C. 6 & 11
D. 22 & 24
C. 6 & 11
Treatment for patients with condyloma acuminatum include all of the following except:
A. Topical acyclovir
B. Podofilox
C. cryotherapy
D. trichloroacetic acid
A. Topical acyclovir
What antibiotic would you expect NOT to give to a pregnant woman with a UTI?
Bactrim - TMP
avoid use during pregnancy secondary to possible risk of teratogenicity
What is the most common symptom of upper UTI in young children?
Fever
What lab result will be altered if a patient has taken an antibiotic?
Urine Culture
What is the preferred method to collect a urine specimen in children who are not toilet-trained?
catheterization
When would you consider a CT scan or renal ultrasound for patients with acute pyelonephritis?
If the
patient has not improved after 48-72 hours on an appropriate antibiotic.
What four reasons would you consider the infection complicated until proven otherwise?
If the
patient is a man, an older adult, or child, or has symptoms lasting more than 7 days
What medication would you expect not to use in acute pyelonephritis?
Do not use nitrofurantoin
because poor tissue concentrations are achieved in the renal parenchyma
To decrease the production of uric acid stones, the family nurse practitioner orders which medication?
A. allopurinol (zyloprim)
B. indomethacin (indocin)
C. bethanechol (urecholine)
D. phenazopyridine (pyridium)
A. allopurinol (zyloprim)
You see a 58-year-old man diagnosed with a kidney stone who reports pain primarily during urination. You consider all of the following except:
A. improved hydration.
B. alpha blocker use.
C. prescribing a diuretic.
D. analgesia use
C. prescribing a diuretic.
Your 35-year-old patient is being worked up for microscopic hematuria. All of the following are differential diagnoses of microscopic hematuria except:
A) Kidney stones
B) Bladder cancer 527
C) Acute pyelonephritis
D) Renal artery stenosis
Renal artery stenosis
A 65-year-old carpenter complains of stiffness and pain in both hands and right knee shortly after waking and worsens in the afternoon. He feels some relief with rest. On, exam the nurse practitioner notices the presence of Heberden’s nodes. Which of the following is most likely?
a. Osteoporosis
b. Rheumatoid Arthritis
c. Osteoarthritis
d. Reiter’s syndrome
c. Osteoarthritis
Mary, age 72, has severe osteoarthritis of her right knee. She obtains much relief from corticosteroid injections. When she asks you how often she can have them, how do you respond?
A. Only once a year in the same joint
B. No more than twice a year in the same joint
C. No more than three to four times a year in the same joint
D. No more than five to six times a year in the same joint
C. No more than three to four times a year in the same joint
Your 75-year-old client with osteoarthritis of the knee will be starting on a course of NSAIDs for pain management. The most important teaching point for your patient currently is:
A. You should start with a high dose first and taper down the dose as needed.
B. You should continue to take your Coumadin as you have been.
C. Report any excessive stomach upset or if you notice that your stools become dark or bloody.
D. At this point, it will not be helpful to lose weight.
C. Report any excessive stomach upset or if you notice that your stools become dark or bloody.
A 45-year-old woman in complaining of generalized stiffness, especially in both her wrist and hands. It is much worse in the morning and last a few hours. She also complains of fatigue and generalized body aches that have been present for the past few months. Which of the following is most likely?
a. Osteoporosis
b. Rheumatoid arthritis
c. Osteoarthritis
d. Gout
b. Rheumatoid arthritis
Ginny, age 48, has rheumatoid arthritis and gets achy and stiff after sitting through a long movie. This is referred to as
A. longevity stiffness
B. gelling
C. intermittent arthritis
D. molding
B. gelling
Mrs. Matthews has rheumatoid arthritis. On reviewing an x-ray of her hip, you notice that there is a marked absence of articular cartilage. What mechanism is responsible for this? A. Antigen-antibody formation B. Lymphocyte response C. Immune complex formation D. Lysosomal degradation
D. Lysosomal degradation
treatment for Myasthenia Gravis Includes: A. IVIG or Plasmapheresis B. Antibiotics C. Analgesic's D. Sedation
A. IVIG or Plasmapheresis
What specific treatment is given patients diagnosed with Myasthenia Gravis that will focus on improving conduction? A. Surgery B. Physical Therapy C. Mestinon (pyridostigmine) Neostigmine D. Fluroquinolones
C. Mestinon (pyridostigmine) Neostigmine
First-line treatment of SLE in a patient with mild symptoms is: A. systemic corticosteroids. B. hydroxychloroquine plus NSAIDs. C. anakinra. D. methotrexate.
B. hydroxychloroquine plus NSAIDs.
Common physical findings of SLE include all the following except:
A. weight gain.
B. joint pain and swelling.
C. fatigue.
D. facial rash.
A. weight gain.
Which of the following is not characteristic of rheumatoid arthritis (RA)?
A. It is more common in women than in men at a 3:1 ratio.
B. Family history of autoimmune conditions often is reported.
C. Peak age for disease onset in individuals is age 50 to 70 years.
D. Wrists, ankles, and toes often are involved.
C. Peak age for disease onset in individuals is age 50 to 70 years.
The use of all of the following medications can trigger gout except:
A. aspirin.
B. statins.
C. diuretics.
D. niacin.
B. statins.
Which of the following dietary supplements is associated with increased risk for gout?
A. vitamin A
B. gingko biloba
C. brewer’s yeast
D. glucosamine
C. brewer’s yeast
Which of the following conditions places a patient at an increased risk of plantar fasciitis?
A. Diabetes
B. Pregnancy
C. Alcoholism
D. Thyroid disease
A. Diabetes
A 48-year old obese female presents to the clinic with complain of pain on the bottom of her feet with the first few steps in the morning that gets worse with prolonged walking. You would suspect:
A. Gout
B. Morton’s Neuroma
C. Rheumatoid Arthritis
D. Plantar fasciitis
D. Plantar fasciitis
Which of the following is used to evaluate patients with medial collateral ligament injury?
a. Varus test
b. McMurray test
c. Lachman test
d. Valgus test
c. Lachman test
The Lachman maneuver is used to detect which of the following?
A. instability of the knee
B. nerve damage of the knee due to past knee injuries
C. integrity of the patellar tendon
D. tears on the meniscus of the
D. tears on the meniscus of the
A positive drawer sign supports a diagnosis of:
a. sciatica
b. cruciate ligament injury
c. hip dislocation
d. patellar ligament injury
b. cruciate ligament injury
A 15-year-old high school athlete complains of a painful area below both knees. He tells you they feel bone-like and are tender to palpation. He denies any hot joints, fever, rash, or difficulties with weight- bearing. Which of the following conditions is most likely?
a) osteomyelitis
b) internal tibial torsion
c) Osgood-Schlatter Disease
d) Calve-Perthe’s Disease
c) Osgood-Schlatter Disease
When caring for the child with Osgood-Schlatter Disease, the nurse practitioner would know her treatment has been effective when
a. The child no longer complains of pain at lower knee at rest
b. The child no longer complains of pain at the ankle at rest.
c. The child no longer complains of pain at the hip during exercise.
d. The child no longer complains of pain at lower knee during exercise.
d. The child no longer complains of pain at lower knee during exercise.
Common risk factors for Osgood Schlatter Disease include:
a. Highly active with open growth plates
b. Significant Growth Spurt
c. Typically asymmetrical but can occur bilaterally
d. Boys> Girls
e. All of the above
e. All of the above
What must you you do to diagnose a distal femur, patellar, and proximal tibia fracture?
Obtain imaging according to Ottawa knee rules
What are the key physical findings of patellar fractures?
palpable DEFECT on patella, HEMARTHROSIS, Failure to do STRAIGHT LEG RAISE = failure of EXTENSOR MECHANISM (retinaculum displaced)
Heidi, age 29, is a nurse who has an acute episode of back pain. You have determined that it is a simple “mechanical” backache and order
A) Bedrest for 2 days
B) Muscle relaxants
C) “Let pain be your guide” and continue activities
D) Back-strengthening exercises
C) “Let pain be your guide” and continue activities
Beth, age 49, comes in with low back pain. An x-ray of the lumbar/sacral spine is within normal limits. Which of the following diagnoses do you explore further? A. Scoliosis B. Osteoarthritis C. Spinal stenosis D. Herniated nucleus pulposus
D. Herniated nucleus pulposus
John, age 17, works as a stock boy at the local supermarket. He is in the office for a routine visit. You notice that he had an episode of low back pain 6 months ago from improperly lifting heavy boxes. In discussing proper body mechanics with him to prevent future injuries, you tell him,
A. “ Bend your knees and face the object straight on. “
B. “ Hold boxes away from your body at arm ‘s length. “
C. “ Bend and twist simultaneously as you lift. “
D. “ Keep your feet firmly together.
A. “ Bend your knees and face the object straight on. “
With the straight-leg-raising test, the NP is evaluating tension on which of the following nerve roots? A. L1 and L2 B. L3 and L4 C. L5 and S1 D. S2 and S3
C. L5 and S1
The most common sites for lumbar disk herniation are: A. L1 to L2 and L2 to L3. B. L2 to L3 and L4 to L5. C. L4 to L5 and L5 to S1. D. L5 to S1 and S1 to S2
C. L4 to L5 and L5 to S1.
Immediate diagnostic imaging for low back pain should be reserved for all of the following EXCEPT:
A. presence of signs of the cauda equina syndrome.
B. presence of severe neurological deficits.
C. presence of risk factors for cancer.
D. presence of moderate pain lasting at least 2 weeks.
D. presence of moderate pain lasting at least 2 weeks.
irst-line therapy for prepatellar bursitis should include: A. bursal aspiration. B. intrabursal corticosteroid injection. C. acetaminophen. D. knee splinting.
A. bursal aspiration.
Clinical conditions with a presentation similar to acute bursitis include which of the following? (More than one can apply.) A. rheumatoid arthritis B. septic arthritis C. joint trauma D. pseudogout E. All of the above
E. All of the above
Patients with subscapular bursitis typically present with:
A. limited shoulder ROM.
B. heat over affected area.
C. localized tenderness under the superomedial angle of the scapula.
D. cervical nerve root irritation
C. localized tenderness under the superomedial angle of the scapula.
Which of the following is usually NOT part of treatment of a sprain? A. immobilization B. applying ice to the area C. joint rest D. local corticosteroid injection
D. local corticosteroid injection
If any limitation or any increase in range of motion occurs when assessing the musculoskeletal system, the angles of the bones should be measured by using A. Phalen ' s test. B. skeletometry. C. the Thomas test. D. a goniometer.
D. a goniometer.
In assessing the skeletal muscles, you turn the forearm so that the palm is up. This is called A. supination.
B. pronation.
C. abduction.
D. eversion.
A. supination.
The most common cause of acute bursitis is: A. Inactivity B. Joint overuse C. Fibromyalgia D. Bacterial infection
B. Joint overuse
First-line treatment options for bursitis usually include:
A. corticosteroid bursal injection.
B. heat to area.
C. weight-bearing exercises.
D. nonsteroidal anti-inflammatory drugs (NSAIDs).
D. nonsteroidal anti-inflammatory drugs (NSAIDs).
Likely sequelae of intrabursal corticosteroid injection include: A. irreversible skin atrophy. B. infection. C. inflammatory reaction. D. soreness at the site of injection.
D. soreness at the site of injection.
Patients with lateral epicondylitis typically present with:
a. electric-like pain elicited by tapping over the median nerve
b. reduced joint pain
c. pain that is worst with elbow flexion (elbow ROM is usually normal)
d. decreased hand grip strength the pain is worse with resisted wrist extension
d. decreased hand grip strength the pain is worse with resisted wrist extension
Risk factors for lateral epicondylitis include all of the following EXCEPT: A. repetitive lifting B. playing tennis C. hammering D. gout
D. gout
Up to what percentage of patients with medial epicondylitis recover without surgery? A. 35%
B. 50%
C. 70%
D. 95%
D. 95%
Initial treatment of lateral epicondylitis includes all of the following EXCEPT:
A. rest and activity modifications
B. corticosteroid injections
C. topical or oral NSAIDS
D. counterforce bracing brace centered over the back of the forearm can help relieve symptoms
B. corticosteroid injections
Carpal tunnel syndrome is inflammation of the: A) Ulnar nerve B) Radial nerve C) Brachial nerve D) Median nerve
D) Median nerve
The Phalen test is used to evaluate for: A) Inflammation of the median nerve B) Rheumatoid arthritis C) Degenerative joint changes D) Chronic tenosynovitis
A) Inflammation of the median nerve
Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to
A. refer her to a hand surgeon.
B. take a more complete history.
C. try neutral position wrist splinting and order an oral NSAID.
D. order a nerve conduction study such as an electromyography (EMG)
C. try neutral position wrist splinting and order an oral NSAID.
Alexander, age 18, sprained his ankle playing ice hockey. He is confused as to whether to apply heat or cold. What do you tell him?
A. “ Use continuous heat for the first 12 hours, then use heat or cold to your own preference. “
B. “ Use continuous cold for the first 12 hours, then use heat or cold to your own preference. “
C. “ Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. “
D. “ Alternate between cold and heat for 20 minutes each for the first 24 - 48 hours.
C. “ Apply cold for 20 minutes, then take it off for 30 - 45 minutes; repeat for the first 24 - 48 hours while awake. “
When Maxwell, age 12, slid into home plate while playing baseball, he injured his ankle. You are trying to differentiate between a sprain and a strain. You know that a sprain
A. is an injury to the ligaments that attach to bones in a joint.
B. is an injury to the tendons that attach to the muscles in a joint.
C. is an injury resulting in extensive tears of the muscles.
D. does not result in joint instability.
A. is an injury to the ligaments that attach to bones in a joint
Which of the following is usually not a part of treatment of a sprain? A. Immobilization B. Applying ice to the area C. Joint rest D. Local corticosteroid injection
D. Local corticosteroid injection
Janice is recovering from osteomyelitis of her leg. She asks you for advice as to what she can do to promote healing. You tell her to:
A. put weight on the affected leg more frequently to promote increased circulation, oxygenation, and nutrition to the tissues of the wound area.
B. eat foods high in vitamins and calcium and increase her calorie and protein intake.
C. spend time in the fresh air and expose the wound to fresh air and sunlight.
D. be sure to use strict aseptic technique when changing the dressing, which should be kept wet at all times to improve wound healing.
B. eat foods high in vitamins and calcium and increase her calorie and protein intake.
Dan, age 49, developed osteomyelitis of the femur after a motorcycle accident. Which of the following statements about the clinical manifestations of osteomyelitis is correct?
A. Integumentary effects include swelling, erythema, and warmth at the involved site.
B. There is a low-grade fever with intermittent chills
C. Musculoskeletal effects include tenderness of the entire leg.
D. Cardiovascular effects include bradycardia.
A. Integumentary effects include swelling, erythema, and warmth at the involved site.
What is the protein lacking or absent in muscular dystrophy
a. coronin
b. tubulin
c. dystrophin
d. keratin
c. dystrophin
Type of muscular dystrophy that is most common in adulthood
a. Becker md
b. Duchenne md
c. facioscapulohumeral md
d. myotonic md.
d. myotonic md.
What type of muscular dystrophy do females get? A. becker md b. Duchenne md c. myotonic md d. none
d. none
The following are causes of scoliosis except:
a. unknown
b. spinal congenital deformity
c. arthritis
d. herniated
d. herniated
It is defined as a true deformity of the spine
a. functional scoliosis
b. structural scoliosis
c. arthritic scoliosis
d. neurofibroma scoliosis
b. structural scoliosis
Screening for females are recommended at what age? A. 5 and 12 B. 7 and 11 C. 14 and 15 D. 10 and 12.
D. 10 and 12.
Bouchard's nodule is found in which of the following? A) Rheumatoid arthritis B) Degenerative joint disease C) Psoriatic arthritis D) Septic arthritis
B) Degenerative joint disease
Podagra is associated with which of the following? A) Rheumatoid arthritis B) Gout C) Osteoarthritis D) Septic arthritis
B) Gout
Which of the following statements is most consistent with fibromyalgia?
A. It is predominantly diagnosed in African Americans.
B. It affects less than 1% of the general population.
C. It is four to seven times more common in women than in men.
D. It is most often initially diagnosed in adults younger than 20 years old and older than 55 years old.
B. It affects less than 1% of the general population.
Fibromyalgia is more common in patients with:
A. type 2 diabetes.
B. rheumatoid arthritis and systemic lupus erythematosus.
C. migraine headaches.
D. chronic obstructive pulmonary disorder (COPD).
B. rheumatoid arthritis and systemic lupus erythematosus.
Which of the following is inconsistent with the clinical presentation of fibromyalgia? A. widespread body aches B. joint swelling C. fatigue D. cognitive changes
C. fatigue
Jonas, age 62, experienced a temporary loss of consciousness that was associated with an increased rate of respiration, tachycardia, pallor, perspiration, and coolness of the skin. How would you describe this? A. Lethargy B. Delirium C. Syncope D. A fugue state
C. Syncope
The Hallpike maneuver is performed to elicit A. a seizure. B. vertigo. C. syncope. D. a headache.
B. vertigo.
Common signs of high-grade aortic stenosis in an individual during exercise include all of the following except:
A. dyspnea.
B. angina.
C. seizure.
D. syncope.
C. Seizure
All of the following are possible etiologies for papilledema
a. Intracranial abscess
b. Ruptured aneurysm
c. Migraine headaches
d. Cerebral edema
c. Migraine headaches
The following measures are used for treating various types of headache. Which is not considered to be effective therapy for migraine?
a. Propanolol prophylaxis
b. Resting in a quiet and darkened room
c. Trimethobenzamide suppositories for nausea
d. Sodium restriction to decrease water retention
d. Sodium restriction to decrease water retention
Which of the following is indicated in the prophylactic treatment of migraine headache
a. ibuprofen (Motrin)
b. Naproxen sodium (Anaprox)
c. Propanolol (Inderal)
d. Sumatriptan (Imitrex)
c. Propanolol (Inderal)
An adult woman comes to the clinic presenting with gradual onset of throbbing headaches behind one eye worsening over several eyes is diagnosed as
a. Cluster headache
b. Migraine headache
c. Trigeminal neuralgia
d. Temporal arteritis
b. Migraine headache
In tension-type headache, which of the following statements is true?
a. Photophobia is seldom reported.
b. The pain is typically described as “pressing” in quality
c. The headache is usually unilateral
d. Physical activity usually makes the discomfort worse
b. The pain is typically described as “pressing” in quality
A first-line prophylactic treatment option for the prevention of tension-type headache is a. Nortriptyline
b. Verapamil
c. Carbamazepine
d. valproate
Nortriptyline
Migraine associated with muscle or neck pain, which is NOT an International Headache Society migraine diagnostic criterion, is often diagnosed as
a. Sinus headache
b. Cluster headache
c. Increased intracranial pressure
d. Tension-type headache
d. Tension-type headache
Acute cerebral hemorrhage is best identified with which of the following imaging techniques?
a. transesophageal echocardiogram
b. CT Scan
c. Cerebral angiogram
d. MR angiography
b. CT Scan
A 64-year-old woman presents to your clinic with a sudden right-sided headache that is worse in her right eye. She claims her vision seems blurred, and her right pupil is dilated and slow to react. The right conjunctiva is markedly injected, and the eyeball is firm. You screen her vision and find that she is 20/30 OS and 20/30 OD. She most likely has A. open-angle glaucoma. B. angle-closure glaucoma. C. herpetic conjunctivitis. D. diabetic retinopathy.
B. angle-closure glaucoma.
Sylvia has glaucoma and has started taking a medication that acts as a diuretic to reduce the intraocular pressure. Which medication is she taking?
A. A carbonicanhydrase inhibitor
B. A beta-adrenergic receptor blocker
C. A miotic
D. A mydriatic
A. A carbonicanhydrase inhibitor
Signs and symptoms of acute angle-closure glaucoma include A. painless redness of the eyes. B. loss of peripheral vision. C. translucent corneas. D. halos around lights.
D. halos around lights.
When evaluating the person who has bacterial meningitis, the NP expects to find CSF results of:
a. low protein
b. predominance of lymphocytes
c. glucose at about 30% of serum levels
d. low opening pressure
c. glucose at about 30% of serum levels
An 18-year-old college freshman is brought to the student health center with a chief complaint of a 3-day history of progressive headache and intermittent fever. On physical examination he has a positive Kernig and Brudzinski sign. The most likely diagnosis is:
a. viral encephalitis
b. bacterial meningitis
c. acute subarachnoid hemorrhage
d. epidural hematoma
b. bacterial meningitis
Which of the following diseases is associated with a high risk of giant cell arteritis?
A. history of transiet ischemia attacks (TIA)
B. Frequent migraine headaches with focal neurological findings
C. Polymalgia rheumatica (PMP)
D. Systemic lupus erythematous (SLE)
C. Polymalgia rheumatica (PMP)
Which of the following diagnostic tests would be most helpful in the diagnosis of this illness? A. CT scan of the brain B. Cranial nerve exam C. Sedimentation rate D. CBC with differential
C. Sedimentation rate
Which of the following conditions is most likely? A. cluster headache B. migraine headache with aura C. migraine headache D. Giant cell arteritis
D. Giant cell arteritis
Of the four types of strokes, which one is the most common and has a gradual onset? A. Thrombotic B. Embolic C. Lacunar D. Hemorrhagic
A. Thrombotic
Which of the following risk factors for a stroke can be eliminated? A. Hypertension B. Carotid artery stenosis C. Smoking D. Hyperlipidemia
C. Smoking
Which of the following complications is the leading cause of death shortly after a stroke? A. Septicemia B. Pneumonia C. Pulmonary embolus D. Ischemic heart disease
B. Pneumonia
Risk factors for transient ischemic attack (TIA) include all of the following except: A. atrial fibrillation. B. carotid artery disease. C. combined oral contraceptive use. D. pernicious anemia.
D. pernicious anemia.
A TIA is characterized as an episode of reversible neurological symptoms that can last: A.1 hour. B.6 hours. C.12 hours. D.24 hours
D.24 hours
When caring for a patient with a recent TIA, you consider that:
A. long-term antiplatelet therapy is likely indicated.
B. this person has a relatively low risk of future stroke.
C. women present with this disorder more often than men.
D. rehabilitation will be needed to minimize the effects of the resulting neurological insult.
A. long-term antiplatelet therapy is likely indicated.
A 56-year-old man complains of several episodes of severe lacerating pain that shoots up to his right cheek and is precipitated by drinking cold drinks or chewing. These episodes start suddenly and end spontaneously after a few seconds with several episodes per day. He denies any trauma, facial weakness, or difficulty swallowing. He has stopped drinking cold drinks because of the pain. Which of the following is most likely? A. Trigeminal neuralgia B. Cluster headache C. Acute sinusitis D. Sinus headache
A. Trigeminal neuralgia
Which of the following cranial nerves is evaluated when a wisp of cotton is lightly brushed against the corner of the eye? A. CN II B. CN III C. CN IV D. CN V
D. CN V
You examine a 29-year-old woman who has a sudden onset of right sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. Her exam is otherwise unremarkable. This presentation likely represents paralysis of CN: A: lll B. lV C. Vll D. Vlll
C. Vll
Which represents the most appropriate diagnostic test for the patient in the previous question? A. CBC with WBC Differential? B. Lyme disease antibody titer? C. CT scan of the head with contrast? D. BUN and Creatine levels?
B. Lyme disease antibody titer?
In prescribing prednisone for the patient with Bells palsy, the NP considers that its use:
A. Has not been shown to be helpful in improving outcomes in the condition.
B. Should be initiated asap after the onset of facial paralysis.
C. Is likely to help minimize ocular symptoms.
D. May prolong the course of the disease.
B. Should be initiated asap after the onset of facial paralysis.
Treatment options for an adult with seizures include all of the following agents EXCEPT:
a. Carbamazepine
b. Phenytoin
c. Gabapentin
d. tamsulosin
d. tamsulosin
tamsulosin
Which of the following best describes patient presentation during tonic-clonic (grand mal) seizure?
a. Blank staring lasting 3 to 50 seconds, accompanied by impaired level of consciousness
b. Awake state with abnormal motor behavior lasting seconds
c. Rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness
d. Abrupt muscle contraction with autonomic signs
c. Rigid extension of arms and legs, followed by sudden jerking movements with loss of consciousness
Central obesity, “moon” face, and dorsocervical fat pad are associated with:\
Cushing’s syndrome
An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient’s pain is:
A Trauma . B Tight shoes . C Arthritis flare . D Hydrochlorothiazide
D Hydrochlorothiazide
The most effective treatment of non-infectious bursitis includes: Conservative treatment includes rest, cold and heat treatments, elevation, administration of nonsteroidal anti-inflammatory drugs (NSAIDs), bursal aspiration, and intrabursal steroid injections
You must initiate the plan of care for the patient
The physician must be on-site and engaged in patient care
You must be employed as an independent contractor
You must be the main health care provider who sees the patient
The physician must be on-site and engaged in patient care
Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?
The metabolic syndrome refers to the co-occurrence of several known cardiovascular risk factors, including insulin resistance, obesity, atherogenic dyslipidemia and hypertension.
Which of the following is not a common early sign of benign prostatic hyperplasia (BPH)?
A. Nocturia
B. Urgency incontinence
C. Strong urinary stream flow
D. Straining to void
C. Strong urinary stream flow
Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?
Food that is very hot or very cold Fatty or fried foods Peppermint or spearmint, including flavoring Coffee, tea, and soft drinks that contain caffeine Spicy, highly seasoned foods
Fried food DT caffeine, chocolate and anticholinergics
Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
Beta antagonist
The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:
Nsaid
A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take?
A Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
B. Perform a diet history and check CBC and FBS.
C. Provide nutritional guidance and have the patient return in one month.
D. Consult home health for intravenous administration
A Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: he A. lateral meniscus B. cruciate ligament C. medial meniscus D. collateral ligament.
B. cruciate ligament
A 32 year old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate management is:
Include 500 mg of oral ciprofloxacin (Cipro) twice per day for seven days; 1,000 mg of extended-release ciprofloxacin once per day for seven days; or 750 mg of levofloxacin (Levaquin) once per day for five days.
A middle-aged man presents to urgent care complaining of pain of the medial condyle of the lower humerus. The man works as a carpenter and describes a gradual onset of pain. On exam, the medial epicondyle is tender and pain is increased with flexion and pronation. Range of motion is full The most likely cause of this patient’s pain is:
epicondylitis
The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy
LABSs to measure albumin in a spot urine sample, collected either as the first urine in the morning or at random, for example, at the medical visit. This method is accurate,:Early morning
What is the first symptom seen in the majority of patients with Parkinson’s disease?
Tremor at rest
The most commonly recommended method for prostate cancer screening in a 55 year old male is:
digital rectal exams,
Martin, age 24, presents with an erythematous ear canal, pain, and a recent history of swimming. What do you suspect?
Otitis externa/ swimmer’s ear
Which of the following symptoms suggests a more serious cause of back pain?
Pain associated with lying down at night
A patient taking levothyroxine is being over-replaced. What condition is he at risk for?
osteoporosis
Which of the following is the most common cause of low back
A Lumbar disc disease . B Spinal stenosis . C Traumatic fracture . D Osteoporosis
A Lumbar disc disease
Which is the most common cause of end-stage renal disease in the United States?
Diabetes
A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects:
A Arthritis . B Ulnar neuritis . C Septic arthritis . D Olecranon bursitis
D Olecranon bursitis
A 60 year old female patient complains of sudden onset unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding, and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal.
Which of the following is the most likely diagnosis?
Trigeminal neuralgia
Temporal arteritis
Parotiditis
Bell’s palsy
Trigeminal neuralgia
Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which diagnoses do you explore further?
Arthritis, C
A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take?
Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
Which of the following is a potential acquired cause of thrombophilia?
Antiphospholipid antibodies
How do you respond when Jessica, age 42, asks you what constitutes a good minimum cardiovascular workout?
20 3x per week
The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is:
electroconvulsive therapy (ECT).
The initial clinical sign of Dupuytren’s contracture is:
Answer: Painless nodule on palmer fascia
A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis?
Osteoarthritis
Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?
“A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.”
Diagnostic confirmation of acute leukemia is based on:
Bone marrow aspiration and biopsy
Sam, age 67, is a diabetic with worsening renal function. He has frequent hypoglycemic episodes, which he believes means that his diabetes is getting “better.” How do you respond?
Because your kidneys are not functioning well, your insuling is not being metabolized and excreted as it should, so you need less of it
patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. How long should the nurse practitioner wait before checking the patient’s TSH?
Answer: 6 – 8 weeks
