Final Exam Flashcards
Which symptom is NOT considered a red flag for a pediatric patient with headaches?
A. positional HA
B. diplopia
C. age <8YO
D. awakening overnight or early morning with emesis
C. age <8years old
NOT
-positional HA
-diplopia
-awakening overnight or early morning with emesis
A mother and her 12-year-old son present to your family clinic after he had a seizure for the first time 2 days ago. The mother is upset that the ER provider he saw did not prescribe anti-seizure medication for his new-onset
epilepsy. What is the appropriate/best response to the mother?
a single seizure does not fully support the diagnosis of epilepsy nor necessarily warrant the use of anti-seizure medications. Let’s discuss more about your son’s seizures now.
NOT
-I will correct the issue and prescribe anti-seizure medication today
-Although he now has epilepsy, anti-seizure medication is not yet indicated d/t risks versus benefits of potential SE
-Epilepsy is serious and complex. Let’s review and discuss his diagnosis.
A 63-year-old male presents with itching and dry flaking to his scalp and around his beard. Upon assessment, the skin on his scalp and around his mouth is red and
appears as white dandruff. He states he was diagnosed with Parkinson’s two years ago. What is the presumptive diagnosis?
Seborrheic dermatitis
NOT
-eczema
-psoriasis
-contact dermatitis
A 22-year-old female presents to the clinic with three sores on her lips and in her mouth that she describes them as burning. They appeared one day ago after she returned from a bachelorette trip. She reports this has never happened to her before and when asked she admitted to sharing drinks with others on the trip. The NP has diagnosed her with HSV1. What is the appropriate treatment?
Acyclovir
NOT
-ice and ibuprofen
-clindamycin
-flagyl
A 51-year-old female presents to the clinic with reports of intermittent lower abdominal pressure and pain
that seems to subside after she empties her bladder. She also reports increased urinary urgency and nocturia. She states that these symptoms started one week ago. The NP suspects that the patient likely has a diagnosis of interstitial cystitis based on clinical presentation and negative urine culture and cytology. What is considered a first-line treatment option for this patient?
A. Tamsulosin
B. Nitrofurantoin
C. Pyridium
D. Amitriptyline
amitriptyline
NOT
-Tamsulosin (treat men for enlarged prostate - BPH)
-nitrofurantoin
-pyridium (tx for urinary urgency/pain/discomfort from UTI, surgery or catheter)
A 41-year-old male presents to the clinic with a 3-day history of fatigue and muscle aches in back and
legs. He also reports frequent urination and states that his urine is dark and describes it as tea colored. He
admits that he works outside in construction and doesn’t get many breaks to drink adequate water. He
reports that he takes Losartan 25 mg daily and reports that he was recently prescribed Atorvastatin 3
months ago for a new diagnosis of hyperlipidemia. Labs and urinalysis performed today in office and reveals that creatinine kinase, AST, and ALT are all mildly
elevated and his urine dipstick is positive for blood. As the NP, which diagnosis is highest on your
differential list?
Rhabdomyolysis
NOT
-UTI
-dehydration
-acute glomerulonephritis
A 3-year-old child presents for repeated ear pulling and fever x3 days. On exam, you notice a bulging TM, an inflamed and opacified ear drum, and impaired visualization of the ossicular landmarks to the bilateral ears. What is your diagnosis and the first-line treatment?
AOM, treat with Amox
NOT
-otitis media with effusion, tx with ciprofloxacin ear drops
-AOM, tx with ciprofloxacin ear drops
-otitis media with effusion, treat with amoxicillin
Acute Bacterial Pharyngitis essentials of diagnosis include all of the following except?
A. pharyngitis
B. tonsillar exudate
C. hoarseness
D. cervical lymphadenopathy
hoarseness
NOT
pharyngitis
tonsillar exudate
cervical lymphadenopathy
12-year-old Bella comes in complaining of left ear pain and is diagnosed with Acute Otitis Media. What is first-line treatment for Bella?
Amoxicillin 80-90mg/kg/day
NOT
Amoxicillin-clavulanate 90mg/kg/day
Cefdinir 14mg/kg/day
Clindamycin 30-40mg/kg/day
A 14-year-old female presents to your clinic with vomiting, abd pain, polyuria, polydipsia, and tachypnea. The mother states the patient has been reporting extreme thirst despite drinking a lot of water over the past 3 months. Based on the patient’s clinical presentation, the astute NP can anticipate the patient to have which acid/base disorder?
A. metabolic alkalosis
B. increased anion gap metabolic acidosis
C. respiratory alkalosis
D. normal anion gap metabolic acidosis
Increased anion gap metabolic acidosis
NOT
metabolic alkalosis
respiratory alkalosis
normal anion gap metabolic acidosis
A 38-year-old male with chronic kidney disease presents to your clinic with generalized weakness and
bradycardia. The EKG reveals sinus bradycardia with peaked T waves and widened QRS complexes. The
astute nurse practitioner knows that the likely cause of the symptoms and EKG changes is:
A. Potassium level of 7.2
B. Phosphorus level of 6.0
C. Sodium level of 129
D. Calcium level of 11.5
A. Potassium level of 7.2 (hyperkalemia)
NOT
-phosphorus level of 6.0
-sodium level of 129
-calcium level of 11.5
An NP student is reviewing intussusception. Which INCORRECT statement indicated a need for further review?
A. Barium and air enemas are the best tx in stable patients
B. Sx include bloody, currant-jelly-like stools and sausage-shaped mass in the upper abd
C. MRI is best for diagnosis
D. US is best tool for diagnosis
MRI is best for diagnosis
A 4-week-old male presents with non-bilious projectile vomiting after feeds. Upon assessment the patient has upper abdominal distension with a palpable olive-like mass in the RUQ with deep palpation. What is the most likely diagnosis and what is the treatment?
pyloric stenosis and pyloromyotomy
NOT
-malrotation and LADD procedure
-pyloric stenosis and IV antibiotics
-intussusception and barium enema
A 2-week-old newborn is brought to the clinic due to the
development of a red, scaly rash on the scalp and behind the ears. The parents report that the rash has become crusty and is occasionally itchy. What is the most likely diagnosis for this condition?
seborrheic dermatitis
NOT
-seborrheic keratosis
-atopic dermatitis
-contact dermatitis
A 23-year-old female presents to the clinic with painful blisters on her lips. She reports experiencing these outbreaks several times a year, typically triggered by stress or illness. Upon examination, you identify the presence of typical herpetic lesions. What is the
first line treatment and dosage for oral HSV-1?
acyclovir 800mg PO 3x daily x7days
NOT
-amoxicillin 500mg PO x10days
-azithromycin 500mg PO x7days
2-month-old female comes into the clinic with symptoms including fever, poor feeding, irritability,
vomiting, and foul-smelling urine. What diagnosis does the NP suspect and what steps should be taken
next?
A. NP suspects patient has UTI. The NP should instruct the parents to take the infant to the hospital for IV antibiotics
B. The NP suspects COVID. The NP should educate parents on symptomatic care
C. The NP suspects Strep throat. the NP should prescribe and antibiotic for the infant to take.
D. The NP suspects COVID. The NP should educate parents on symptomatic care.
NP suspects patient has UTI. The NP should instruct the parents to take the infant to the hospital for IV antibiotics.
NOT
-the NP suspects COVID. The NP should educate parents on symptomatic care.
-the NP suspects Strep throat. The NP should prescribe an antibiotic for the infant to take.
-the NP suspects COVID. The NP should educate parents on symptomatic care.
An 8-year-old girl comes into the clinic with the following symptoms: frequency, dysuria, and urgency. You diagnose the girl with uncomplicated cystitis. As the NP, what antibiotic would you prescribe the patient?
amoxicillin
NOT
-azithromycin
-ciprofloxacin
-tetracycline
A 70-year-old female comes into the clinic with complaints of a headache around the left temple, jaw
pain, and some vision loss in the left eye. Which of the following would be your best presumptive
diagnosis?
giant cell arteritis
NOT
-migraine HA
-tension HA
-cluster HA
A 45-year-old female patient presents to the clinic with complaints of a headache. She states the headache
that begins around her eye(s) and lasts for several minutes to hours the pain is a 9/10 on a 1-10 pain scale.
What type of headache does this patient have?
cluster
NOT
-migraine HA
-tension HA
-rebound HA
For a 54-year old patient who currently smokes 1 pack per day with a 30-pack-year history, which of the
following screening recommended?
low-dose CAT scan of the chest
NOT
-PET scan
-spirometry
-one view chest x-ray
Which of the following is NOT a component of the “5 A’s” framework for behavioral counseling interventions?
A. Ask
B. Advise
C. Assess comprehension
D. Arrange
Assess comprehension
-assess readiness for change is included in 5 A’s
NOT
-Ask
-Advise
-Arrange
5 A’s: ask, advise, assess, assist, arrange
Which of the following interventions is the most effective lifestyle intervention for reducing cardiovascular disease risk in overweight patients?
Regular physical activity and weight loss
NOT
-stress management/reduction
-alcohol cessation
-tobacco cessation
22-year-old woman presents to your clinic for follow up from an ED visit, the diagnosis in the ED was pancreatitis. While discussing the lifestyle modification factors, you confirm that the patient understands the education
when she states which of the following?
A. I will increase my water intake to at least 2L of water daily to flush the pancreas
B. I will change my diet, adding more fat and less protein and carbs
C. I will increase my exercise routine to at least 30 min a day, 5 days a week
D. I will eat 5-6 small meals throughout the day, instead of 3 large meals; this will help my pancreas keep up with my digestion
I will eat 5-6 small meals throughout the day, instead of 3 large meals; this will help my pancreas keep up with my digestion
A 5-year-old with good nutrition and normal growth presents to the clinic for a check-up. Mom reports frequent abdominal pain and always crying when she is having bowel movements. Mom was worried after she got a call from school to bring a change of clothes because she had an episode of fecal incontinence and decided to bring her for a check-up. A nurse practitioner will ask all the following questions except?
A. Is there any family history of constipation?
B. In the last 2 months, how often did she have bowel movements per week?
C. Is there any time you have had to unclog the toilet after she uses the bathroom?
D. In the last 2 months, how many episodes of fecal incontinence has she had in a week?
Is there any family history of constipation?
A mother reports her 6-month-old baby has a “red and irritated bottom” from a diaper rash, which is also known as contact dermatitis. As the primary care provider, what should the NP advise the mother to do?
change diaper frequently, clean area with cloth and water, apply zinc, or barrier cream with each diaper change.
NOT
-apply topical corticosteroid cream once every other day
-use of cloth diapers instead of disposable diapers
-do not use barrier cream after diaper changes as this may cause further irritation
A 35 year old woman with a history of anxiety, depression, and opioid use reports having increased anxiety. She also admits to increased use of oxycodone that started during the COVID-19 pandemic and has only gotten worse. She was able to keep her job through the pandemic and also used telehealth for appointments with her provider. What may be the main reason she has increased anxiety and opioid misuse from the pandemic?
A. financial strain
B. feelings of being isolated and lonely
C. easier access to opioids
D. inability to receive care to help with anxiety
feelings of being isolated and lonely
NOT
-financial strain
-easier access to opioids
-inability to receive care to help with anxiety
A 35-year-old male comes to urgent care with acute shoulder pain after lifting a heavy box. On examination, there is swelling and tenderness over the anterior shoulder, and the patient reports a feeling of “instability.” Which of the following examination techniques should you perform to assess for possible shoulder dislocation?
A. Neer test
B. Phalen’s test
C. Apprehension test
D. Cross-body adduction test
apprehension test
NOT
-neer test (shoulder pain/limited range of motion caused by rotator cuff impingement; fully pronate forearm, stabilize scapula in one hand; passively flexing arm until over the head)
-phalen’s test (dx carpel tunnel; hands waist height and place back of hands together; hold; raise arms so elbows are chest level)
-cross-body adduction test (assess integrity of acromioclavicular (AC) joint by passively adducting a flexed arm across the body, aiming to reproduce pain in AC joint if there is injury/pathology present)
A 41-year-old male comes to the clinic with shoulder pain after playing basketball. He describes difficulty reaching overhead and has pain on the outer side of his shoulder. On examination, there is tenderness over the greater tuberosity and weakness with external rotation. What is the most likely injury?
rotator cuff tear
NOT
-acromioclavicular joint injury
-shoulder dislocation
-bicep tendonitis
What lifestyle modifications are needed to prevent falls in a patient with osteopenia?
strength training and balancing exercises such as Tai Chi
NOT
-order a HoverRound from Amazon via Prime for 2 day free delivery
-drink a gallon of whole milk every few days
-enroll in kickboxing lessons
A 68-year-old female presents to clinic to discuss recent Dexa scan results. Her T-score is -1.4. What is the first line treatment for this Tscore and when should she have a repeat Dexa scan?
A. Vitamine D/5 years
B. Fosamax/every 6MO
C. Raloxifene/10 yrs
D. No treatment is required/PRN
vit D/every 5 years
NOT
-fosamax/every 6 MO
-raloxifene/10 YRs
-no treatment is required/PRN
A 60-year-old female presents to clinic with left foot pain. She was walking her dog when she almost tripped over a branch and landed hard on her left foot 5 days ago. Oblique/lateral x-ray shows decreased radiodensity to
left 3rd metatarsal. She is post-menopausal, former 20 pack year smoker, and not currently taking a multivitamin. What diagnostic test would confirm a
diagnosis of osteopenia?
Dexa scan
NOT
-ANA
-MRI of the left foot
-PET scan
A mother brings her 8-year-old son to the clinic for an acute visit. She verbalizes concern that her son has been complaining of joint aches and pains for the past two months. She has tried Tylenol and Motrin but the symptoms continue to return. The child reports feeling more tired recently. On exam the NP notes swelling and warmth to the right olecranon, bilateral knees, and uveitis. The patient’s vital signs reveal a low-grade fever of 99.8F. Lab tests display an elevated CRP, ESR, and a joint fluid analysis of 10,000 WBC. The NP suspects which diagnosis?
Juvenile idiopathic arthritis
NOT
-psoriatic arthritis
-septic arthritis
-osteomyelitis
The NP is caring for a 15-year-old female with complaints of muscle weakness and pain in her shoulders and pelvis. Physical exam reveals a heliotrope rash on her upper eye lids and scaly plaques on her knees. The NP suspects what diagnosis?
A. Polymysitis
B. Psoriatic psoriasis
C. Dermatomyositis
D. SLE (systemic lupus erythmatosus)
dermatomyositis
NOT
Polymyositis
Psoriatic psoriasis
SLE (systemic lupus erythematosus)
A mother brings her 5-year-old son to the clinic stating that the patient was recently diagnosed in the ER with a Torus fracture and a cast was placed on the arm to immobilize it. The mother reports that since leaving the ER her son has been crying in severe pain and is unsure what to do for him. She had tried Motrin and Tylenol with little relief. Your most appropriate response is?
A. It’s not uncommon for there to be pain after casing. Keep giving Tylenol and Motril.
B. He may have a green stick fracture that was misdiagnosed and needs further evaluation.
C. Continue to monitor and follow-up in 2 weeks if not better.
D. The case needs to come off if it’s causing that much pain.
B. He may have a green stick fracture that was misdiagnosed and needs further evaluation
NOT
-It’s not uncommon for there to be pain after casing. Keep giving Tylenol and Motrin.
-Continue to monitor and follow-up in 2 weeks if not better.
-The case needs to come off if it’s causing that much pain.
A 35-year-old female presents to clinic to discuss paroxetine that was started 2 weeks ago for generalized anxiety disorder. The patient reports that she doesn’t notice much difference and wants to know if she should continue the medication. The most appropriate response
would be?
Keep taking current medication as prescribed and follow-up in two weeks
NOT
-Let’s add xanax 0.5mg and see if that helps
-Increase dose of paroxetine
-Change to venlafaxine
Mother presents to the clinic with her 9-year-old son after being treated for generalized anxiety disorder. The child and parents have been attending cognitive
behavioral therapy which has been unsuccessful. Mother states the child continues to have reoccurring headaches and abdominal pain. Since CBT is unsuccessful and as the
NP what would be your next choice of treatment?
low dose fluoxetine (Prozac) with continued CBT
NOT
-Low dose duloxetine (Cymbalta)
-Low dose venlafaxine (Effexor)
-Low dose lorazepam (Ativan)
Mother presents to the clinic with her 9-year-old son with complaints of reoccurring headaches and abdominal pain for the last 8 months. Mother states she has taken her son to multiple providers and all physical exams and test results have been unremarkable. As the NP, you diagnose the child with generalized anxiety disorder. What would be your first choice of treatment for the child?
Cognitive behavioral therapy
NOT
-fluoxetine (Prozac)
-Sertraline (Zoloft)
-Venlafaxine (Effexor)
Which of the following would be considered a HIPAA violation?
A. Reporting an HIV+ result to the local health department
B. Telling your spouse about the celebrity that you got to care for today because it was a once in a lifetime opportunity and that celebrity will never remember you
C. Sharing lab results in a patients room with the spouse present
D. Forwarding ER visit results to the patient’s PCP
B. Telling your spouse about the celebrity that you got to care for today because it was a once in a lifetime opportunity and that celebrity will never remember you
A mother brings her 8-year-old daughter to the clinic with concerns that her teacher reports the patient cannot sit still, wait for her turn, pay attention, and gets easily
distracted. With additional questioning, can you predict which of the following is the diagnosis?
Combined inattentive and hyperactivity-impulsivity type ADHD
NOT
-GAD
-Hyperactivity-impulsivity type ADHD
-Inattentive type ADHD
A 14-year-old soccer player presents for evaluation a few hours after sustaining a hit to the head in practice. Patient’s mother reports he has had a severe headache, fatigue, sensitivity to light and noise, and has been unable to concentrate on his homework. What condition would the NP suspect?
Concussion
NOT
-Migraine with neurological sx
-Meningitis
-Epidural hemorrhage
2-year-old African American male presents to clinic with mother for fatigue, pallor, and yellowing of sclera for the past couple of days. States it started as a belly ache and fatigued. Then his eyes started turning yellow. Nurse practitioner suspects what hematologic disorder may be present?
Sickle cell disease
NOT
-Hemolytic anemia
-acute hepatitis E
-B-thalassemia
Martha is a 78-year-old female who presents to the clinic today with her daughter due to concerns that Martha has become more forgetful over the last few years. She is easily distracted, forgets the names of objects, forgets tasks she is performing, and forgets why she entered a room. She has even found herself getting lost in surroundings she is familiar with, so she is unable to leave the house without her daughter since she cannot find her way back home. Her forgetfulness has gradually worsened over the last couple of years. Martha should be assessed for:
Dementia
NOT
-delirium
-depression
-cerebral mass
Providers should know that different age groups have different resting heart rate ranges. Which age group has a resting heart rate of 80 to 200 beats per minute?
1-3MO
NOT
2-10MO
<1MO
2-24MO
As a provider using Step therapy for a personalized asthma management plan, which of the following is
Step #3 out of the 6 Steps?
Combination low-dose ICS plus formoterol daily and as needed
NOT
-low dose ICS daily and SABA as needed
-Combination medium-dose ICS-formoterol daily and as needed
-Medium-high dose ICS-LABA plus LAMA and SABA as needed
A young, adult female presents to clinic for education regarding contraception options. She has recurrent
migraines and is a smoker. What type of contraception would be the best option for this patient?
Copper IUD
NOT
-Mirena IUD
-The mini pill
-Nexplanon
A sexually active female presents to clinic complaining of abnormal vaginal discharge, itching, a fishy odor, and pain with intercourse. The wet mount reveals clue cells on examination. What would the initial
diagnosis be for this?
Bacteria vaginosis
NOT
-chlamydia
-gonorrhea
-trichimoniasis
A 10-year-old boy comes to the clinic with his mother with complaints of worsening asthma exacerbations. The mother reports him being breathless at rest which limits his activity, he prefers to be sitting, has loud wheezing throughout exhalation, and has Spo2 of 94% on RA. As the practitioner, one can classify the severity of his asthma as:
Moderate
NOT
-Severe
-Mild
-Respiratory Arrest Imminent
What testing is essential to establish a diagnosis of community-acquired pneumonia?
Chest radiography
NOT
-diagnostic thoracentesis
-sputum culture
-respiratory viral panel
A pregnant woman is diagnosed with hyperthyroidism. Which of the following medications is considered safe for use during pregnancy to manage her condition?
Propylthiouracil (PTU)
NOT
-radioactive iodine
-methimazole
-levothyroxine
A 35-year-old female is in clinic complaining of fatigue, weight gain, dry skin, and constipation and has been diagnosed with hypothyroidism. What is the test that is most commonly used to diagnose hypothyroidism?
Thyroid stimulating hormone (TSH)
NOT
-Free thyroxine (FT4)
-Triiodothyronine (T3)
-Thyroid ultrasound
A 20-year-old female presents to the OBGYN clinic to discuss possible birth control options. The patient
states that she is interested in only non-hormonal birth control options but would like the most effective
option. Which is the patient’s best option of birth control at this time?
Copper-bearing TCu380A IUD
NOT
-Male condoms
-Cervical sponge and spermicide
-Cervical cap usage with contraceptive jelly
A 55-year-old male presents to the clinic for an annual well-check. He is curious about lung cancer screenings and when to start them. The patient reports he is a current smoker and has a 25-pack-year smoking history. What information and treatment plan should you provide for this patient?
A. Annual low-dose CT scan once a year, along with smoking cessation efforts and counseling during visit
B. Encourage smoking cessation only
C. Advise patient that he should get a chest x-ray once a year to screen for lung cancer
D. Pulmnoary function testing once a year, along with chest X-ray
Annual low-dose CT scan once a year, along with smoking cessation efforts and counseling during visit
NOT
-Encourage smoking cessation only
-Advise patient that he should get a chest x-ray once a year to screen for lung cancer
-Pulmonary function testing once a year, along with chest X-ray
What is not a “diagnostic criteria” when diagnosing Kawasaki Disease in a 4-year-old with 6 days of
fever?
A. Polymorphous generalized rash
B. Bilateral enlarged cervical lymph nodes (>1cm)
C. Strawberry tongue
D. Unilateral enlarged cervical lymph nodes (>1.5cm)
Bilateral enlarged cervical lymph nodes (>1cm)
A 15-year-old female comes into the clinic for a follow up after an ER visit for possible seizures. Per ER
records, a CT, EEG, labs were obtained, and the patient was diagnosed with syncopal episodes. The
patient and mother reported that this was the third incident in 2 months. The mother states this happened
to her when she was a teenager as well. What would not be a next step in this appointment as a Nurse Practitioner?
A. Educate the family on the importance of proper hydration with a goal of clear urine at least 5 times a day
B. Obtain a thorough family hx and ask if there is any family hx of sudden cardiac arrest. Refer to cardiology.
C. Prescribe a beta blocker as prevention for future episodes.
D. Discuss the importance of slow position changes and how to prevent syncopal episodes from occurring if feelin lightheaded prior to. Inform to lie patient flat if an episode occurs.
Prescribe a beta blocker as prevention for future episodes
A patient with moderate BPH is being treated with tamsulosin. What should the NP educate the patient on
regarding this new medication?
A. Check the patient’s BP in office and advise the patient to keep BP log at home
B. Send UA to lab
C. Keep a voiding log
D. Limit oral intake
Check the patient’s BP in office and advise the patient to keep BP log at home.
NOT
-Send UA to lab
-Keep a voiding log
-Limit oral intake
When providing treatment for a patient with erectile dysfunction, what medication should be avoided when using PDE-5 inhibitors such as sildenafil?
Isosorbide mononitrate
NOT
-lisinopril
-metoprolol
-amlodipine
According to the 2018 American Heart Association/American College of Cardiology, when should screening for high blood cholesterol in adult men begin?
20 years old with cardiac history; 35 years old without a cardiac history
NOT
-20 years old with HTN
-30 years old coronary artery disease
-35 years old without a cardiac history
When screening your patient for cholesterol-related disorders, you know all the below items are
considered “enhanced risk factors” except:
A. Psoriasis
B. South Asian Ancestry
C. Ankle brachial index of 0.6
D. Father developing this disease at 75
Father developing this disease at 75YO
At what age should routine screening for sexually transmitted infections (STIs) begin in sexually active
adolescents?
14YO
NOT
-12YO
-16YO
-18YO
Which of the following is the recommended first-line treatment for chlamydia in adolescents?
Doxycycline
NOT
-Amoxicillin
-Ciprofloxacin
-Azithromycin
A 26-year-old female presents to the clinic with complaints of increased vaginal discharge, itching and
discomfort when urinating. During the pelvic exam, the nurse practitioner notices the presence of thin,
white discharge that has a fishy odor. On microscopic examination there is a presence of “clue cells”. The
diagnosis for these clinical findings is:
Bacterial vaginosis
NOT
-Trichomoniasis
-Vulvovaginal candidiasis
-Chlamydia
A mother presents to the pediatric clinic with her 2-year-old son for his well-visit. Based on the developmental chart, the nurse practitioner expects the child to be able to:
A. Copies circle
B. Build tower of 6-7 cubes
C. Holds crayon with fingers
D. Climbs stairs with alternating feet
Build tower of 6-7 cubes
A 30 year old female recently diagnosed with hyperlipidemia presents to the clinic requesting medication therapy options. The patient desires pregnancy within the next year and asks how this diagnosis affects her options. What is the appropriate
response regarding hyperlipidemia in pregnancy?
A. We will start you on a medication calss called a bile acid-binding resin as this is considered safe in pregnancy
B. You can start on statin therapy now until you become pregnant, at which point we will switch your medication
C. For now, continue to try diet and lifestyle adjustments to try and lower your cholesterol
D. We will start statin therapy today as it has no known effect on pregnancy
we will start you on a medication class called a bile acid-binding resin as this is considered safe in pregnancy
NOT
-you can start on statin therapy now until you become pregnant, at which point we will switch you medication
-for now, continue to try diet and lifestyle adjustments to try and lower your cholesterol
-we will start statin therapy today as it has no known effect on pregnancy
George presents to the clinic to discuss lab results. He has a family history of hyperlipidemia and a high
risk for cardiovascular disease. Despite lifestyle changes and maximum statin therapy, his LDL remains
>100mg/dL. Which of the following would be considered an appropriate second-line therapy for George?
add Ezetimibe 10mg/day PO in addition to his statin
NOT
-switch medications to just a PCSK9 and stop the statin
-stop the statin and try omega-3 fatty acid and diet changes
-continue to monitor his labs and keep the medication the same
Gonorrhea, a sexually transmitted disease caused by the bacterium Neisseria Gonorrhoeae can present as which of the following in females?
A. vaginal abscess
B. Carbuncle
C. Pustular rash
D. Mucopurulent cervicitis with a yellowish discharge
Mucopurulent cervicitis with a yellowish discharge
The most sensitive way to test for chlamydia is by?
Nucleic acid amplification test (NAAT)
NOT
-Enzyme linked immunosorbent essay (ELIZA)
-Direct fluorescent antibody (DFA)
-Urine culture
Which of the following characteristics distinguishes a phyllodes tumor from a fibroadenoma?
Phyllodes tumors can be either benign or malignant and may grow rapidly, unlike fibroadenomas
NOT
-Fibroadenomas are more common after menopause, while phyllodes tumors are not
-Phyllodes tumors are typically painful, while fibroadenomas are not.
-Fibroadenomas always metastasize to lymph nodes, while phyllodes tumors do not
Which of the following is a common initial clinical finding in male breast cancer?
A. Painless lump beneath the areola, usually in men over 50
B. Painful lump beneath the nipple, usually in men over 40
C. Swollen lymph nodes without a breast lump, usually in men under 30
D. Sharp perisstent pain in the breast tissue, usually in men over 80
-Painless lump beneath the areola, usually in men over 50
NOT
-Painful lump beneath the nipple, usually in men over 40
-Swollen lymph nodes without a breast lump, usually in men under 30
-Sharp persistent pain in the breast tissue, usually in men over 80
You are working in the ER when an RN who works on the floor approaches you and tells you that she has looked through your patient’s EMR because he is her neighbor
and his wife texted and asked her to. She has some concerns about lab results and wants to discuss them with you. What is the appropriate response?
You have committed a HIPAA violation by accessing his EMR and by discussing results with his wife. I will have to report this.
NOT
-Tell his wife to come in and I will discuss it with her.
-I will elevate your concerns to the supervising MD
-Your concern is valid; let me look into his lab work more.
A 34-year-old woman comes to clinic with facial weakness. The patient states she looked in the mirror this morning and noticed her face appeared “distorted.” She didn’t notice any asymmetry before going to bed
the night before. There are no complaints of pain. Assessment shows she in unable to smile on the right side of her mouth, she has difficulty closing her right eye, and she in unable to wrinkle her forehead on the
right side. She is also experiencing numbness to the right side of her face but can sense coolness and heat.
Upon examination, strength and motor function are within normal limits at all extremities. Balance and
coordination are unaffected. She’s able to communicate and answers all questions appropriately. What would be the best INITIAL plan of care?
Prednisolone 25mg orally twice daily for 10 days
NOT
-Call an ambulance to report a stroke
-CT of head
-Referral to a neurosurgeon
Which of the following vaccinations are recommended for a 4-month old child?
A. IPV
B. Hep A
C. MMR
D. Varicella
IPV
NOT
-Hep A
-MMR
-Varicella
Tammy is a 12-year-old female coming into the office for a well-child visit and an HPV vaccination.
While doing routine screenings, if she admits to which of the following would require immediate referral
for psychiatric crisis assessment?
A. Suicidal ideation with a plan
B. Random suicidal ideation
C. Access to lethal means
D. Fleeting homicidal ideation
Suicidal ideation with a plan
M-CHAT is the screening tool used to screen for autism, at what age should this be administered?
18 and 24 months
NOT
-16 and 28MO
-12 and 15MO
-24MO
When making a medical decision about imaging studies for a patient with suspected appendicitis, which
of the following factors should be considered first?
A. Patient’s age and sex
B. Cost of imaging studies
C. Availability of imaging techniology
D. Clinical presentation and history
clinical presentation and history
NOT
-patient’s age and sex
-cost of imaging studies
-availability of imaging technology
Which of the following is the most appropriate initial SCREENING diagnostic test for a patient presenting
with suspected diabetes mellitus?
Fasting plasma glucose
NOT
-Hemoglobin A1C
-Oral glucose tolerance test
-Random plasma glucose
A Nurse Practitioner is evaluating a 16-year-old female that reports occasional marijuana use. The NP
recognizes that all of the following factors influence the progression of substance use to substance
abuse except?
A. Early onset of sexual behavior
B. Popularity with peers
C. Genetic predisopition
D. History of trauma
Popularity with peers
A 14-year-old white male presents to the clinic with mother for a well child visit. Mother reports concerns
that the patient is skipping school, failing several classes, and having problems with peer relationships.
The NP recognizes these as possible signs of substance use and recalls that the most frequently abused
substance in adolescents is?
Alcohol
NOT
-Marijuana
-Cocaine
-LSD
A 48-year-old female presents to the clinic with joint pain. All of the following complaints would lead you to think Rheumatoid Arthritis except:
A. Symmetrical swelling of multiple joints
B. Joint pain that is NOT relieved with rest
C. Joint stiffness in the morning lasting less than 30 minutes
D. Juxta-articular osteoporosis seen on x-ray
Joint stiffness in the morning lasting less than 30 minutes
Which of the following clinical manifestations would NOT be indicative of Osteoarthritis as compared to symptoms of Rheumatoid Arthritis?
A. Involvement of the wrist and MCP joints
B. Involvement of the DIP and PIP joints
C. Presence of Heberden and Bouchard’s nodules
D. Involvement of a joint with prior injury
Involvement of the wrist and MCP joints
John, a 62-year-old Caucasian male was just diagnosed with atrial fibrillation. As his provider you have decided to start him on a Direct-Acting Oral Anticoagulant (DOAC). After reviewing his lab results, you note his creatinine clearance is 25mL/min. Which of the following DOACs is
contraindicated due to reduced kidney function?
A. Edoxaban (Savaysa)
B. Rivaroxaban (Xarelto)
C. Apixaban (Eliquis)
D. Dabigatran (Pradaxa)
Dabigatran (Pradaxa)
NOT
-Edoxaban (Savaysa)
-Rivaroxaban (Xarelto)
-Apixaban (Eliquis)
Which of the following is NOT a treatment modality for sickle cell anemia in the adult patient?
A. L-glutamine 30g oral powder once daily
B. Meperidine 50mg every 3-4 hours as needed for chronic pain
C. Hydroxyurea 500-750mg once daily
D. Morphine 5-15mg every 4 hours as needed
Meperidine 50mg every 3-4 hours as needed for chronic pain (type of narcotic)
NOT
-L-glutamine 30g oral powder once daily
-Hydroxyurea 500-750mg once daily
-Morphine 5-15mg every 4 hours as needed
A 27-year-old female presents to your clinic with complaints of fatigue, insomnia, heart palpitations, and
weight loss of 14 pounds in the past two months. The patient is 18 weeks pregnant with her first child and
has no other medical history. The patient is aware losing weight during the first trimester of pregnancy is
not uncommon. But she is concerned about the continued weight loss into her second trimester without
any nausea, vomiting, or other GI upset. As the nurse practitioner, what lab orders will you place for this
patient?
A. CBC, CMP, TSH with reflex, T4 and T3
B. CBC, CMP, magnesium, B12 levels
C. Serum hcg, CMP, serum vit B12 levels
D. Serum hcg, TSH with reflex, T4
CBC, CMP, TSH with reflex T4 and T3
NOT
-CBC, CMP, magnesium and B12 levels
-Serum hcg, CMP, serum vit B12, serum vitamin D, serum folate
-serum hcg, TSH with reflex T4
A 54-year-old Caucasian male presents to your clinic with lower back pain that began approximately three
days ago. The current pain was first noticed upon waking and slowly progressed during the workday; the
patient works as an industrial welder at a shipyard. The patient reports previous episodes of occurring
once or twice a year, lasting several days to one week before resolving. Previously pain has been treated
successfully with a steroid injection and Naproxen; the patient is requesting the same treatment today to
speed up recovery. What finding during physical exam can help the nurse practitioner determine the cause
of recurrent low back pain?
A. Pain is relieved with steroids and NSAIDS
B. The pain is worse while back is extended in standing position
C. Pain is associated with urinary incontinence
D. Pain is worse at bedtime
The pain is worse while back is extended in standing position
NOT
-pain is relieved with steroids and NSAIDS
-pain is associated with urinary incontinence
-pain is worst at bedtime
A 35-year-old female presents with symptoms of depression, including low mood, lack of energy, and
difficulty concentrating for the past two months. What is the most appropriate initial pharmacologic
treatment?
A. Trazodone 50mg at bedtime
B. Venlafaxine 225mg twice daily
C. Sertraline 25mg daily
D. Olanzapine 10mg daily
Sertraline 25mg daily
NOT
-Trazodone 50mg at bedtime
-Venlafaxine 225mg twice daily
-Olanzapine 10mg daily
A 58-year-old postmenopausal woman with no history of hysterectomy, breast cancer or cardiovascular
disease presents with severe vasomotor symptoms. She is considering hormone replacement therapy
(HRT). What is the most appropriate recommendation?
Recommend combined estrogen-progestin therapy
NOT
-avoid HRT due to age
-use alternative therapies like black cohosh
-take estrogen alone
A 40-year-old male was brought into the emergency room. It has been determined that he is going through alcohol withdrawal. He has a CIWA-Ar score of 18. What stage of withdrawal is he experiencing and what is the initial treatment?
A. Moderate withdrawal; chlordiazepoxide 100mg orally
B. Moderate withdrawal; chlordiazepoxide 50mg orally
C. Severe withdrawal; lorazepam 1-2mg IV
D. Severe withdrawal; lorazepam 3-4mg IV
Moderate withdrawal; chlordiazepoxide 100mg orally
NOT
-severe withdrawal; lorazepam 3-4mg IV
-moderate withdrawal; chlordiazepoxide 50mg orally
-severe withdrawal; lorazepam 1-2mg IV
Which of the following medications is considered to be a first line treatment for mania?
A. Lamotrigine
B. Lithium
C. Valproid acid
D. Carbamazepine
Valproic acid
NOT
-lamotrigine
-lithium
-carbamazepine
A 14-year-old girl presents to the clinic and the mother states “she avoids or restricts food intake even
though she isn’t concerned with her weight or body image”. What is your presumptive diagnosis?
A. Avoidant-restrictive food intake disorder
B. Binge-eating disorder
C. Anorexia nervosa
D. Bulimia nervosa
avoidant-restrictive food intake disorder
NOT
-binge-eating disorder
-anorexia nervosa
-bulimia nervosa
What is considered the gateway drug for adolescents?
Alcohol
NOT
-prescription drugs
-Nicotine
-marijuana
Thomas received a concussion at his football game on Tuesday. He had no loss of consciousness at the time of the event but did experience some mild nausea. He has been asymptomatic for 24 hours. Regarding the six-step progression, what is the next step that Thomas should progress to:
A. Continue rest as he could be asymptomatic for a minimum of 48 hours
B. Light aerobic exercise
C. Sport-specific exercise
D. Noncontact drills
light aerobic exercise
NOT
-continue rest as he could be asymptomatic for a minimum of 48 hours
-sport-specific exercise
-noncontact drills
Lucy is an 11-year-old girl who was recently diagnosed with scoliosis. Her mom has several questions
regarding scoliosis and current recommendations and treatment. All the following are true regarding
scoliosis except:
A. Scoliosis is more common in males than females
B. Surgical correction is recommended for spinal curvature of 40-60 degrees
C. Scoliosis is a lateral curvature of the spine
D. Bracing is recommended for spinal curvature of 20-40 degrees
Scoliosis is more common in males than females
A 57-year-old female patient was admitted to the hospital with a deep vein thrombosis (DVT) and started on heparin therapy. Four days later, her platelet count decreased from 250,000/μL to 95,000/μL. She reports no signs of bleeding. What is the most appropriate next
step in managing this patient?
A. Continue heparin and monitor platelet counts closely
B. Administer platelet transfusions and continue heparin
C. Discontinue heparin and start a direct thrombin inhibitor (e.g. argatrogan)
D. Switch to low-molecular-weight heparin (e.g. enoxaprin)
discontinue heparin and start a direct thrombin inhibitor (e.g. argatroban)
NOT
-continue heparin and monitor platelet counts closely
-administer platelet transfusions and continue heparin
-switch to low-molecular-weight heparin (e.g. enoxaparin)
A 32-year-old female presents to the clinic with complaints of easy bruising, petechiae on her legs, and
intermittent nosebleeds. She denies any recent illness, medication changes, or significant medical history.
A complete blood count reveals isolated thrombocytopenia with a platelet count of 25,000/μL. Other blood cell counts and coagulation studies are normal. Which is the most appropriate next step in managing treatment for this patient?
A. Refer for bone marrow biopsy
B. Administer IV immunoglobulin (IVIG)
C. Begin corticosteroid therapy
D. Observe without intervention
begin corticosteroid therapy (prevent bleeding by decreasing the production of antibodies against platelets. If effective, the platelet count will rise within two to four weeks of starting steroids.)
NOT
-refer for bone marrow biopsy
-administer IV immunoglobulin (IVIG)
-observe without intervention
Tom is 22 years old, he was physically active, played basketball. Last year while leaving a game with his
friends, he was involved in a motor vehicle accident that left him quadriplegic. His mother came to see
you as their primary care provider, and she wants you to guide her about getting Tom some help with his
mobility. She stated: “I have heard that rehabilitation medicine is a thing to do”, can you talk more about?
A. Yes, rehabilitation medicine is a “thing to do”, but it is too late, Tom had an accident 1 year ago.
B. Yes, I will make referrals for Tom, rehabilitation medicine is good, it is not too late to start. Its goal is to help improve function and minimize impairment
C. Tom is still young, and he is not dying, rehabilitation medicine is best when someone is near the end.
D. Rehabilitation medicine can cure Tom, he can walk and use his hands again
B. Yes, I will make referrals for Tom, rehabilitation medicine is good, it is not too late to start. Its goal is to help improve function and minimize impairment
Mr. Letter, a 94-year-old man with medical history of HTN, Aortic stenosis, CHF, and HLD. He stopped
smoking 20 years ago and does not complain of cough or shortness of breath. His daughter brought him
today for his annual visit. The daughter expressed the need to have her father screened for lung cancer,
prostate and colon cancer. As a provider you order:
A. No screening tests, but proceed by telling the daughter that screening her dad for any type of cancer at this age
would not be cost- effective, and more importantly any cancers that can be diagnosed at this age would
probably not become symptomatic during his lifetime, and even attempting to treat them can cause more harm
than benefits
B. Low dose Lung CT scan to screen for lung cancer since he just quit 20 years ago
C. PSA to screen for prostate cancer, he is man why not, it could have cancer
D. Colonoscopy, as a USPSTF recommendation for everyone older than 45-year-old
A. No screening tests, but proceed by telling the daughter that screening her dad for any type of cancer at this age
would not be cost- effective, and more importantly any cancers that can be diagnosed at this age would
probably not become symptomatic during his lifetime, and even attempting to treat them can cause more harm
than benefits
What is the hallmark symptom of aplastic anemia?
Pancytopenia
NOT
-iron deficiency anemia
-elevated vit B12
-decreased ferritin
A 38-year-old female presents to your clinic with frequent fatigue and mild shortness of breath with
exertion. Upon interpreting her CBC with differential, you notice a H/H of 11.8/ 30 with a low MCV and
low MCH. Her ferritin is 8 ng/ml. What diagnosis do you make considering her symptoms and lab
findings?
iron deficiency anemia
NOT
-macrocytic anemia
-folic acid deficiency
-anemia of chronic disease
A mother brings her 22 month old daughter into the pediatricians office because she has been vomiting
every morning for the last 2 weeks. After she vomits she seems to feel better and goes about her day. On
physical exam the nurse practitioner notices that the child’s gait is quite unsteady and she has some
hyperreflexia on the left side. All of the following are part of the differential diagnosis EXCEPT:
A. brainstem glioma
B. astrocytoma
C. nephroblastoma
D. medulloblastoma
nephroblastoma
Which of the following is responsible for more than 25% of all cancer diagnoses made in children under
the age of 15 years on an annual basis?
Acute lymphoblastic leukemia
NOT
-medulloblastoma
-wilms tumor
-ewing’s sarcoma
Which of the following medications would be the best first line treatment for generalized anxiety disorder?
Escitalopram (lexapro)
NOT
-Alprazolam
-Propranolol
-Gabapentin
What statement indicates the correct education being given to a patient about colorectal cancer screening?
A. Without a family history of colorectal cancer, you should not get screened until you are over 75 years old.
B. Most cases of colorectal cancer arise from benign polyps and the removal has been shown to prevent the
majority of colorectal cancers
C. Getting screened for colorectal cancer is not that important as most cases are unpreventable and incurable
D. If you get screened for colorectal cancer one time you will never develop colon cancer
Most cases of colorectal cancer arise from benign polyps and the removal has been shown to prevent the
majority of colorectal cancers
You are a preceptor to a Family Nurse Practitioner student, and she would like to know what symptoms
hyperthyroidism usually presents with. You proceed to tell her that the following are symptoms of
hyperthyroidism except?
A. palpitations
B. sweating
C. menstrual irregularity
D. cold intolerance
cold intolerance
Oghenekaro a 23-year-old female with hyperthyroidism is actively trying to conceive and would like to
know which medication is safest to use for hyperthyroidism treatment during pregnancy. As her PCP, you explain to her that ________ has the least potential to cause fetal anomalies during the first trimester.
Propylthiouracil (PTU)
NOT
-Armour thyroid
-methimazole
-carbimazole
Which of the following screening tools is used in the primary care setting to assess for alcohol use disorder?
CAGE questionnaire
NOT
-GAPS
-PHQ-9
-GAD-7
A patient presents to the clinic with a “dull, aching, pain” in his epigastric region for several weeks. He states he has mild relief with antacids, but the pain returns 2-4 hours later. He does report taking Advil frequently for headaches. The patient c/o mild epigastric tenderness with deep palpation on physical exam. What is your first treatment action as the NP?
A. Tell the patient you are not concerned and continue taking daily OTC pepcid for GERD sx
B. Order CT scan of the abd
C. Start on PPI and refer to GI for endoscopy to R/O peptic ulcer disease (PUD)
D. Tell patient it is okay to continue taking Advil and refer to GI
start on PPI and refer to GI for endoscopy to R/O peptic ulcer disease (PUD)
NOT
-tell the pt you are not concerned and continue taking daily OTC pepcid for GERD sx
-order CT scan of the abd
-tell patient it is okay to continue taking Advil and refer to GI
A 30-year-old male patient presents with complaints of heartburn and occasional regurgitation after meals. He reports taking Pepcid which relieves his symptoms, but he has been needing it more frequently. What is the most likely diagnosis?
GERD
NOT
-IBS
-Angina pectoris
-peptic ulcer disease
A 2-year-old female patient presents to the clinic with her mother due to crying during urination. Her urinalysis revealed positive nitrites and 2+ leukocytes. The mother reports the patient is currently potty training and denies fevers, vomiting, or lethargy. What is your recommendation for treatment?
Amoxicillin for 7 days
NOT
-this is normal behavior when potty training. No tx necessary.
-tx should be delayed until receiving the urine culture sensitivity report
-doxycycline for 10 days
A mother presents to the clinic with her 5-day-old female baby. She is distraught because her baby has had
bug bites since she was 3 days old, and she is not sure what could have bitten her. On exam, you find
several erythematous macules with wheals 2cm in diameter on the chest, back, arms, and legs. What is
your response to the patient’s mother as her healthcare provider?
A. “We will treat her insect bites with a topical steroid cream.”
B. “This rash is common in newborns and is not caused by insect bites. It should resolve in about a week.”
C. “Vigorous exfoliation will speed the healing process.”
D. “Her rash appears to be an allergic reaction. You should rewash her clothing and linens in a new detergent.”
This rash is common in newborns and is not caused by insect bites. It should resolve in about a week.
A 4-week-old infant is brought to the clinic by his parents, who report that he has been projectile vomiting after most feedings. The vomiting occurs shortly after eating and is described as non-bilious. On examination, you palpate an “olive-shaped” mass in the right upper quadrant of the abdomen. What is the most
likely diagnosis?
Pyloric stenosis
NOT
-GERD
-intestinal obstruction
-appendicitis
4yo female presents with complaints of abdominal pain, low grade fever, poor appetite, and no bowel movements over the last 3 days. Mother reports abdominal pain began yesterday and today patient has worsening abdominal pain and one-time episode of emesis. What step should the provider take next?
A. Order a miralax flush for patient to complete at home for constipation
B. Advise mother it’s likely just a “stomach bug” and that patient just needs fluids and rest
C. Order an abdominal US to R/O appendicitis
D. Order a 3-day course of Flagyl and tell mother to continue Tylenol at home for fever
Order an abdominal US to R/O appendicitis
NOT
-order a miralax flush for patient to complete at home for constipation
-advise mother it’s likely just a “stomach bug” and that patient just needs fluids and rest
-order a 3-day course of Flagyl and tell mother to continue Tylenol at home for fever
A 2-year-old female who is in daycare full time is brought to the clinic today by her mother. The mother reports she noticed thick, and honey colored like crusted sores on her daughter’s face mainly around her nose and mouth. What would be your number 1 differential diagnosis?
Impetigo
NOT
-Herpes simplex
-Herpes zoster
-fifth’s disease
A 26-year-old male presents to the clinic with complaints of low-grade fever, localized tenderness with guarding in the right lower quadrant, and pain that is worsened when walking. Symptoms started mild with periumbilical pain and became severe over the past several hours. Which of the following is your most likely presumptive diagnosis?
Appendicitis
NOT
-Cholecystitis
-pancreatitis
-diverticulitis
A 45-year-old female presents with symptoms of dyspepsia, nausea, vomiting, and loss of appetite. The
patient is afebrile and denies diarrhea. During further assessment, patient reveals a long history of NSAIDs for arthritis pain. The NP must also suspect:
A. Helicobacter pylori (H. Pylori)
B. Clostridium difficile (C-diff)
C. Escherichia coli (E-coli)
D. Salmonellosis (Salmonella)
Helicobacter pylori (H. Pylori)
NOT
-clostridium difficile (C-diff)
-escherichia coli (E-coli)
-salmonellosis (Salmonella)
A first-time pregnant mother is at a routine OB/GYN visit and asking questions regarding her unborn child. She states she has a bad family history of dental
health and wants to prevent that with her child. As the NP, you should reassure the mother that at what age should the child have received a caries-risk assessment?
6MO
NOT
-18MO
-24MO
-36MO
As a nurse practitioner specializing in pediatrics, you know that the most common permanent dentition injury in pediatrics is noted to be?
A. Odontogenic infections
B. Alveolar fracture
C. Crown fracture
D. Common fracture
Crown fracture
NOT
-odontogenic infections
-alveolar fracture
-common fracture
You are seeing a patient in the office for their annual appointment and they inform you that they have
been using an over the counter sinus spray that contains oxymetazoline daily for the past 3 months. What
type of education would you provide to this patient?
A. These nasal sprays can be very effective but should not be used for more than a few days. Stop this medication and let us know if rebound congestion occurs
B. Nasal sprays containing Oxymetazoline or phenylephrine can be very addicting and you will need to wean yourself off by slowly decreasing how often you use it
C. It is safe for you to continue using the OTC nasal spray daily.
D. Only nasal sprays containing Phenylephrine can cause rebound congestion when stopping them, so make sure
that you are using the OTC nasal spray that contains Oxymetazoline for chronic use.
A. These nasal sprays can be very effective but should not be used for more than a few days. Stop this medication and let us know if rebound congestion occurs
Sensorineural hearing loss is common in adults and is normally caused by?
A. Cerumen impaction
B. MIddle ear effusion
C. Transient eustachian tube dysfunction
D. Deficits of the inner ear or central auditory pathway
Deficits of the inner ear or central auditory pathway
NOT
-Cerumen impaction
-Middle ear effusion
-Transient eustachian tube dysfunction
A 5-year-old patient presents with her mother for ear pain. Upon examination you note a bulging TM with middle ear effusion. Mother states she (the child) was recently treated for strep and completed amoxicillin 3 weeks ago. What medication would be best for treatment?
Amoxicillin=clavulanate 90mg/kg PO
NOT
-ceftriaxone 50mg/kg IM
-amoxicillin 90mg/kg PO
-clindamycin 25mg/kg PO
An 8 month old male patient presents to the clinic with a low-grade fever and cough. Dad states the daycare called, reporting that the infant was being extremely fussy, and they have noticed a rash. You note small papules on the palms of his hands and soles of his feet along with ulcers on the tongue. Which of the following would be your first presumptive diagnosis?
HFM
NOT
-pharyngitis
-mononucleosis
-herpangina
35-year-old male presents to the clinic with complaints of diarrhea, loss of appetite, weight loss and fever. Patient states he has been uncomfortable and “cramping” for the past 3 weeks and at times has seen blood in his stool. Based on this information, what is the likely diagnosis?
Crohn’s disease
NOT
-IBS
-food poisoning
-acute chronic gastritis
Which of the follow precautions should a person diagnosed with Impetigo take?
A. wash all household items in diluted household bleach
B. hand wash all household items
C. there are no extra precautions to take for household items with impetigo contamination
D. wash all household items with cold water
A. wash all household items in diluted household bleach
A 46-year-old female presents to the clinic with complaints of nausea, vomiting, and muscle pain. She reports that she recently came home from a
mission trip and her symptoms started shortly after. Labs reveal markedly elevated AST and ALT levels. After further workup, you determine that she has Hepatitis A. What education is appropriate for this patient?
A. quarantine until sx fully resolve
B. nothing. She should not be concerned about the dx
C. continue with strenuous workouts multiple times a week since her body is used to it
D. avoid alcohol and hepatotoxic medications such as Tylenol
D. avoid alcohol and hepatotoxic medications such as Tylenol
26-year-old male presents to the clinic with complaints of right lower quadrant abdominal pain, nausea, and vomiting for the last 2 days. He states that the pain started as dull and achy, but it has progressively
worsened especially when he is walking. On exam he has a low-grade fever, positive McBurney’s point, and elevated WBC on his CBC. What is your suspected diagnosis and plan of treatment?
Appendicitis; send to ED immediately
NOT
-GERD; encourage patient to avoid spicy, acidic foods and prescribe Pepcid
-Constipation; instruct patient to begin Miralax daily and increase water intake
-Gastroenteritis; send home with instructions for rest and hydration, along with a prescription for ondansetron
A 52 y/o female Caucasian presents to your office to discuss lab results. 6 months ago, her eGFR was 58.
Today it is 44. She is taking metformin 500 mg daily for T2DM and amlodipine 5 mg daily for hypertension. Her blood pressure today is 138/86, and she states her home readings have been 130-140s/90s for the last month. Her Hgb A1C is 7.2%. What plan of care would be the most important to implement for this patient considering her kidney function? (fix everything)
A. Continue metformin. Discontinue amlodipine and replace with lisinopril/HCTZ 10mg/12.5mg for blood
pressure control. Add Jardiance 5-10mg daily to this regimen
B. Discontinue the metformin due to her decreased kidney function. Increase amlodipine to 10mg daily for blood pressure control.
C. Continue medications as is, continue home blood pressure readings, and follow up with the patient in 4 weeks.
D. Discontinue the metformin due to decreased kidney function. Continue amlodipine and add HCTZ 12.5mg for
blood pressure control.
A. Continue metformin. Discontinue amlodipine and replace with lisinopril/HCTZ 10mg/12.5mg for blood
pressure control. Add Jardiance 5-10mg daily to this regimen
A 46 y/o male presents to the clinic stating his gastroenterologist ordered a CT of the abdomen and pelvis with IV contrast. He is concerned, because he has been told it is “hard on the kidneys”. The patient has a
h/o T2DM controlled with metformin. Recent labs reveal an eGFR of 45. As the nurse practitioner, you understand he is at higher risk of contrast nephropathy due to decreased filtration and comorbidities. All the following are appropriate interventions to decrease the risk of contrast nephropathy EXCEPT:
A. Instruct the patient to hold his metformin the day before, day of, and the day after testing as metformin, in
combination with IV contrast, can increase the risk of contrast nephropathy.
B. Recommend 500-1000mL of 0.9% normal saline over 6 hours prior to and after the IV contrast infusion to
help dilute and excrete the contrast.
C. Order Lasix 20 mg PO the day of and the day after testing for enhanced renal excretion of the contrast.
D. Recommend a lower osmolality IV contrast at lower volumes to be used for testing in this patient.
C. Order Lasix 20 mg PO the day of and the day after testing for enhanced renal excretion of the contrast.
A 74-year-old male patient with a history of Type 2 diabetes, chronic kidney disease (eGFR =
28 mL/min/1.73 m²), and heart failure presents to the clinic with complaints of fatigue, nausea, and mild
shortness of breath over the past few days. He denies chest pain or cough. His medications include
metformin, lisinopril, and a beta-blocker. Recent lab results show:
● Sodium: 138 mEq/L
● Potassium: 4.9 mEq/L
● Chloride: 100 mEq/L
● Bicarbonate (CO₂): 17 mEq/L
● Creatinine: 2.5 mg/dL (baseline 2.0 mg/dL)
● Glucose: 110 mg/dL
Which of the following is the most appropriate next step in managing this patient?
A. Administer sodium bicarbonate to correct metabolic acidosis and continue metformin
B. Discontinue metformin and assess for metformin-associated lactic acidosis (MALA).
C. Increase the dose of metformin to improve glycemic control.
D. Start insulin therapy and continue metformin to improve glucose control.
B. Discontinue metformin and assess for metformin-associated lactic acidosis (MALA).
A 65-year-old patient with a history of hypertension and chronic kidney disease is currently taking lisinopril (an ACE inhibitor), spironolactone (an aldosterone antagonist), and ibuprofen (an NSAID) for joint pain. Recent lab results show mild hyperkalemia (elevated potassium levels) and worsening kidney function. What is the best next step in managing this patient’s medications?
A. Continue the current regimen and recheck potassium levels in one week
B. Stop ibuprofen and add acetaminophen for pain control.
C. Discontinue spironolactone and add a thiazide diuretic.
D. Stop both spironolactone and ibuprofen, and add a thiazide diuretic.
Stop both spironolactone and ibuprofen, and add a thiazide diuretic
A 6-year old presents to the clinic with his mother. His mother reports he is having seizure like episodes.
She reports the episodes are short and consist of blank facial expressions, a vacant stare, and rapid
blinking. She reports he becomes pale, but does not lose consciousness. What is the most likely diagnosis?
Petit mal seizure
NOT
-Complex partial seizure
-tonic-clonic seizure
-simple partial seizure
A 24-year old patient presents to the clinic reporting a unilateral throbbing headache. The headache is accompanied by photophobia and nausea and is worse with routine physical activity. The nurse practitioner diagnoses this as what type of headache?
Migraine
NOT
-Cluster
-Tension
-Posttraumatic
If your patient presents with cellulitis and you suspect MRSA, which antibiotic would you chose for treatment?
Clindamycin
NOT
-Nitrofurantoin
-Cefazolin
-Amoxicillin
A mother presents to the clinic with a 7 year old male, reports poor weight gain, loud snoring, and has recently started sleepwalking and having trouble concentrating at school. Upon physical exam you notice enlargement of the tonsils and adenoids. What is the most likely diagnosis?
Obstructive sleep apnea
NOT
-central sleep apnea
-attention deficit disorder
-insomnia
An 18 month old male presents to the clinic with cough, low grade fever and decreased PO intake. Mother states he has had a runny nose for a few days before the other symptoms developed. Upon auscultation, the NP hears
wheezing and prolonged expiration. What is the most likely diagnosis?
viral bronchiolitis
NOT
-asthma exacerbation
-epiglottis
-viral croup
Which of the following risk factors is unique to women and may increase their future risk
of cardiovascular disease (CVD)?
A. smoking
B. HTN
C. hyperlipidemia
D. early menopause
early menopause
What is the main reason weight-bearing exercise is recommended for osteoporosis prevention?
A. Decreases calcium absorption
B. Improves vitamin D levels
C. Increases bone density
D. Reduces risk of kidney stones
increases bone density
NOT
-decreases calcium absorption
-improves vitamin D levels
-reduces risk of kidney stones
You just diagnosed a 64-year-old female with hypertension and prescribed Amlodipine 10mg daily. The patient asks you what the most common side effect of this medication is. Which is the correct response?
Peripheral edema
NOT
-diarrhea
-cough
-tachycardia
52-year-old male with a history of Type 2 Diabetes Mellitus and Hyperlipidemia
presents to the clinic for laboratory value follow up. His LDL remains elevated at 162mg/dL. He is currently on Rosuvastatin 40mg daily and reports compliance with taking medication daily. As the provider, what is your treatment of choice?
A. Start patient on Ezetimibe 10mg daily in addition to his Rosuvastatin 20mg
B. Change patient from 40mg Rosuvastatin to 20mg Atorvastatin
C. Counsel on improving diet and exercise and follow up in 6 months
D. Educate patient to begin taking 2 pills of Rosuvastatin 40mg daily
A. Start patient on Ezetimibe 10mg daily in addition to his Rosuvastatin 20mg
Potential side effects of initiating ACE therapy include all the following except?
A. Angioedema
B. Cough
C. Extremity swelling
C. extremity swelling
Which of the following is not an example of exacerbating factors with regard to
primary hypertension?
A. ETOH use
B. NSAID use
C. MyPlate diet
D. Obesity
C. MyPlate diet
Which reflex is the examiner testing when placing a finger in the newborn’s palm?
Palmar grasp
NOT
-Moro
-Sucking
-Babinski
What is the most common treatment for indirect hyperbilirubinemia?
Phototherapy
NOT
-oral iron supplementation
-antibiotic therapy
-corticosteroids
Sally is 20 years old. She shares that she is sexually active and has forgotten to use
a condom during a few sexual encounters. She is concerned because her mother told her she needed a PAP smear. What guidance should you share?
A. Because you have had unprotected sex, we should perform your PAP smear today.
B. PAP smears should begin at age 18, or the onset of sexual activity, whichever comes first.
C. You will begin PAP testing routinely at age 25.
D. The USPSTF recommends against screening for cervical cancer in women younger than age 21 years.
D. The USPSTF recommends against screening for cervical cancer in women younger than age 21 years.
Katie presents to the clinic with vaginal itching. Her exam reveals a frothy, yellow-green discharge, and a strawberry cervix. Which infection do you suspect?
Trichomonas vaginalis
NOT
-PID
-Bacterial vaginosis
-Vulvovaginal candidiasis
What is the gold standard for diagnosis of an urinary tract infection in pediatric patients?
A properly collected urine specimen
NOT
-elevated BUN/Creatinine ratio
-leukocytosis
-renal ultrasound
The most reliable indicator of glomerular function is:
A. urinalysis
B. serum creatinine level
C. serum urea nitrogen level
D. estimated GFR
B. serum creatinine level
A 14-year-old male presents with his mother for wellness visit. The patient has a sexual maturity rating (SMR) between 3 and 4. He is experiencing gynecomastia. Which of the following physical exam findings would not warrant further investigation into gynecomastia?
A. Rapid breast enlargement
B. Presence of testicular mass
C. Persistence of gynecomastia over 3 years or past age 17
D. Full pubic hair, but limited in area
D. Full pubic hair, but limited in area
Woman is 26 weeks pregnant today and comes in for screening for gestational diabetes. You administer the non-fasting glucose challenge test and in 1 hour you obtain her blood glucose. Her blood glucose reading is 142. According to ACOG guidelines, what is your next step?
A 3-hour oral glucose tolerance test will be needed
NOT
-No other steps are needed, her blood glucose level is normal based on gestational age.
-The 1-hour glucose challenge test will need to be repeated next week
-No other steps are needed, based on her blood glucose reading you are able to diagnose her with gestational
diabetes.
A 37-year-old woman comes into the clinic with a headache. She is 34 weeks pregnant with her first child. Her blood pressure is 148/98 after arrival. You send her to the OB emergency department in the hospital. She decides to go home first and pack some bags and eat some lunch to see if it helps her headache. Four
hours later, in the OB ED her BP is 156/101. They draw lab work and find large amounts of protein in her urine. You know this woman most likely has which of the following:
A. HELLP syndrome
B. Eclampsia
C. Pre-eclampsia
D. Gestational HTN
C. Pre-eclampsia
An eight-year-old child has repeated urination in clothing during the day and in bed at night at least twice a week for 3 months. He is developmentally appropriate for his age. Next actions include all the following EXCEPT:
A. Wait and watch for this child to grow out of this normal behavior.
B. Complete H&P to rule out any anatomical abnormalities or medical or psychological implications
C. Education and avoidance of being judgmental and shaming.
D. Desmopressin acetate (DDAVP) if behavioral strategies fail.
A. Wait and watch for this child to grow out of this normal behavior.
The NP would be looking for a three-year-old child meeting developmental milestones to:
A. Button clothes, know the day of the week, draw a person, 100% understandable speech
B. Build a tower of 6-7 cubes, speak short phrases, jump on 2 feet, parallel play
C. Concrete operations, copy a triangle, catch a ball, skip smoothly
D. Build a tower of 9-10 cubes, copy a circle, give name, ride tricycle, collaborative play, 75% understandable speech
D. Build a tower of 9-10 cubes, copy a circle, give name, ride tricycle, collaborative play, 75% understandable speech
Jacob, a 12-year-old boy, comes to the clinic with complaints of recurrent flank pain and blood in his urine. His mother reports that he has had similar symptoms in the past, but they usually resolve on their own. A urinalysis reveals microscopic hematuria, and an ultrasound shows small, non-obstructive kidney
stones. Which of the following would be most appropriate in Jacob’s management?
A. Prescribe potassium citrate to dissolve the stones
B. Increase fluid intake and initiate salt intake to less than 2,000mg/day
C. Perform a percutaneous nephrolithotomy
D. Begin prophylactic antibiotics to prevent future infections
B. Increase fluid intake and initiate salt intake to less than 2,000mg/day
Which of the following is the most common causative organism of urinary tract infections (UTIs) in children?
Escherichia coli
NOT
-streptococcus pyogenes
-staphylococcus aureus
-pseudomonas aeruginosa
The patient with a history of nephrolithiasis arrives at the clinic for a follow-up visit. The laboratory test of the kidney stone that the patient passed two weeks ago showed it was composed of calcium oxalate. Which of the following is not an appropriate dietary recommendation for the FNP to give to the patient?
A. Decrease sodium intake less than 3500 mg/day
B. Increase fluids intake to 3000 ml daily
C. Decrease daily calcium intake
D. Reduce daily animal protein intake (eggs, fish, chicken, pork, and beef)
C. Decrease daily calcium intake
