Final Flashcards
Mother and a 6- months old patient visited the clinic today for his 6 months well baby check-up
and the mother asked the NP when will be a good age for the baby to start getting the flu shot.
The best answer for the NP is?
A. Baby is too young to get the flu shot at this time, so you don’t have to worry about it yet
B. The baby can get the flu shot starting at age 6 months if it is flu season so he can get it at this
visit
C. Babies do not have to worry about the flu shot because they never get the flu
D. The baby can get his flu shot starting at 4 months if it is the flu season.
B. The baby can get the flu shot starting at age 6 months if it is flu season so he can get it at this
visit
Rationale: Healthy children aged 6-23 months are at higher risk of influenza related
hospitalizations and ER visits even more so than older kids so annual influenza vaccination is
recommended for all kids 6 months or older. Children younger than 6 months should not be
immunized. Two doses are recommended for children under the age of 9 and who did not get 2
doses in the past.
A 66 year old male presents to the clinic for his annual exam. Patient has a medical history of HIV, bronchitis and TB. You look at this immunization record and noticed he is due for his pneumonia vaccine. His last ppsv23 vaccine was at age 63. Which vaccine should your patient receive next?
A. PPSV23
B. FLU
C. DTAP
D. PPSV13
D. PPSV13
If a patient is considered high risk for pneumococcal disease, they are able to
received PPSV23 prior to age 65. If the patient turns 65 and needs another
pneumonia vaccine they must wait 5 years to received another dose of PPSV23.
However, the patient can receive a dose of PPSV13 if it is one year after receiving
the PPSV23 vaccine. Patients who are >65 and never received the pneumococcal
vaccine should receive the PPSV23. The following dose should be given in 6-12
months. The PPSV23 should be given in 2 doses if patient is not considered high
risk.
You screen a 36 year old pregnant female for hepatitis B. What vaccination
education would advise for the infant if the mother’s test results came back positive
for hepatitis B?
A. Your new born will not need vaccination due to immunity from the mother
B. Your new born will need the hep b vaccine
C. Your new born will need the hep b vaccine and HBIg
D. Your new born will need only HBIg
C. Your new born will need the hep b vaccine and HBIg
All expecting mothers are to be tested for hepatitis B during pregnancy. If the
mother is positive for hep b the infant must receive the hep b vaccine and receive
HBIg. HBIg is an immunoglobulin that is given patients who are positive for hep b.
All infants born should be vaccinated with hep b within 24 hours of birth regardless
of mother’s status. Hep b Vaccination will continue at 2 and 6 months. Infants whose
mother is HBsag status is unknown should receive the vaccine within 12 hours of
birth. Preterm infants whose mother is hbsag positive or unknown should receive
Hep B and HBig. Preterm infants whose mother is HBSag negative should delay the
hep b vaccine for 30 days or until stable.
A 42-year-old patient with a history of COPD who uses a daily corticosteroid inhaler presents to
the clinic with complaints of discomfort in his mouth. On exam, you notice white, curd-like
patches on the base of the tongue with an erythematous oral pharynx. What is the most likely
diagnosis?
A. Herpangina
B. Streptococcal Pharyngitis
C. Aphthous Ulcers
D. Oral Candidiasis
D. Oral Candidiasis
Oral Candidiasis is an infection caused by the fungus Candida albicans. When an adult presents
with symptoms of oral candidiasis, it is often a result of chemotherapy administration,
corticosteroid use, or antibiotics. The nurse practitioner should educate any patient using
corticosteroids via inhalation to rinse their mouth after use. Oral candidiasis often presents
with a
painful or sore mouth, erythematous oral cavity and/or oropharynx, and the classic white-curd
patches on the tongue or oropharynx.
Mom and baby present to your clinic for a 6 month well child check. Mom reports she is breast
feeding, but having a hard time due to sore, cracked nipples. While examining baby you notice
white plaques on the buccal mucosa and dorsal tongue. What is the recommended treatment
for this condition?
a. Both mom and baby require treatment. The mother with oral Diflucan and infant with
nystatin suspension.
b. Mother does not require treatment. Treat baby with Gentian Violet application.
c. Treat baby only with Diflucan
d. Treat Mom only with Nystatin powder on breasts
a. Both mom and baby require treatment. The mother with oral Diflucan and infant with
nystatin suspension.
Candida is found in the oral flora in 60% of the population. In infants thrush presents as an
erythematous base with white plaques involving the buccal mucosa and dorsal tongue. Thrush
can spread to the pharynx and larynx causing pain with swallowing. In older children and adults
thrush can be caused by inhaled steroids and is more common in those with a weaned immune
system. Both breast feeding mom and baby require simultaneous treatment. The mother
should be treated with oral Diflucan and baby is treated with nystatin mouth wash or an
application of Gentian Violet.
A 12-year-old female comes into the clinic and informs you strep throat is going around
school. She reports a sore throat, fatigue, low grade fevers and mild abdominal discomfort. She
has been taking Tylenol which helps. Upon exam her throat appears red with tonsillar exudate.
You assume she has strep throat and send her home with Amoxicillin. A few days later she
returns to the clinic with a rash. What is your diagnosis?
a. Hand Foot and Mouth disease
b. Infectious Mononucleosis
c. Viral rash
d. Herpangina
b. Infectious Mononucleosis
Exam findings of infectious mononucleosis consist of exudative tonsillitis, cervical adenitis,
fever. Additional findings include palpable spleen and axillary adenopathy. Mono is more
common after 5 years of age. A positive mononucleosis spot test or greater than 10% atypical
lymphocytes on peripheral blood smear indicates a positive case of mono. These tests are less
reliable in children under 5. A definitive test for mono is Epstein-Barr serology, demonstrating n
elevated IgM-capsid antibody. Amoxicillin is contraindicated in patients with mononucleosis,
because the drug often causes a rash.
A mother brings her 4-year-old daughter to your office for red lesions to her mouth
and nose. She first noticed them after picking her up from daycare 3 days ago. Upon
inspection, you note the lesions to have a honey-colored crust. What would be the proper
treatment for this patient?
a. Selenium Sulfide 2.5% suspension
b. Permethrin 5% cream
c. Desonide 0.05% ointment
d. Mupirocin 2% topical
d. Mupirocin 2% topical
Rationale: Impetigo is a bacterial infection of the skin that presents as erosions covered
by a honey-colored crust. Treatment consists of a topical antimicrobial that is effective
against staphylococcus aureus and group A streptococci. Tinea versicolor is a fungal
infection that has hypopigmented macules and is best treated with selenium sulfide.
Permethrin is the treatment of choice for scabies, which presents as linear burrows around
wrists, ankles, or finger webs. Atopic dermatitis is described as oval patches typically to
the trunk and extremities. The first line treatment includes emollients and topical steroids.
A 3-week-old male presents to the clinic with projectile vomiting for 3 days despite a ravenous
appetite. After witnessing the mother feed the patient a bottle, the APRN notes abdominal
distention. Shortly after the feeding, the patient projectile vomits across the exam room. The
emesis is blood-streaked & non-bilious. Upon exam, the APRN palpates a 10 mm oval-shaped
mass in the RUQ. The APRN reviews which of the following treatment plans with the mother.
A. Your child probably has a milk-protein allergy. Switch to soy formula and see if that
decreases his symptoms. Follow-up in 1 week for a feeding and weight check.
B. We will start a medication called famotidine to treat reflux. You will give this daily, 30
minutes prior to his morning bottle, and hold your baby upright for 30 minutes after each
feeding to decrease symptoms.
C. I am going to send your baby to get an ultrasound to confirm that he has pyloric stenosis. If confirmed, your son will likely be admitted to the hospital for intravenous
hydration and surgery.
D. I suspect your baby has a stomach ulcer. I will send a STAT referral to the G.I. specialist
so they can perform an upper G.I. endoscopy.
C. I am going to send your baby to get an ultrasound to confirm that he has pyloric stenosis. If confirmed, your son will likely be admitted to the hospital for intravenous
hydration and surgery.
Pyloric stenosis is caused by hypertrophy of the pylorus. It is characterized by worsening gastric
outlet obstruction, nonbilious emesis, and alkalosis in children less that 12 weeks old. It is more
common in males than females. Affected patients are usually between 2-4 weeks old. Signs and
symptoms include projectile vomiting after feeding. Vomit is nonbilious and sometimes bloodstreaked. Infants are usually very hungry and bottle-feed/nurse aggressively. The upper
abdomen is usually distended after feeds. A 5-15 mm oval mass (“palpable olive”) may be felt upon deep palpation of the right upper abdomen. Upper G.I. contrast radiography or abdominal ultrasound are diagnostic. Pyloromyotomy is the treatment of choice. Dehydration and electrolyte
imbalances must be corrected prior to surgical treatment.
A 65-year-old female presents to the clinic with complaints of weakness and fatigue. She states
that she had to go to the E.R. over the weekend for the same symptoms and that her blood
work
from the E.R. showed low magnesium and low potassium. The patient is not sure what caused
her to have low magnesium. The APRN shares which of the following are true statements about
hypomagnesemia.
A. The medication you take for GERD, pantoprazole, can cause low magnesium. In fact, the FDA has issued a warning stating this potential risk.
B. Only a diet low in fruits and vegetables causes low magnesium.
C. Smoking cigarettes is known to cause low magnesium so you should consider
quitting.
D. Penicillin can be a cause. You should not take this medicine in the future
A. The medication you take for GERD, pantoprazole, can cause low magnesium. In fact, the FDA has issued a warning stating this potential risk.
Module 5: McPhee Ch. 21 Electrolyte & Acid-Base Disorders - hypomagnesemia
A 12-year-old boy comes in the clinic with colicky, periumbilical pain present 2 days
ago, accompanied by nausea and vomiting. Upon examination, you notice pain is felt
when passive extension of the hip is performed. You suspect Appendicitis. What best
describes this objective finding?
A. Rovsing’s
B. Psoas
C. Obturator
D. McBurney’s
B. Psoas
All these signs are associated with Appendicitis. Psoas sign is when pain occurs with passive
extension in the right hip. McBurney’s point is tenderness or localized rigidity to the RUQ, when
palpating the left lower quadrant. Rovsing’s is pain in the RLQ and elicited by palpation of the
LLQ. The Obturator sign is when discomfort is felt while the knee is flexed and internal rotation
of the right hip.
A 17-year-old female is brought into the clinic by her mother. She is concerned her child
has a “stomach bug” that has been going around the high school. Symptoms reported
include abdominal pain, vomiting, and lethargy. Upon reviewing the patient’s chart, she
has lost 15 pounds and has been treated for two urinary tract infections in the last 6
months. Physical exam reveals Kussmaul respirations with regular rhythm, heart rate 120,
and abdominal pain to palpation. You suspect this patient is experiencing:
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
a. Metabolic acidosis
Rationale- metabolic acidosis is the loss of HCO3 from the kidneys or
GI tract (Hay, 2020). Papadakis (2021) textbook provides examples of
metabolic acidosis including: DKA, lactic acidosis, starvation, etc. The
STEM portion of this question is interpreting the patient history and
presenting symptoms. Metabolic acidosis is the correct answer because the patient presented is in DKA. We determine the patient is in DKA by adolescent patient, history of weight loss, frequent UTIs, and vomiting.
The biggest clue given is the deep sighing breaths which are the
definition of Kussmal respirations (Papadakis, 2021).
A mother brings in her 6-year-old son and reports he has had two days of diarrhea and is
not urinating as often. He is still eating and drinking. On physical exam vital signs are
within normal limits for age, face is pale, dry mucous membranes are present, and no skin
tenting noted. What is the appropriate advice to give the parent on hydration at this time?
a. “Offer the child only water”
b. “Give him whatever fluids he will take”
c. “Offering an electrolyte solution is best”
d. “I want to send you to the ER for IV fluid replacement”
c. “Offering an electrolyte solution is best”
Rationale- this patient has mild to moderate dehydration based on the
physical assessment provided. Oral rehydration therapy is appropriate
for this level of dehydration if it contains electrolytes (answer C).
However, clear liquids found in the home are not appropriate making A
and B incorrect (Hay, 2020). Answer D is also incorrect, because it
would be treating the patient too aggressively at this stage of
dehydration. It was also important in the question that the child can
drink and hold down fluids, otherwise he would not be a candidate for
oral rehydration therapy at home (Hay, 2020).
A 54-year-old male patient presents to the office with complaints of reddened, itchy skin
around his nose and mouth. Upon exam, the NP sees erythematous, greasy, and scaly macular
patches to bilateral nasolabial folds. The next step for the NP would be to:
A. Prescribe a daily clindamycin foam wash to the affected area
B. Perform a skin culture and treat accordingly
C. Refer to dermatology
D. Prescribe hydrocortisone 1% cream
D. Prescribe hydrocortisone 1% cream
Rationale: Seborrheic dermatitis is chronic inflammatory skin condition that affects proximately
2-5% of the population. It is found more often in infants, adults 20-60 years of age, and men. It
is
characterized by reddened plaques or macules, white to yellow flaky scales on oily skin, and
pruritus. The commonly affected areas are the center of the face, scalp, upper chest, and body
folds. It is diagnosed by its characteristic features. No skin biopsy or culture is required.
Treatment for non-hairy areas of the skin include low-dose corticosteroid creams, like hydrocortisone or desonide. If no improvement with steroid cream, an antifungal cream, like ketoconazole, can be added to the regimen. For hairy areas, like the scalp or chest, a shampoo
with selenium or zinc pyrithione can be used. For the eyelids, gentle cleansing with baby shampoo can resolve the problem. Predisposing and aggravating risk factors for seborrheic dermatitis include dry weather, family history, nutritional deficiencies (niacin, zinc,
and pyridoxine), and even some medical conditions, like immunosuppression, HIV, and
psoriasis.
Mother presents with 5-year-old daughter for a rash on the child’s legs. Mother reports the
rash started a month ago with a few bumps that have been increasing in number and spreading
to different areas on the legs. She states that child has not been scratching or complaining
about the rash. Upon exam, the NP notes numerous 2-3mm round, flesh-colored, and
umbilicated papules to bilateral knees, popliteal fossae, and thighs. What is an appropriate
treatment plan for this child?
A. Observation and monitoring should be utilized because lesions will self-resolve.
B. Treatment should include oral antibiotics.
C. The lesions should be treated with an antifungal cream.
D. Removal all skin irritants and triggers and take oral antihistamines.
A. Observation and monitoring should be utilized because lesions will self-resolve.
Rationale: The characteristic appearance of molluscum contagiosum includes flesh or pink
colored, umbilicated, and 2-5mm round papules that can be found anywhere on the body. It is
often seen in young children and sexually active adults. Molluscum contagiosum is caused by a
poxvirus that triggers the skin for form these papules. It is transmitted through skin-to-skin
contact. It further spreads on the skin from scratching or touching the lesions. Treatment
includes physical removal, oral medications, topical therapy, and observation. Physical removal
would be done by curettage (removing the white caseous core), cryotherapy, or laser therapy,
which can be painful and lead to scarring. Cimetidine oral therapy has been used, but
effectiveness has been inconsistent. Topical therapies include podophyllotoxin cream, tretinoin,
and cantharidin. Observation is a very reasonable treatment because the lesions usually self-
resolve in 6-13 months. The location and number of lesions, age of child, and parental wishes
must be considered when choosing a treatment. Antibiotics would only be used if there
was a secondary infection of the skin, which is not described here
A 28-year-old female presents to the clinic today with complaints of worsening itchy patches on
her elbows and knees that seem to have worsened over the past few weeks. Upon
examination, you observe bright red, well demarcated, silvery scale plaques on her bilateral
knees and elbows. This is consistent with which diagnosis?
A. Atopic dermatitis
B. Candidiasis
C. Pityriasis rosea
D. Psoriasis
D. Psoriasis
Rationale—One of the most common descriptions for psoriasis are the well demarcated silvery
scale patches. Mild itching often accompanies the diagnosis, and the most common locations
appear on the knees, elbows, and scalp. Atopic dermatitis does not have well demarcated
borders. A scalloped and erythemic rash would rule out candidiasis. Pityriasis rosea may
present with itching but has a “Christmas tree” presentation where the lesions are oval and
fawn colored.
A 20-year-old male presents to your clinic today with complaints of worsening “large, painful
zits” on his face and neck and you diagnose him with acne vulgaris, moderate cystic acne. He
has no known allergies to medications. What oral antibiotic will you choose to treat him?
A. Doxycycline
B. Amoxicillin
C. Erythromycin
D. Azithromycin
A. Doxycycline
Rationale—Doxycycline, minocycline and cephalexin are the most common oral antibiotics to
treat moderate acne vulgaris. Erythromycin is reserved for pregnant women. Amoxicillin and
azithromycin are not first line treatments for moderate acne vulgaris
A 33 year old female presents today for a Papanicolaou exam. What level of prevention does
this display?
A. Secondary Prevention
B. Tertiary Prevention
C. Cancer prevention
D. Primary prevention
A. Secondary Prevention
Rationale: This is secondary prevention as these are prevention techniques that promote early
detection of disease. Primary prevention is getting immunizations, healthy diet, or giving up or
not starting smoking. Tertiary prevention aims to limit the impact of the established disease ,
such as a mastectomy or radiation.
A patient presents to the clinic complaining of continued fullness in the ear 4 weeks after being treated for Acute Otitis Media. What is the correct teaching for the patient?
A. “We will give you another antibiotic because the first one did not work.”
B. “The feeling of fullness in your ear can be present for up to 12 weeks.”
C. “There’s nothing there, it’s all in your head.”
D. “According to research, you shouldn’t be feeling anything. Let’s talk about tubes in your ears
to help drain the fluid.”
B. “The feeling of fullness in your ear can be present for up to 12 weeks.”
Fullness and decreased hearing are common after an AOM infection, but they should resolve.
Another antibiotic would only be necessary if signs of infection are still present, including erythema and decreased mobility of the tympanic membrane. Dismissing a patient’s concerns is never correct and jumping straight to a surgical correction is a last resort after multiple infections.
A mother brings her 2-month-old into the clinic for what she expects is an ear infection due to increased fussiness from the child and a fever of 100.9. What is the correct action by the NP?
A. Tell the mother that infants are fussy from time to time and that she shouldn’t worry so much
B. Give the mother a prescription for Amoxicillin for 10 days with instructions to give the infant
the entire course of medication
C. Send the mother home with a SNAP prescription to use if the infant’s symptoms get worse
D. Send the infant and mother to the Emergency Room immediately for further evaluation
D. Send the infant and mother to the Emergency Room immediately for further evaluation
Infants younger than 3 months old should immediately be sent to the emergency room for further evaluation because of they are more susceptible to serious infections. Amoxicillin can be used in infants but this infant should be seen in the emergency room first. Sending the infant away is also wrong because infants with fevers need to be seen as soon as possible.
A 6-month-old male infant is brought into the clinic by his mother for sudden onset abdominal pain, uncontrollable crying, vomiting, and bloody diarrhea. On physical exam of the abdomen, you palpate a sausage-shaped mass. As the nurse practitioner, what is the next appropriate step in diagnosis and treatment for this infant?
A. Order an abdominal CT with contrast and have the patient return to the clinic in 24 hours if
symptoms fail to improve
B. Send the mother and patient to the ER for a STAT abdominal ultrasound due to concern for
Intussusception
C. Order an abdominal x-ray and encourage PO fluid intake as this is most likely constipation
D. Reassure the mother that this is gastroenteritis and prescribe PO ondansetron, along with
education that symptoms should subside over the next 24-48 hours
B. Send the mother and patient to the ER for a STAT abdominal ultrasound due to concern for
Intussusception
A 20-year old female presents to the clinic with small, painless, bumps on her elbow that
come and go over the past year. She denies recent illness or fever. Upon examination, the
FNP observes elevated, round, ½ cm diameter, hyperkeratotic skin papules with rough
grayish white surface. What is the most likely diagnosis?
A. Hypertrophic actinic keratoses
B. Contact Dermatitis
C. Squamous Cell Carcinoma
D. Verrucae vulgaris
D. Verrucae vulgaris
A mother brings in her two-year-old daughter. She has noticed that her daughter’s eyes sometimes cross.
She also said they had a photographer’s family photos done last week, and the photographer
could not use flash. She said that every time she did that, one of her daughter’s pupils was white. What would be most concerned about the child having?
A) Strabismus
B) Coats Disease
C) Retinoblastoma
D) Leukoria
C) Retinoblastoma
A 19-year-old patient arrives at the clinic with a concern about discolored spots on his skin. The
spots are located on his upper back and consist of velvety macules that vary in size, approximately 4-5mm. The patient reports that they do not bother him, but states that when
he is out in the sun, these areas will not tan like the rest of his body. He also reports that he has tried
over-the-counter creams and that nothing has worked. Which is the correct diagnosis?
a. Tinea Versicolor
b. Pityriasis Rosea
c. Vitiligo
d. Contact Dermatitis
a. Tinea Versicolor *
A 16-year-old female is brought into the clinic by her mother, who states her daughter has been having frequent headaches over the last three weeks that are progressively
worsening. Up until now, she has rarely had headaches. The patient denies any recent trauma. She often wakes up early in the morning with a headache, nausea, and occasional
vomiting. When asked, the girl states the pain is in the back of her head and often gets worse when standing up. The NP’s treatment plan should start with:
a. Suggesting bio-behavioral management, including sleep hygiene, improved fluid
intake, and eating a healthy diet
b. Telling mom Tylenol 15mg/kg (max dose 650mg) or Ibuprofen 10mg/kg (max
dose 800mg) and laying down in a darkened room should be sufficient
c. Prescribing Topiramate for prevention and Rizatriptan for abortive treatment
d. Ordering CT or MRI as soon as possible
d. Ordering CT or MRI as soon as possible
Which complimentary regimen would be most beneficial in slowing the rate of functional decline in a patient with moderate to severe Alzheimer disease being treated with Aricept 10 mg PO and Memantine 10 mg PO BID?
A. Memory Drills
B. Vitamin E 100 IU PO BID
C. 30 mins Aerobic Exercise Three Times Weekly
D. Axona PO 40 mg Daily After Dinner
C. 30 mins Aerobic Exercise Three Times Weekly
A caregiver brings her 5month old infant into the clinic for a diaper rash. She states the rash has been present for 6 days. As an NP you know that the majority of cases of diaper dermatitis are colonized with what organism even before the classic symptoms of satellite lesions and sharply marginated borders appear.
A. C albicans
B. Streptococcus
C. Staphylococcus
D. E. Coli
A. C albicans
Cluster headaches are most common in middle aged men. The signs and symptoms can be specific in nature but attacks occur usually at the same time and can awaken the patient at night. Which of the following most accurately depicts the pain that is associated with cluster headaches?
A. Peaks in 3-4 hours
B. Dullness
C. Unilateral in the periorbital area
D. Throbbing/pulsating
C. Unilateral in the periorbital area
A 7-year-old female is in your clinic, and you have diagnosed her with acute otitis externa. The NP knows that the most common pathogen that causes acute otitis externa is?
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae
C. Aspergillus
D. Histoplasma
A. Pseudomonas aeruginosa
You are the nurse practitioner caring for a 74-year-old male patient with hypertension and stage 3 chronic kidney disease. Upon careful review of his medication list, you note that he is taking lisinopril and spironolactone concurrently. You are most concerned with him developing which of the following electrolyte imbalances?
a. Hyponatremia
b. Hyperkalemia
c. Hypermagnesemia
d. Hypokalemia
b. Hyperkalemia
A 16 y/o female presents to the clinic today for a yearly wellness exam. Her mother asks about the HPV vaccine and questions whether or not her daughter needs it. An appropriate response from the healthcare provider might be:
A. This vaccine is only recommended if your daughter is currently sexually active.
B. This vaccine is recommended by the CDC for children starting at 11-12 years old for prevention against seven types of HPV which are linked to cancer. Your daughter will
need three doses of the vaccine to complete her HPV series.
C. This vaccine is very important in protecting against HPV which is linked to multiple types of cancer. We’ll give her one dose today. She’ll need to return again in 6 months to get the second dose to complete the series.
D. This vaccination is only recommended for males.
B. This vaccine is recommended by the CDC for children starting at 11-12 years old for prevention against seven types of HPV which are linked to cancer. Your daughter will
need three doses of the vaccine to complete her HPV series.
A 4yr old child presents with a mother who complains of non healing, red, fluid-filled blisters around her son’s mouth. She reports some have ruptured leaving a yellow crust. Upon assessment you find localized areas with honey-colored crust and others with moist red
erosions. The child is a febrile with no other systemic symptoms. The child is diagnosed with impetigo. In addition to washing with soap and water, which treatment option is most appropriate?
A. Topical retapamulin along with oral dicloxacillin
B. Topical mupirocin
C. No medication is required
D. Cephalexin
B. Topical mupirocin
A 16-year-old male presents to the clinic with his mother. Patient was recently diagnosed with comedonal acne and started on Tretinoin 0.05% cream 7 days ago. The patient is concerned that the treatment is not working and presents for further evaluation. The NP’s next step would
be:
A. To discontinue treatment immediately since it is not working.
B. Continue Tretinoin 0.05% cream and begin oral Clindamycin.
C. Educate that treatment can take up to 8-12 weeks to see results. Continue using the cream
as prescribed and reevaluate in 3 months.
D. Stop using Tretinoin and begin oral Doxycycline only.
C. Educate that treatment can take up to 8-12 weeks to see results. Continue using the cream
as prescribed and reevaluate in 3 months.
A 25 year-old female presents to the clinic with abdominal pain that began 9 months ago and has worsened in the past few weeks. She complains of fatigue, weight loss, frequent bloody bowel movements, and abdominal cramping. Upon abdominal exam the clinician finds
tenderness with palpation. What is the most likely diagnosis?
A) Appendicitis
B) Ulcerative colitis
C) Cholecystitis
D) Toxic mega colon
B) Ulcerative colitis
A 62 y/o male presents to your office with a chronic productive cough, mild dyspnea on exertion and wide abdominal girth. You noticed he was previously prescribed ipratropium for COPD. He has not had any exacerbations that led him to the hospital. Which inhaler would you add next in addition to ipratropium?
- Theophylline
- Fluticasone
- Albuterol
- Formoterol
Formoterol is a long-acting beta agonist (LABA) that is used to treat COPD. The mechanism of
action is to relax the smooth muscle by stimulating beta2 -adrenergic receptors which causes
vasodilation in the bronchioles. LABAs are used for initial treatment for COPD. LABA duration of
action is 12 hours or greater which exceeds SABA (short acting beta agonists). Formoterol is to
be given twice daily and is showed to improved FEV, lung volumes, dyspnea and number of
exacerbations. Side effects includes resting tachycardia, hypokalemia and tremors.
Theophylline is in a class called xanthines. It is considered 4th line treatment for COPD. It
relaxes the smooth muscle by inhibiting phosphodiesterase which breaks down nucleotides.
This medication has a small therapeutic index and must be given in large doses which is why it
is not used as often. Fluticasone is an inhaled corticosteroids used to treat moderate to severe
COPD. This medication is normally used with a LAMA or LABA if 2 or more exacerbations occur.
Albuterol is a short acting beta agonist and is in the same class as ipratropium. This is also
optional to use a first-time treatment if the patient is experiencing sob. Therefore, in this
scenario this medication would not be appropriate.
A patient presents to the clinic with SOB, bilateral lower leg edema, activity intolerance, and weight gain. The NP suspects that the patient has heart failure. The NP orders which test as the MOST useful for evaluation of heart failure?
a) B-type natriuretic peptide
b) Chest x-ray
c) Echocardiogram
d) Troponin
c) Echocardiogram
Rationale: An echo can differentiate HFpEF from HFrEF. It can evaluate the size and function of
the atria and ventricles. In addition, it can assess the valves for abnormalities and ventricular
wall motion to detect old MI, pleural effusion, and pericardial thickening or effusion from
pericarditis and can evaluate cardiac output and pulmonary artery pressures.
A 19-year-old female arrives to your clinic and reports having unprotected sex. She denies
receiving the human papillomavirus vaccines. Her last STD testing was two years ago. The nurse practitioner will complete which of the following:
A. Conduct a Pap smear but exclude HPV cancer screening
B. Screen for chlamydia and gonorrhea with a NAAT
C. Conduct a Pap smear with HPV cancer screening
D. Screen for chlamydia and gonorrhea with a NAAT plus conduct a Pap smear
B. Screen for chlamydia and gonorrhea with a NAAT
All sexually active females that are 25 years old or younger should be
screened for chlamydia and gonorrhea annually using a nucleic acid amplification test (NAAT).
A Pap smear should be conducted for the first time at age 21 and be repeated every three
years.
Screening for HPV is not advised before the age of 30
A 43-year-old transgender male comes into your clinic for a well visit checkup. Which of these screenings are important to do?
- PSA
- Pap smear
- Colonoscopy
- Bone density screening
Pap smear. Even though the patient identifies as male, they still have female body parts. Since
the patient still has female body parts, it is important to include female health promotion such
as a pap smear. Bone density screening isn’t recommended until age 65. PSA lab draw is
recommended for males with prostates. A colonoscopy isn’t recommended until age 45.
A 43-year-old African American male presents to your clinic today for a routine follow-up. He has no prior medical problems and all his labs are normal. You note that his blood pressure is 152/87. He reports that he monitors his blood pressure at home and has gotten similar readings over the last month. He has been counseled on lifestyle modifications in the past, but he has
had no improvement in BP readings. You discuss the need for starting an oral antihypertensive.
Which of the following medications would you anticipate starting?
a. Hydrochlorothiazide
b. Clonidine
c. Lisinopril
d. Valsartan
HCTZ. First-line treatment for hypertension in African Americans is with a calcium channel
blocker or a diuretic. Clonidine is typically used for hypertensive urgencies or emergencies.
African Americans are more likely to develop angioedema related to Lisinopril use. Also, ACE
inhibitors and ARBs have been shown to be less effective in the African American population;
therefore, these are reserved for second-line or combined treatment options.
A 21-year-old male presents with increased wheezing and shortness of breath while exercising,
and a cough that is worse at night. He is prescribed Symbicort (budesonide and formoterol) and
ProAir (albuterol) to treat his moderate persistent asthma. He admits to taking the Symbicort
“when he remembers” and has used the ProAir 6 times in the last 10 days. What should you tell this patient?
a. Continue what you are doing, these symptoms are normal with the changing of the seasons
b. Stop the Symbicort and only use the ProAir as needed
c. Stop the ProAir and only use the Symbicort as needed
d. Explain the importance of taking the Symbicort every day and only using the ProAir as
needed
d. Explain the importance of taking the Symbicort every day and only using the ProAir as
needed
Asthma is characterized by wheezing, shortness of breath, and cough with
symptoms often being worse at night. Long-term controller medications are used daily to
decrease inflammation of airways, prevent symptoms, and decrease risk of exacerbations.
Examples of maintenance therapies include long-acting beta-adrenergic agonists (salmeterol,
formoterol, and olodaterol), inhaled corticosteroids (budesonide, flunisolide, fluticasone,
mometasone, triamcinolone), combined medications (budesonide/formoterol,
fluticasone/salmeterol, fluticasone/vilanterol, mometasone/formoterol). Short-acting
medications are used for sudden onset of symptoms such as cough, wheezing, or shortness of
breath. Examples of reliever medications include short-acting beta-agonists (albuterol,
levalbuterol), anticholinergics (ipratropium HFA, ipratropium with albuterol), systemic
corticosteroids (methylprednisolone, prednisolone, prednisone). Uncontrolled asthma for long
periods of time can lead to irreversible airway damage which causes higher mortality rates.
A 36-year-old G0P0 comes into your clinic after 3 months off birth control. At what point would she be considered a candidate for infertility evaluation and treatment?
A. 6 months of trying to conceive
B. 1 year of trying to conceive
C. 3 months of trying to conceive
Questions 6
D. 18 months of trying to conceive
A. 6 months of trying to conceive
Fertility decreases after age 35 in women. A woman who is 35 or older can be considered infertile after 6 months of actively trying to conceive. Infertility workup (including STI panel, substance abuse, timing of intercourse, and ovarian reserve/hormone labs) should be
considered in this population to pinpoint course of treatment
A 19-year-old patient presents to the clinic and tests positive for chlamydia with a urine nucleic acid amplification test. Which course of treatment is the most appropriate?
A. Ceftriaxone 500mg intramuscular once
B. Doxycycline 100mg by mouth twice daily for 7 days
C. Metronidazole 500mg by mouth twice daily for 7 days
D. Doxycycline 500mg by mouth once daily for 7 days
B. Doxycycline 100mg by mouth twice daily for 7 days
100mg Doxycycline is the preferred treatment in non-pregnant patients. Alternate treatments in the case of allergy or pregnancy are 1 gram azithromycin by mouth once or
500mg of levofloxacin by mouth once daily for 7 days; since neither of those is an option,100mg of doxycycline is the most appropriate in this scenario.
An adolescent female presents to your clinic requesting an emergency contraceptive. She admits to having unprotected sex with her boyfriend within the last 24 hours. As the NP, you know what to be true about emergency contraception?
A.) It is recommended that patients take these products within 72 hours of unprotected intercourse.
B.) These products are only available with a prescription and not for OTC sale.
C.) Emergency contraception is 90% effective if used within the first 120 hours of unprotected sex.
D.) Once emergency contraception is administered, there is no need to conduct a follow-up appointment with the patient.
A.) It is recommended that patients take these products within 72 hours of unprotected
intercourse.
Emergency contraception is the only contraceptive method designed to prevent pregnancy from occurring after unprotected sex. It is recommended that patients take these products within 72 hours of unprotected sex as the product loses its’ effectiveness with the more
time that passes. EC is 90% effective if used within the first 24 hours and is available for sale OTC to adolescents aged 17 or older.
A 65 year old male presents to your office with complaints of shortness of breath while laying down, dry cough and nocturia. You suspect left sided heart failure. Which test would be most helpful in establishing diagnosis?
A. Chest X-ray
B. Echocardiogram
C. ECG
D. Cardiac stress test
s B. Echocardiogram is the most useful test in establishing
diagnosis of heart failure. It can recognize the abnormal heart function and determine whether
or not left ventricular function is preserved. ECG may reveal some nonspecific cardiac abnormalities, but does not confirm the diagnosis of heart failure. Cardiac stress test is mostly useful in confirming diagnosis of angina in patients with intermittent chest pain. Chest X-ray
may reveal cardiomegaly and abnormal vasculature but does not determine if ventricular function is within normal limits
An unvaccinated 3-year-old patient presents to your clinic with a 104 F fever that started a few hours ago. Upon entering the exam room, you notice the patient sitting in a “sniffing dog” position with excessive drooling. You hear mild stridor and see inspiratory retractions on exam.
The patient has trouble swallowing, and his voice sounds muffled. His heart rate is 130bpm with an oxygen saturation of 90%. What should the nurse practitioner do next?
a. Order a chest x-ray to rule out community acquired pneumonia
b. Prepare a racemic epinephrine nebulizer treatment as the patient shows symptoms of croup.
c. Transfer the patient to the emergency department STAT for respiratory distress possibly due
to epiglottitis.
d. Conduct a rapid RSV swab as patient shows signs of bronchiolitis.
c. Transfer the patient to the emergency department STAT for respiratory distress possibly due
to epiglottitis.
A sudden onset of high fever, dysphagia and excessive drooling are key symptoms of
Epiglottis. Other symptoms may include a muffled voice, retractions, and cyanosis. The “sniffing dog” position is a key indicator of respiratory distress with the neck hyperextended and chin upward to open the airway. Epiglottitis is a medical emergency, and the patient should be transferred to a hospital as soon as possible to prevent airway obstruction. Symptoms may be
similar in those with croup; however, croup usually presents with a barking cough and no drooling.
Which of the following statements by the NP to a male patient complaining of fatigue, low libido, and erectile dysfunction would be incorrect?
a. “Your fasting morning serum testosterone level was 240 ng/dL, which is low. We should consider initiating testosterone therapy.”
b. “Your non-fasting morning serum testosterone level was low. We will need to repeat the test and check your serum LH and PRL levels.”
c. “Your morning serum testosterone levels averaged 230ng/dL. Your current BMI is 40, which makes you a possible candidate for bariatric surgery. Have you ever considered this option?”
d. “Your serum free testosterone levels were confirmed to be 33pg/mL. At the age of 72, this is
considered normal.”
a. “Your fasting morning serum testosterone level was 240 ng/dL, which is low. We should consider initiating testosterone therapy.”
Serum testosterone reference ranges are based on non-fasting morning specimens
when testosterone levels are highest. Fasting specimens or those drawn later in the day may
be misleading. Serum testosterone levels are considered low if a non-fasting morning
testosterone level is less than 240ng/dL and is confirmed with a second test. Testing for LH
levels will help differentiate between hypergonadotropic hypogonadism (LH is high) and hypogonadotropic hypogonadism or normal aging (LH is low or normal). Serum PRL helps
screen for pituitary/hypothalamic lesions. Obesity may contribute to low testosterone, and bariatric surgery can be an effective means of weight loss. Significant weight loss can help normalize testosterone levels. Serum free testosterone levels are low if they are less than 35pg/mL for men ages 16-69 and less than 30pg/mL for men older than 70.
A 42-year-old female presents with complaints of weight gain, dry skin, and fatigue. What testing should the nurse practitioner order to screen for hypothyroidism?
A. Serum TSH, free T4, free T3
B. Serum TSH, free T4
C. Serum TSH
D. Serum TSH with thyroid ultrasound
B. Serum TSH, free T4
For primary hypothyroidism, TSH and free T4 are the most sensitive. Assessing serum TSH and free T3 is performed for hyperthyroidism. In patients with thyroid nodules, thyroid ultrasounds should be ordered as ultrasound can be done to monitor growth and differentiate
between thyroid nodules and a multinodular goiter.
A 42-year-old female presents with complaints of weight gain, dry skin, and fatigue. What testing should the nurse practitioner order to screen for hypothyroidism?
A. Serum TSH, free T4, free T3
B. Serum TSH, free T4
C. Serum TSH
Questions 6
D. Serum TSH with thyroid ultrasound
B
A 14-year-old male who is 5’ 9” and weight is 150-pound present to the clinic with his mother with concerns of enlarged breast. His current medication is Methylphenidate ER (Concerta) 18 MG. What education should the nurse practitioner give the adolescence and his mother?
A. Gynecomastia is enlargement of the breast which abnormal and warrant further investigation.
B. Gynecomastia is enlargement of the breast is normal in adolescences and it usually disappears by age 15.
C. Gynecomastia is enlargement of the breast which is abnormal in adolescence males and requires a watch and wait approach.
D. Gynecomastia is enlargement of the breast and is normal in adolescences and it usually
disappears by age 17.
D. Gynecomastia is enlargement of the breast and is normal in adolescences and it usually
disappears by age 17.
Gynecomastia is enlargement of the breast which normal which occurs at the peak of sexual maturity and disappears by age 17 if occurs after 17 it warrants further assessment. A. Gynecomastia is normal not abnormal is adolescences males.
B. Incorrect. Age 15 is to earlier to assess for problem enlarge stated in above providers worry
after age 17 years. C. Incorrect Gynecomastia is abnormal in adolescences males and requires a
watch and wait approach is incorrect it should disappear by age 17 years old.
Patient taking a high-intensity statin presents to the clinic for myalgia, weakness, and red-tobrown urine. The NP should:
A) discontinue statin therapy immediately and order creatine kinase, urinalysis, CBC, CMP and
ECG.
B) Decrease statin medication to moderate intensity and see if symptoms persist.
C) Refer to the hospital because the patient is in acute renal failure.
D) Encourage the patient to increase water intake to one gallon a day.
A) discontinue statin therapy immediately and order creatine kinase, urinalysis, CBC, CMP and
ECG.
The patient has the three classical signs of rhabdomyolysis. Patients taking high-intensity statins
or combination therapy are at higher risk. Statin medication should be stopped completely and not reduced if rhabdomyolysis is suspected. Rhabdomyolysis can cause acute renal failure however more information is needed to determine renal status.
The CDC recommends that targeted lead screenings should be performed for:
a. older children living in areas with a high percentage of homes that were built before the
1950’s.
b. all older children who live in rural areas.
c. older children who live within city limits.
d. older children regardless of where they live.
a. older children living in areas with a high percentage of homes that were built before the
1950’s.
Rationale: Since older homes were painted with lead based paints, it is imperative to assess children who live in those homes or areas where most of the homes were built before the 1950’s.
A 32-year-old female presents to the primary care clinic complaining of a tender lump in her
right breast that she first noticed several months ago and seems to come and go. On exam, the lump is in the medial upper quadrant, firm, mobile, 1.5cm in diameter. She is worried about breast cancer. She denies a family history of breast cancer, changes in the skin and nipple discharge. The NP advises:
A. This is most likely a fibroadenoma, which is a benign condition. The next step will be an
ultrasound.
B. This is most likely a benign finding called fibrocystic condition of the breast. The next step will be an ultrasound to determine if the mass is a cyst that could be aspirated or if it’s solid. You should do a self-breast exam regularly just after menstruation and report any changes or masses.
C. This is likely carcinoma. The next step should be fine needle aspiration for cytology to look at
the cells.
D. This is most likely fibrocystic condition of the breast, which is associated with a lower risk of
breast cancer than the general population; self-breast exams are not necessary.
B
A. Fibroadenoma of the breast is a common benign condition. These lesions are typically 1-5cm,
relatively mobile, nontender, rubbery to palpation and often discrete and round or oval in shape. Ultrasound can rule out fluid filled cysts and definitive diagnosis can usually be made with a core needle biopsy. Stable fibroadenomas do not require intervention. B. Fibrocystic
condition of the breast is the most frequent abnormality of the breast. Characteristic findings include painful breast masses that are often multiple and bilateral. Fluctuation in size and tenderness is often mediated by estrogen changes in the menstrual cycle, and it is most
common in women 30-50 years of age. Specific subtypes of fibrocystic conditions of the breast are associated with higher rates of breast cancer than then average population, so patients with fibrocystic condition of the breast are advised to perform SBE regularly and report masses or changes to
their health care provider. C. Breast carcinoma is often a nontender, single, poorly defined mass. Risk factors include positive family history (BRCA 1, 2, others), childbirth after 30, and nulliparity. The general population is no longer recommended to perform regular SBE. D. Patients with fibrocystic condition of the breast are encouraged to perform SBE regularly.
A family nurse practitioner is assessing the growth and development of a 6-month-old. The
child is placed on the exam table to assess for gross motor skills. Which of the following developmental milestones is appropriate at this age?
A. Infant sits alone for short periods
B. Infant builds tower of 3 cubes
C. Infant points to desired object
D. Infant gives toy on request
A. Infant sits alone for short periods
The correct answer is A. Between 6-8 months the infant sits alone, reaches with one hand, imitates bye-bye, and babbles. Building towers of 3-4 cubes is an activity observed in an 18-
month-old. Pointing to a desired object and giving toys on request is a behavior observed in a one-year-old.
A 4-year-old male presents to clinic accompanied by his mother with complaints of a barking cough that is worse at night, hoarseness, and fever of 101.1 for the last 2 days. She reports a history of a “cold” the previous week with a runny nose and green sputum but thought he was getting better because his nasal symptoms improved with over-the-counter remedies. Upon exam you notice a cough, inspiratory stridor with mild intercostal retractions, no drooling, and can speak in full sentences with a hoarse voice. The most likely diagnosis is:
A: Epiglottis
B: Peritonsillar Abscess
C: Bacterial Tracheitis
D: Viral Croup
D: Viral Croup
The correct answer is D. Rationale: A new onset of stridor in the presence of an upper respiratory illness or fever is the hallmark characteristic of croup that generally affects children
between the ages of 6 months and 5 years of age. Croup is distinguished by a “seal-like barking” cough, stridor, hoarseness, and difficulty breathing that worsens at night. Croup is
differentiated from epiglottis by the absence of drooling and positional breathing (tripoding). Peritonsillar abscess is ruled out by the absence of a sore throat and the classic “hot potato” voice. Bacterial tracheitis is ruled out by the non-toxic appearance of the patient with the ability to maintain his airway and low-grade fever.
What is the leading cause of death in adolescents aged 15-19 years?
A. Unintentional Injury
B. Suicide
C. Homicide
D. Cancer
A. Unintentional Injury
Cultural and environmental factors pose the greatest threats to adolescent life, not organic factors. Unintentional injury is the leading cause of death among adolescents aged 15-19 making up 38.5% of all causes of adolescent death. Suicide is the second leading cause of death, homicide is the third, and cancer is the fourth leading cause of death among adolescents. Motor vehicle crashes are the leading cause of unintentional injury death making up 52% of all adolescent deaths caused by unintentional injury. Poisoning is the second leading cause of unintentional injury death and prescription drug overdose is the third leading cause of unintentional injury death among adolescents.
A mother comes into the clinic with her 4-month-old, worried about his development. She states that the infant no longer automatically grasps her fingers when she places them in his palm. What is the correct response by the provider?
A. The Palmar grasp typically disappears at 4 months of age. He is developmentally appropriate
for his age.
B. We should have him evaluated as soon as possible, this is a bad sign
C. That reflex comes and goes. It should return in the next week or two
D. That should not be your concern right now. You need to worry about his weight
A. The Palmar grasp typically disappears at 4 months of age. He is developmentally appropriate
for his age.
Newborns are born with the Palmar grasp, and it typically disappears around 4 months of age. The provider knows this developmental milestone and can reassure the mother. The infant does not need to be evaluated further because this is normal development. The reflex will not reappear in a week or two. The provider should never dismiss parental concerns but instead
should educate on all aspects of growth and development.
A 4-day-old infant presents to clinic. He was born at term and is currently breastfed. On exam, you note yellow discoloration of the skin and sclera. As a provider, you are reassured in your diagnosis of physiologic jaundice by which of the following findings?
A. A serum total bilirubin level of 22 mg/dl.
B. The mother describes her infant as always sleepy and uninterested in feeding.
C. Hospital records and the mother confirm visible jaundice appeared after 24 hours of age.
D. A family history of hereditary spherocytosis and a palpable spleen.
C. Hospital records and the mother confirm visible jaundice appeared after 24 hours of age.
In physiologic jaundice, the peak bilirubin should not exceed 15 mg/dl. Excessive hyperbilirubinemia is classified as levels greater than 17. A level of 22-25 indicates need for
intervention such as exchange transfusion. A lethargic infant who is not interested in feeding could be a sign of acute bilirubin encephalopathy. Physiologic jaundice appears after 24 hours of age, peaks on day of life 3-4, and resolves by 1 week in the full-term infant. Hereditary spherocytosis leads to hemolysis and subsequent hyperbilirubinemia. A peripheral blood smear is used to diagnose this condition.
A 53yo female presents to the clinic with complaints of irritative voiding symptoms. Her urine analysis reveals a urinary tract infection. When choosing the appropriate antibiotic therapy for this patient, the nurse practitioner remembers that which of the following bacteria is known to be the most common pathogen for uncomplicated urinary tract infections?
A: Enterococcus faecalis
B: Proteus mirabilis
C: Klebsiella pneumoniae
D: Escherichia coli
D. E. coli
According to Papadakis and McPhee (2020), coliform bacteria are responsible for the majority of uncomplicated UTIs with E Coli being the most common pathogen
A 38-year-old African American obese woman, who is 18 weeks pregnant, presents to the clinic
today with a blood pressure of 140/90. She denies headache, blurred vision, or right upper
quadrant pain, and her urinalysis is negative for protein. These findings are consistent with:
A. This a normal finding in pregnancy
B. Chronic hypertension
C. Pregnancy-induced hypertension
D. Severe pre-eclampsia
B. Chronic hypertension
Chronic hypertension is diagnosed before 20 weeks’ gestation, given this patient is 18 weeks, this would be considered a chronic condition. This is not considered pregnancyinduced given it was diagnosed before 20 weeks gestation, and it is not considered severe preeclampsia because she is negative for severe features such as headache, blurred vision, and right upper quadrant pain, and she is negative for proteinuria. Older, obese, African American females are at increased risk for chronic hypertension.
A 23-year-old female patient presents to the clinic with complaints of foul-smelling discharge. Upon exam you notice that the discharge appears frothy and green and the cervix appears to
have petechial hemorrhages. What is your most likely diagnosis?
a. Trichomoniasis
b. Bacterial vaginosis
c. Chlamydia
d. Gonorrhea
a. Trichomoniasis
Petechial hemorrhages also known as strawberry cervix along with green, frothy, malodorous discharge and vaginal itching are seen in over 50% of females with trichomonas.
The appearance of flagellated protozoa on wet prep are diagnostic of trichomonas, culture and NAAT are also available if there is unclear diagnosis
A 68-year-old, post-menopausal woman presents for an annual exam. She has a previous surgical history of a bilateral breast reduction 20 years ago. When performing a breast exam, the NP notices a small, nontender hard mass in the upper outer quadrant of the right breast with poorly defined margins. Based on the clinical presentation, what is the suspected
diagnosis?
a. Fibroadenoma of the breast
b. Cyst of the breast
c. Fat necrosis
d. Breast cancer
d. Breast cancer
Breast cancer usually presents as a firm, non-tender mass that has poorly defined margins due to infiltration to the surrounding tissues. The most common anatomic region of the breast for breast cancer is the upper lateral quadrant, consisting of 60% of most cases.
A male patient presents to the clinic with complaint of irritative voiding symptoms and mild suprapubic discomfort for the past 4 months. You collect a full STI panel with
negative results for Chlamydia, Gonorrhea, Syphilis, and HIV. You also obtain cultures of prostatic secretions and urine with negative results for both. However, expressed
prostatic secretions do reveal an elevated leukocyte count. Which of the following diagnoses is probable?
A) Acute Bacterial Prostatitis
B) Chronic Bacterial Prostatitis
C) Nonbacterial Chronic Prostatitis/Chronic Pelvic Pain Syndrome
D) Acute Epididymitis
C) Nonbacterial Chronic Prostatitis/Chronic Pelvic Pain Syndrome
a) Acute Bacterial Prostatitis yields positive cultures of urine and prostatic secretions
b) Chronic Bacterial Prostatitis yields positive cultures of urine and prostatic secretions
c) Nonbacterial Chronic Prostatitis/Chronic Pelvic Pain Syndrome yields negative cultures of
urine and prostatic secretions
d) Acute Epididymitis of non-STI origin yields a positive urine culture result
A 22 y/o male presents to the clinic with c/o occasional dry cough and SOB with exertion which has gotten worse over the last few months. The patient denies the use of drugs, alcohol, or nicotine. Medical history consists of eczema. Physical exam reveals mild expiratory wheezing
heard at bilateral lung bases. Vital signs are as follows: BP 110/65, HR 72, RR 18, O2 99%, Temp:
98.2.
Based off of this information, what diagnostic test is essential in the diagnosis of this
patient?
A. Chest x-ray
B. CT scan of chest
C. Arterial blood gas
D. Spirometry
Asthma is the presumptive diagnosis in this scenario. Chest tightness, cough, shortness of breath, and episodic wheezing are all characteristic of asthma. Common physical exam findings are atopic dermatitis, expiratory wheezing, nasal mucosal swelling or polyps. ABGs may be normal in a patient with asthma exacerbation therefore should not be the initial diagnostic test to rule in/out this diagnosis. Although albuterol would likely help to alleviate this patient’s symptoms and will likely be included in the treatment plan, it would not help to identify the cause in this scenario. Chest radiograph are not indicated in asthmatics as they are typically normal. In cases where pneumonia is suspected, chest x-ray would be necessary. Evaluation and diagnosis of asthma should include spirometry as this test helps to determine the extent of airflow obstruction
A 2-year-old male is brought to the clinic by his mother for the onset of a barking cough and noted stridor when he is upset. The mother reports a lot of children have been sick at his daycare. She denies that her son has had a fever. Based on the child’s symptoms, you would
expect treatment to NOT include:
A. Symptomatic treatment including oral fluids and rest
B. Amoxicillin 80-90 mg/kg/day in two divided doses for 5 to 7 days
C. Use of a humidifier at home
D. Nebulized racemic epinephrine
B. Amoxicillin 80-90 mg/kg/day in two divided doses for 5 to 7 days.
Croup is an inflammatory disorder of the upper airways typically occurring following a viral upper respiratory infection. The traditional seal like-barking cough is due to edema and
inflammation of the subglottic space. The goals of treatment are supportive and to reduce
upper airway inflammation. In this case, antibiotics would be a completely inappropriate therapy and not beneficial based on the pathophysiology of the disease.
The FNP examines a 2-day old newborn diagnosed with coarctation of the aorta. Which physical exam finding supports this diagnosis?
A. Decreased or absent femoral artery pulses
B. Jaundice
C. Acrocyanosis
D. Lower extremity blood pressure higher than upper extremity blood pressure
A. Decreased or absent femoral artery pulses
Coarctation of the aorta involves stenosis of the aorta, usually the aortic arch
between right and left subclavian arteries. Inadequate arterial blood supply to the lower extremities causes decreased or absent femoral artery pulses. Blood pressure readings are also typically inconsistent between both upper extremities. With coarctation of the aorta, lower extremity blood pressures are LOWER, than upper extremity blood pressures, not HIGHER. Jaundice and acrocyanosis are physiologic findings of newborns within the first few days to a week.
A 25-year-old Female present to the clinic complaining of breast tenderness and states her breast “feel lumpy”. She states the “lumps” seem more prominent closer to her menstrual cycle. She denies nipple discharge, inversion, or skin changes, family history of breast cancer. What education is best for the NP to give to the patient?
A. We need to order an MRI as soon as possible. This type of finding is usually consistent with breast cancer.
B. As women get older, their breasts become lumpy and sensitive. This is normal to experience.
C. This is a likely a common finding called fibrocystic breast tissue and it is benign. We will order an ultrasound and possible biopsy for confirmation.
D. This is a fibroadenoma. It will need to be removed immediately.
- Fibrocystic breast disease is a common condition that causes the breast tissue to be lumpy or feel like a rope. Hormone changes during the women’s menstrual cycle can cause the breasts to become lumpy, swollen, sensitive or tender. In order to confirm fibrocystic breast
disease, an ultrasound and biopsy will be done. Mammograms are not indicated for women under 30 years old due to the breast tissue being too radiodense to result in an accurate
evaluation.
A 47-year-old female presents to your office for shortness of breath with a past medical history of asthma. She reports her asthmatic symptoms are interfering with daily
activities, she has asthmatic awakenings about 2 times a week and is having to use her rescue inhaler 1-2 times daily. Currently the only asthma treatment she is on is an albuterol rescue inhaler. As the NP you would?
A: Continue current asthma regimen, her asthma is controlled
B: Step up her asthma treatment one step by adding a daily low dose inhaled corticosteroid
C: Step up her asthma treatment two steps by adding a daily low dose inhaled corticosteroid as well as a LABA
D: Treat her asthma exacerbation with tapered steroids and leave her daily regimen as it is.
B: Step up her asthma treatment one step by adding a daily low dose inhaled corticosteroid
This patient’s asthma is not well controlled as she is not meeting three asthma control components. Her asthma is affecting daily activities, causing nighttime awakenings and she is using her rescue inhaler more than 2 times a week. The patient needs to step up to the next step, in her particular case this would be Step 2- adding an ICS. When treating asthma, it is
important to find the lowest effective step, which is why stepping up 2 steps in treatment is not suggested at this time. The patient should continue to monitor asthma components and return to the clinic to see if her asthma is controlled after adding the ICS.
A 50 years old African American, male comes to family practice clinic complaints of chest pain this morning. He points to the substernal area and states the pain occurred during his morning jog and stopped after he rested. After the physical exam, which recommendation should the NP tell the patient?
A. Do light exercises like walking
B. Take TUMS after breakfast and before running
C. Take nitro within 5 minutes if chest pain occurred again during any exercises
D. Make an appointment with a cardiologist for further work-up
D. Make an appointment with a cardiologist for further work-up
Patient is experiencing stable angina pectoris; a chest pain occurs with physical exertion and relieves when rested. To rule out any other complications, it is best to refer the patient to the cardiology for further cardiac work up.
A 54-year-old African American male currently takes hydrochlorothiazide 25 mg tab po daily and reports compliance. His BP log readings range from 140-145/80-90s. Currently his BP is 146/92 mm Hg, HR 62 bpm. What action should the NP take?
A. Continue current regimen and follow up in four weeks
B. Immediately refer to cardiology for BP management
C. Initiate metoprolol 25 mg tab po BID daily and follow up in 2 weeks
D. Initiate amlodipine 5 mg tab po daily and follow up in four weeks with updated BP logs
D. *Initiate amlodipine 5 mg tab po daily and follow up in four weeks with updated BP logs
Blood pressure less than 130/80 mm Hg is recommended for patients being treated with antihypertensive drugs. African Americans (AA) respond better to calcium channel blocker drugs such as amlodipine and diuretics, which this patient is currently on. Calcium channel blockers are superior to beta blockers in AA patients in controlling BP and should be followed up in four to six weeks post initiation to assess BP (Sutters, 2021).
A 45 year old patient presents to the clinic with shortness of breath especially on exertion, a
nonproductive cough worse when lying flat, and paroxysmal nocturnal dyspnea. On exam there is no noted ascites, hepatic congestion, or edema noted. The patient denies chest pain, recent infection, or any previous cardiac history. As the NP you suspect?
A. Right sided heart failure
B. Rheumatic fever
C. Left sided heart failure
D. Tetralogy of Fallot
C. Left sided heart failure
: Tetralogy of Fallot is usually diagnosed in childhood and includes symptoms of a ventricular septal defect, right ventricular stenosis, right ventricular hypertrophy, and a dilated aorta. Left sided heart failure includes symptoms of shortness of breath especially on exertion, a nonproductive cough worse when lying flat, and paroxysmal nocturnal dyspnea. Right sided heart failure includes symptoms of retention of fluid, ascites, hepatic congestion, loss of appetite, nausea, and edema. Rhematic fever is rare after age 40 and occurs after an infection
causing carditis, arthritis, and erythema marginatum.
When metformin is prescribed for impaired glucose tolerance or type 2 diabetes in teenage girls, the provider should keep in mind which of the following?
A. Metformin will improve the frequency of ovulation, contraception should be
prescribed for sexually active teens
B. Metformin should not be prescribed to teenage girls
C. Teenage girls taking metformin will require a higher dose
D. Metformin will improve menstrual regulation and decrease dysmenorrhea
A. Metformin will improve the frequency of ovulation, contraception should be
prescribed for sexually active teens
