Fitzgerald

Question 1

Which of the following is not seen in the dx of acute cholecystitis?

1. Elevated AST
2. Elevated ALP
3. Microcytic Anemia
4. Inc. total WBC

Answer 1

Microcytic anemia

Question 2

Which of the following is usually found in a person with a PLT count of 20k-50k?

1. No excessive bleeding risk
2. Minor spontaneous bleeding risk
3. Potential serious bleeding risk
4. Major spontaneous bleeding risk

Answer 2

Minor spontaneous bleeding risk

Question 3

A 10yo boy is being tx’d c oral PCN for pharyngitis caused by GAS. Which of the following is the most accurate information about when he can return to school?

1. Immediately after 1st dose of abx.
2. Infectious for x1 wk even p starting abx.
3. May return after on abx for 24 hrs and s fever
4. Risk of transmitting disease is minimized since he is on abx.

Answer 3

May return after on abx for 24 hrs and s fever

Question 4

As long as certain criteria are met, “incident to” billing is an option in all of the following settings except:

1. Office visits
2. Hospital
3. Nursing Home
4. Home visits

Answer 4

Hospital

Question 5

A prostate cancer lesion detectable by digital rectal exam will likely be described as:

1. Firm nodule
2. Mobile and non-tender
3. Boggy, tender lobe
4. Rubbery in texture

Answer 5

Firm nodule

Question 6

To avoid rx errors when using symbols and abbrev., which of the following is not recommended?

1. Use a zero before a decimal point when the dose is less then a whole unit (ie 0.5mg)
2. Use a zero following a decimal point when the dose is a whole unit (ie 10.0mg)
3. Write out Unit rather than U or u
4. Write out mcg or microgram rather than using ng

Answer 6

Use a zero following a decimal point when the dose is a whole unit (ie 10.0mg)

Question 7

You are performing well examination on a 10yo c no documented immunizations. The immunizations "catch up" regimen does not need to include:
1 MMR
2 Haemophilus influenza type B
3 Tdap
4 Hep B

Answer 7

H influenzae type B

Question 8

A patient with IBS is likely to report all of the following except:
1 Abdominal discomfort relieved by defecation
2 Appearance of blood in the stool
3 Symptom onset associated c change in stool freq
4 Symptom onset associated c change in stool form

Answer 8

Appearance of blood in the stool

Question 9

First-line therapy for management of urge incontinence for an otherwise healthy 57yo woman who is not taking any medication can include behavioral therapy plus:
1 Oral biphosphonate
2 Oral anticholinergic
3 Botulinum toxin injection
4 Oral thiazide diuretic

Answer 9

Oral anticholinergic

Question 10

A first-line intervention for a 52yo pt with Cushing's syndrome who does not have a hx of taking corticosteroid medications is:
1 Low-dose oral prednisone
2 DPP-4 inhibitor
3 Thyroxine
4 Surgical intervention

Answer 10

Surgical intervention (pituitary gland tumor)

Question 11

Which of the following is most consistent with the presentation of the person with bipolar 1 disorder?
1 Increased need for sleep
2 Impulsive behavior
3 Fatigue
4 Anhedonia

Answer 11

Impulsive behavior

Question 12

With most maternal medication use, the level of the drug in breast milk is highest when:
1 mother's serum level is at its peak
2 drug's T1/2 is near its end
3 mother's serum level has waned
4 just prior to breastfeeding

Answer 12

mother’s serum level is at its peak

Question 13

A 52 year old woman of African ancestry complains of dark brown patches on her forehead. She is otherwise healthy and takes no medications other than hormone replacement therapy to manage vasomotor symptoms. Considering a diagnosis of melasma appropriate management would include:
1 topical metronidazole
2 benzoyl peroxide 
3 topical corticosteroid
4 chemical peel

Answer 13

chemical peel

Question 14

Of the following test results which is most likely to be found in Graves disease?
1 increased TSH + free T4
2 single cold spot on thyroid scan
3 decreased TSH with elevated free T4
4 presence of a solid lesion on thyroid ultrasound

Answer 14

decreased TSH with elevated free T4

Question 15

What is the best approach to the pharmacologic care of a person with beta thalassemia minor?

1. no special pharmacologic care
2. folic acid supplementation
3. long-term iron supplementation
4. advice about possibility of hemolytic reaction with stress

Answer 15

no special pharmacologic care

Question 16

The most common source of hepatitis A infection is:

1. Shared injection drug equipment
2. contaminated water
3. sexual contact
4. cooked Seafood

Answer 16

contaminated water

Question 17

You have initiated therapy for a 16 year old man with acne vulgaris and have prescribed a systemic antibiotic as part of the treatment plan. He returns in 3 weeks complaining that his skin is no better. Your next action is to:

1. add a second systemic antimicrobial agent
2. discontinue the systemic antimicrobial
3. counsel him that six to eight weeks of treatment is often needed before significant Improvement is achieved
4. advise the patient that this antibiotic is likely not an effective treatment for him and change to a different systemic antimicrobial

Answer 17

counsel him that six to eight weeks of treatment is often needed before significant Improvement is achieved

Question 18

You see an 18 year old male with cystic acne who has been treated with oral doxycycline and topical retinoid for the past 8 weeks with no improvement. The most appropriate next course of action would be to:

1. switch to oral ciprofloxacin therapy
2. switch to topical erythromycin
3. switch to isotretinoin (Accutane)
4. continue with the current regimen for an additional four weeks

Answer 18

switch to isotretinoin (Accutane)

Question 19

Which of the following physical examination findings is consistent with a diagnosis of acute otitis media in a four-year-old child?

1. submental lymphadenopathy
2. tympanic membrane immobility
3. itchiness and crackling at the affected year
4. prominent bony landmarks

Answer 19

tympanic membrane immobility

Question 20

Bacterial vaginosis is in part a result of:

1. a sexually transmitted organism
2. protozoan infection
3. alkaline vaginal secretions
4. overgrowth of vaginal anaerobes

Answer 20

overgrowth of vaginal anaerobes

Question 21

Which of the following is most consistent with the diagnosis of bulimia nervosa?

1. hyperkalemia often results from laxative abuse
2. periods of anorexia can occur
3. most patients with BN are significantly obese
4. the person with BN usually seeks treatment

Answer 21

periods of anorexia can occur

Question 22

Which strategy would be favored in a practice that is under a capitated system of reimbursement?

1. as few face-to-face visit and services as possible
2. limiting the number of patients
3. prefer that services are performed by physicians
4. limiting the use of telephone calls for providing Healthcare

Answer 22

as few face-to-face visits and services as possible

Question 23

The US preventive Services Task Force recommends screening for Hepatitis C virus for all individuals:

1. who have not received the hcv vaccine
2. born before 1980 in greater or equal to one risk factor present
3. born between 1945 and 1965 without regard of risk
4. with an alt and or AST >3x ULN

Answer 23

born between 1945 and 1965 without regard of risk

Question 24

When evaluating a patient with lumbar radiculopathy red flags for a potentially serious underlying cause include all of the following except:

1. history of recent trauma
2. unexplained weight loss
3. radiation of pain to buttocks
4. bladder dysfunction

Answer 24

radiation of pain to buttocks

Question 25

Symptoms characteristic of asthma include all of the following except:

1. a recurrent spasmodic cough that is worse at night and with exertion
2. recurrent shortness of breath and chest tightness
3. a congested cough that is worse during the day
4. wheezing with and without respiratory infections

Answer 25

a congested cough that is worse during the day

Question 26

A 53 year-old woman with systemic lupus erythematosus presents with the following hemogram: hemoglobin 9.9 hematocrit 30% MCV 81 (80-96) reticulocytes 0.7% (1-2). These findings are most consistent with:

1. iron deficiency anemia
2. anemia of chronic disease
3. folate deficiency anemia
4. thalassemia trait

Answer 26

anemia of chronic disease

Question 27

The nurse practitioner is evaluating an 18 year old patients understanding of the treatment plan for eczema. Assuming the patient understands her plan of care he expects that she will say:

1. when it flares up I will probably need to use a prescription corticosteroid cream
2. I can reduce the incidence of flare-ups by cleaning aggressively with soap
3. I need to keep a diet logs to look for food triggers for my Eczema
4. putting plastic wrap over the eczema can help reduce the number of flare-ups I have

Answer 27

when it flares up I will probably need to use a prescription corticosteroid cream

Question 28

Which of the following examples describes a potential malpractice scenario?

1. a patient with no and penicillin allergy is prescribed amoxicillin but no allergic reaction occurs
2. a patient with diabetes mellitus is prescribed an inappropriate dose of sulfonylureas medication and experiences a severe hypoglycemic episode
3. a patient with acute bacterial sinusitis does not see any Improvement in signs and symptoms 3 days after given a dose appropriate prescription for Amoxicillin clavulanate
4. the patient realizes prior to taking any of the medication that the wrong drug was dispensed at the pharmacy

Answer 28

a patient with diabetes mellitus is prescribed an inappropriate dose of sulfonylurea medication and experiences a severe hypoglycemic episode

Question 29

Which of the following adolescents can be seen for medical evaluation and treatment without parental consent?

1. a 15 year old female who wishes to initiate combined oral contraceptives
2. a fourteen-year-old who needs adjustment to his asthma medication regimen
3. a 16 year old who presents with conjunctivitis
4. a 13 year old with a suspected knee sprain

Answer 29

if 15 year old females who wishes to initiate combined oral contraceptives

Question 30

The legal Authority for NPs to perform Healthcare Services as defined by state law is called:

1. scope of practice
2. duty of care
3. autonomy
4. beneficence

Answer 30

scope of practice

Question 31

Appropriate management of a first degree burn on the forearm caused by exposure to boiling water can include all of the following except:

1. cold compresses to the affected area
2. topical silver sulfadiazine
3. analgesics
4. moisturizing lotion

Answer 31

topical silver sulfadiazine

Question 32

You see an elderly woman with depression in recent acute coronary syndrome who is taking multiple medications. She feels anxious is sleeping poorly and has decreased appetite. Her score on the Beck depression inventory is 28, suggesting moderate depression. The best choice of antidepressant medication is:

1. bupropion
2. citalopram
3. amitriptyline
4. Fluoxetine

Answer 32

citalopram

Question 33

When prescribing a medication to A lactating woman the NP considers that:

1. the nursing infant generally receives 1% or less of the maternal dose
2. lipid soluble medications do not pass into breast milk
3. few products are safe to use
4. pumping the breast and discarding the milk is an effective method of protecting the infant from drug exposure

Answer 33

the nursing infant generally receives 1% or less of the maternal dose

Question 34

A 15 year old male presents with a 3-day history of sore throat and fatigue. During physical examination the nurse practitioner appreciates exudative pharyngitis anterior and posterior cervical lymphadenopathy but is slightly tender to palpation and upper abdominal tenderness bilaterally. This constellation of signs and symptoms is highly suggestive of:

1. infectious mononucleosis
2. gonococcal pharyngitis
3. Hodgkin’s disease
4. pertussis

Answer 34

infectious mononucleosis

Question 35

The most common causative organisms in acute cystitis are:

1. gram negative cocci
2. gram positive coccobacilli
3. gram-negative rods
4. gram positive cocci

Answer 35

gram-negative rods

Question 36

Which of the following statements about migraine headache is most accurate?

1. the pain is described as pulsating
2. migraines are more common in men than women
3. migraine with aura is more common than without aura
4. the pain is typically bilateral

Answer 36

the pain is described as pulsating

Question 37

All of the following are elements of malpractice except:

1. duty of care
2. a fee is charged to the patient and or third-party payer for the health care services related to the malpractice claim
3. breach of the standard of care
4. injury

Answer 37

a fee is charged to the patient and or third-party payer for the healthcare services related to the malpractice claim

Question 38

Tammy, a 24 year old woman, presents with a 1-week history of thin green yellow vaginal discharge. Microscopic examination reveals greater than 20 WBC per hpf pH=5.5 and large motile organisms. These findings most likely represent:

1. Motile sperm
2. trichomoniasis
3. bacterial vaginosis
4. vaginitis caused by Candida albicans

Answer 38

trichomoniasis

Question 39

The body’s iron Supply is mainly derived from:

1. recycled content of aged red blood cells
2. vegetable based food sources
3. animal-based food sources
4. water supply

Answer 39

recycled content of aged red blood cells

Question 40

A 45 year old man presents for a Well Visit examination. He states that he has not had a physical examination in over 10 years. He is generally healthy, does not smoke, and consumes one to two alcoholic drinks per week. Which of the following physical findings would be expected during the eye examination?

1. retinal arteries wider than veins
2. pale conjunctiva
3. brisk corneal reflex
4. yellow sclera

Answer 40

brisk corneal reflex

Question 41

Which of the following is a common vision problem for the person with untreated open-angle glaucoma?

1. peripheral vision loss
2. difficulty with distant vision
3. blurring of near vision
4. need for increased illumination

Answer 41

peripheral vision loss

Question 42

You see a 14 year old female with a BMI equal to 34 and hyperpigmented plaques with a velvet like appearance at the nape of the neck. She states that she has had this condition for a while. Laboratory assessment should include which of the following tests?

1. hemoglobin A1c
2. TSH
3. lipid profile
4. CBC with differential

Answer 42

hemoglobin A1c

Question 43

All of the following changes in electrolytes can be seen with thiazide diuretics used except:

1. calcium wasting
2. potassium wasting
3. sodium wasting
4. magnesium wasting

Answer 43

calcium wasting

Question 44

Which of the following statements about actinic keratosis is most accurate?

1. they are best described as raised red scaly plaque in a skin fold
2. they are best described as vesicular lesions on the trunk
3. they can evolve into basal cell carcinoma
4. they can evolve into squamous cell carcinoma

Answer 44

they can’t evolve into squamous cell carcinoma

Question 45

Mary Kate is a 39 year old woman who was recently started on sumatriptan 100 mg tablet orally for acute migraine pain. When evaluating her response to the medication the nurse practitioner can anticipate all of the following adverse effects except:

1. sedation
2. chest tightness
3. dry mouth
4. diarrhea

Answer 45

sedation

Question 46

The nurse practitioner sees a 45 year old woman with well controlled hypertension with an Ace inhibitor and history of migraines. She states that she has started to take daily doses of Feverfew and her headaches have lessened in frequency. The nurse practitioner advises that caution should be used when taking Feverfew as it:

1. exhibits antiplatelet activity
2. can reverse the effects of her antihypertensive medication
3. can increase the risk of dyslipidemia
4. can increase the risk of type 2 diabetes mellitus

Answer 46

exhibits antiplatelet activity

Question 47

Who is least likely to have drug-induced hepatic failure?

1. a 30 year old man who drinks about four beers in total over a two-day weekend
2. a 48 year-old woman with history of hepatitis B infection
3. a 78 year old man with hepatitis C infection
4. an 88 year old woman who takes daily acetaminophen for back pain

Answer 47

a 30 year old man who drinks about 4 beers in total over a two-day weekend

Question 48

Simultaneous presentation of sore throat, low-grade fever, and maculopapular rash of 1 days duration in a 13 year-old including coincident posterior cervical and occipital lymphadenopathy, suggest a diagnosis of:

1. roseola
2. rubeola
3. scarlet fever
4. rubella

Answer 48

rubella

Question 49

ECG of a 54 year old man is shown below. A history of myocardial infarction is indicated in this patient by the presence of:

1. T wave inversion
2. pathologic Q wave
3. ST segment elevation
4. tall R wave

Answer 49

pathologic Q wave

Question 50

Stacy is a 17 year old female who presents for follow up after being started on a treatment plan for asthma. She continues to have symptoms, including cough and wheeze, but wake her at night and interfere with her job performance. Her Peak expiratory flow rate is 70% predicted. The nurse practitioner must evaluate:

1. her inhaler technique
2. her fev1/fvc ratio
3. her eosinophil count
4. her use of OTC medications

Answer 50

her inhaler technique

Question 51

When examining a 22-year old man, you note a mid systolic murmur that gets louder with standing. This could represent a:

1. aortic stenosis
2. physiologic murmur
3. hypertrophic cardiomyopathy
4. still’s murmur

Answer 51

hypertrophic cardiomyopathy

Question 52

The presence of microalbuminuria is most likely an indication of:

1. kidney disease
2. drug-induced hepatotoxicity
3. CHF
4. hypotension

Answer 52

kidney disease

Question 53

Which of the following is most consistent with untreated hyperthyroidism?

1. TSH=8.9, free t4=15
2. TSH<0.15, free t4=79
3. TSH<24, free t4=3
4. TSH<1.9, free t4=22

(tsh 0.4-4, t4 10-27)

Answer 53

TSH<0.15, free t4=79

Question 54

For a 7 year old child with severe atopic dermatitis on the face and appropriate alternative to higher potency topical corticosteroid therapy is:

1. oral tacrolimus
2. topical NSAIDs
3. oral prednisone
4. adalimumab injection

Answer 54

oral tacrolimus

Question 55

Which of the following women is the best candidate for post menopause hormonal therapy?

1. a 62 year old with osteopenia
2. a 54 year old with complaints of vasomotor symptoms
3. a 57 year old with a family history of myocardial infarction
4. a 66 year old with moderate renal impairment

Answer 55

a 54 year old with complaints of vasomotor symptoms

Question 56

Which of the following is true concerning hepatitis C infection?

1. this is the most common form of infectious hepatitis transmitted by sexual contact
2. rate of infection in babies born to affected mothers exceeds 40%
3. acute infection stage is usually symptomatic
4. in the United States, this disease is the most common reason for hepatic transplantation

Answer 56

in the United States, this disease is the most common reason for hepatic transplantation

Question 57

A thirty-three-year-old woman is 7 weeks pregnant. She has moderate persistent asthma, well-controlled with Daily Timed fluticasone used with albuterol used as needed and asks about continuing her current medications. You give her the following advice:

1. add Theophylline
2. discontinue inhaled corticosteroid
3. continue your current medication
4. most women find their asthma is improved with pregnancy

Answer 57

continue your current medication

Question 58

Which of the following is the desired therapeutic action of tiotropium bromide when used in the treatment of COPD?

1. mucolytic agent
2. bronchodilator
3. increases mucociliary clearance
4. reduces total lung volume

Answer 58

bronchodilator

Question 59

A middle school student presents, asking for a letter stating that he should not participate in gym class because he has asthma. The most appropriate response is to:

1. write the note since physical activity could trigger an asthma flare
2. excuse him from outdoor activities only in order to avoid pollen exposure
3. remind him that with appropriate asthma care, he should be capable of participating in gym class
4. excuse him from indoor activities in order to avoid dust mite exposure while allowing participation in outdoor activities

Answer 59

remind him that with appropriate asthma care, he should be capable of participating in gym class

Question 60

A 45 year old woman with a 5-day history of vaginal itch presents with perineal excoriation, vaginal erythema, and white, clumpy discharge. On laboratory examination, you expect to find:

1. abundant white blood cells
2. clue cells
3. pseudohyphae
4. alkaline pH

Answer 60

pseudohyphae

Question 61

According to the US preventive Services Task Force, a 46 year-old woman with normal risk for breast cancer should undergo a mammogram:

1. every year
2. every two years
3. every two years beginning at age 50 years
4. every five years beginning at age 50 years

Answer 61

every two years beginning at age 50 years

Question 62

Which of the following is an expected finding for a patient with Meniere’s disease?

1. a negative Rhomberg test
2. a normal rinne’s test
3. absence of lateralization during the Weber test
4. normal hearing

Answer 62

a normal rinne’s test

Question 63

Which of the following agents represents the best choice for an otherwise well child taking no other medications who has a rash type of allergic reaction to penicillin and requires antimicrobial therapy for acute otitis media?

1. Ciprofloxacin
2. clarithromycin
3. amoxicillin
4. cefpodoxime

Answer 63

cefpodoxime

Question 64

Identify which of the following individuals is most likely to have a diagnosis of reactive arthritis?

1. a 67 year old with bilateral knee pain that is alleviated with NSAIDs
2. a 54 year old with wrist pain and who is ANA positive
3. a 34-year-old experiencing heel pain 2 weeks following an episode of acute bacterial diarrhea
4. a 56 year old with recurrent sharp pain in the large toe, typically occurring after eating a large quantity of meat

Answer 64

a 34 year old experiencing heel pain 2 weeks following an episode of acute bacterial diarrhea

reactive arthritis is an acute non purulent arthritis that is secondary to an infection in another part of the body. The condition is typically seen days 2 weeks following an episode of acute bacterial diarrhea that can be caused by shigella species salmonella speciescampylobacter species chlamydia trachomatis or ureaplasma urealyticum. findings include asymmetrical oligoarthritis, dactylitis, toe or heel pain, conjunctivitis or uveitis, and genital ulceration

Question 65

Any pregnant woman with asthma, symptoms and bronchospasm are likely to worsen during:

1. 6 to 14 weeks
2. 15 to 23 weeks
3. 24 to 33 weeks
4. 29 to 36 weeks

Answer 65

29 to 36 weeks

Question 66

What is the anticipated language skill for a healthy 24 month old child?

1. speaks one to two words
2. speaks in sentences of two word
3. speaks in sentences of three words
4. speech includes plurals and personal pronouns

Answer 66

speaks in sentences of two words

Question 67

The two most common reasons for lawsuits against nurse practitioners are missed diagnosis and:

1. lapsed follow up
2. declining to prescribe a medication that the patient request but is not clinically indicated
3. incorrect medication dosing
4. patient allergic reaction in response to a prescribed medication

Answer 67

lapsed follow up

Question 68

Jamie is a 4 year old well child who presents in follow up two weeks after being treated for acute otitis media with Amoxicillin 90 mg per kilogram for 7 Days. Mom says he has not had any fever, still occasionally pulls at his ear, and sometimes doesn’t seem to hear her. Otoscopic examination reveals a blunted light reflex and a pale yellow tympanic membrane with air fluid levels. The nurse practitioner understands that:

1. the patient probably has eustachian tube dysfunction and should be managed accordingly
2. otitis media with effusion often occurs following acute otitis media and this reflects the normal course of healing
3. the blunted light reflex suggest inadequate treatment and Amoxicillin with clavulanic acid should be started
4. this is consistent with an Allergic Disease component and should be managed with a second generation antihistamine

Answer 68

otitis media with effusion often occurs following acute otitis media and this reflects the normal course of healing

Question 69

Proficient with crohn’s disease involving the small intestines will likely report each of the following except:

1. abdominal cramping
2. weight loss
3. constipation
4. blood in the stool

Answer 69

constipation

Question 70

In which of the following situations is postmenopausal hormone replacement therapy most helpful?

1. treatment of hypothyroidism
2. prevention of unstable angina
3. reduction in frequency and severity of hot flashes
4. reduction in death rates post MI in older women

Answer 70

reduction in frequency and severity of hot reduction in frequency and severity of hot flashes

Question 71

Treatment choices for abortive migraine therapy in a 42 year old man with angina pectoris include:

1. ergotamine
2. ibuprofen
3. Verapamil
4. sumatriptan

Answer 71

ibuprofen

Question 72

The S4 sound is heard during:

1. early systole
2. late systole
3. early diastole
4. late diastole

Answer 72

late diastole

Question 73

A 54 year old woman presents with rosacea that has not resolved with Lifestyle Changes (ie monitoring diet, avoiding triggers). The nurse practitioner considers initiating treatment with an oral antimicrobial but considers that changes in skin pigmentation can occur with the use of:

1. tetracycline
2. metronidazole
3. Minocycline
4. erythromycin

Answer 73

Minocycline

Question 74

The most common cause of acute pyelonephritis in a 62 year old woman who experienced recurrent urinary tract infections is:

1. E. Coli
2. k. Pneumoniae
3. P. Aeruginosa
4. s. Pneumoniae

Answer 74

E. Coli

Question 75

Stasis dermatitis and is a clinical condition most often associated with or secondary to:

1. repeated sunburns
2. nursing home acquired infection
3. chronic venous insufficiency
4. poorly controlled diabetes mellitus

Answer 75

chronic venous insufficiency

Question 76

Which of the following best describes a milestone of a normally developing 7 month old child?

1. a child that is able to sit with support
2. a child that resists being placed in a Supine position
3. a child that can stand by holding onto furniture
4. a child that will hand over an object upon request

Answer 76

a child that resists being placed in a Supine position

Question 77

Physical or cognitive symptoms associated with generalized anxiety disorder include all of the following except:

1. restlessness
2. increased muscle aches and soreness
3. tension-type headaches
4. difficulty sleeping

Answer 77

tension-type headaches

Question 78

All of the following are likely to be reported in acute pyelonephritis except:

1. Gross hematuria
2. fever
3. cloudy urine
4. costovertebral angle tenderness

Answer 78

gross hematuria

Question 79

Which scenario is most consistent with Legionella pneumonia?

1. a 56 year-old heating and cooling repair person with a dry cough and abdominal pain
2. a 78 year old retired firefighter recovering from influenza with thick yellow sputum and abscess noted on chest x-ray
3. 24 year old with severe sore throat, hoarseness, and a hacking cough
4. 42 year old computer programmer with fever, chills, and Rusty sputum

Answer 79

a 56 year-old heating and cooling repair person with a dry cough and abdominal pain

Question 80

According to jnc 8, the blood pressure goal for a 48 year old African American woman with type 2 diabetes mellitus is:

1. 130 / 80
2. 130 / 90
3. 140 / 90
4. 150 / 90

Answer 80

140 / 90

Question 81

The most common cause of peptic ulcer disease is:

1. coffee consumption
2. helicobacter pylori infection
3. alcoholism
4. viral gastritis

Answer 81

helicobacter pylori infection

Question 82

Blake is a 10-year old boy who is seen in the clinic one week ago with a 3-day history of sore throat, fever, and generally feeling unwell. The rapid strep test was negative but the physician prescribes empiric amoxicillin because he had a strong clinical suspicion for strep throat. Today the patient presents in follow up. He still feels unwell but now has a diffuse maculopapular rash. The nurse practitioner knows that Blake likely has:

1. a penicillin allergy
2. infectious mononucleosis
3. bacterial meningitis
4. viral exanthem

Answer 82

infectious mononucleosis

Question 83

Which of the following is true about the Hepatitis B virus vaccine?

1. the vaccine contains live, attenuated HBV
2. children should have Hepatitis B surface antibody titers drawn after 3 doses of vaccine
3. Hepatitis B immunization should be universally offered
4. serologic testing for Hepatitis B surface antigen should be checked before hbv vaccination is initiated in children

Answer 83

Hepatitis B immunization should be universally offered

Question 84

A rise in serum creatinine is indicative of:

1. decrease glomerular filtration rate
2. early renal damage
3. volume expansion
4. impaired renal perfusion

Answer 84

decrease glomerular filtration rate

Question 85

A 27 year old woman presents with a urinary tract infection. She is otherwise healthy and has no reported drug allergies. The local E. Coli resistance rate to tmp - SMX is 25%. Which of the following is the most appropriate first-line treatment choice?

1. ampicillin
2. trimethoprim-sulfamethoxazole
3. nitrofurantoin
4. Ciprofloxacin

Answer 85

nitrofurantoin

Question 86

The use of which of the following medications is most likely to cause granulocytopenia?

1. valproic acid
2. Fluoxetine
3. amitriptyline
4. carbamazepine

Answer 86

carbamazepine

Question 87

All of the following practices are recommended when prescribing medications with confusing or similar sounding names except:

1. writing the purpose of the medication on the prescription order
2. considering selecting medications without nomenclature problems
3. including either the generic or brand-name in the prescription order, but not both
4. providing patients with written information about their drugs

Answer 87

including either the generic or brand-name in the prescription order, but not both

Question 88

You see a 58 year-old manner pastry of poorly controlled hypertension. At this visit his blood pressure is 185 / 110 but does not report any symptoms. Auscultation will likely reveal:

1. s3 heart sound heard during early diastole
2. s3 heart sound heard during late diastole
3. S4 heart sound heard during early diastole
4. S4 heart sound heard during late diastole

Answer 88

S4 heart sound heard during late diastole

Question 89

Mrs. B, a 49 year-old female, first came to the clinic with profound knee pain, hand pain, and a history of rheumatoid arthritis. She was started on Methotrexate and presents for her follow-up. In order to ensure that the drug is not causing adverse systemic effects, which of the following laboratory studies must be ordered?

1. BUN and creatinine
2. Hgb and Hct
3. WBC/RBC
4. AST/ALT (aspartate aminotransferase/alanine aminotransferase)

Answer 89

AST/ALT (aspartate aminotransferase/alanine aminotransferase)

Question 90

Caution should be used when prescribing drospirenone/ethinyl estradiol COC to a woman who is also taking a:

1. beta adrenergic antagonist
2. Angiotensin converting enzyme inhibitor
3. calcium channel blocker
4. Alpha adrenergic antagonist

Answer 90

Angiotensin converting enzyme inhibitor

Question 91

Tammy is a 52 year old woman who presents with a chief complaint of urinary incontinence. She states that she sometimes experiences urine loss while sneezing or coughing, but does not report nocturia. She has a history of well controlled hypertension with an Ace inhibitor and her BMI is 31. The nurse practitioner considers that Tammy is most likely experiencing:

1. stress incontinence
2. urge incontinence
3. functional incontinence
4. drug-induced adverse effect

Answer 91

stress incontinence

Question 92

A patient in your practice has an abnormal pap test result and requires a follow-up visit. The patient repeatedly fails to show up for the follow-up visit. Which of the following is the best approach to inform the patient of the need and urgency for a repeat test?

1. a message left on her voicemail
2. a visit to her home
3. an email message via a secure service marked as urgent
4. a certified letter

Answer 92

a certified letter

Question 93

Which of the following is the most common UTI organism in children?

1. pseudomonas aeruginosa
2. escherichia coli
3. klebsiella pneumoniae
4. proteus mirabilis

Answer 93

escherichia coli

Question 94

A 43 year old woman presents with a 12-hour history of fever, pain, and positive Murphy’s sign. The most likely diagnosis is:

1. hepatoma
2. chronic cholelithiasis
3. acute cholecystitis
4. acute viral hepatitis

Answer 94

acute cholecystitis

Question 95

Which of the following is most consistent with a diagnosis of depression?

1. anhedonia
2. gastrointestinal complaints
3. difficulty initiating sleep
4. recurring headache

Answer 95

anhedonia

Question 96

which of the following statements is most consistent with a patient experiencing vertigo?
I get light-headed when I stand up too fast
I get nervous when exposed to extreme Heights
the room seems to spend, even with my eyes closed
I passed out and found myself on the floor

Answer 96

the room seems to spend, even with my eyes closed

Question 97

Which of the following provides an example of when a provider patient relationship is established?

1. a new patient makes an appointment over the phone for an initial Well Visit at the clinic
2. a nurse practitioner Witnesses a car accident and called nine-one-one
3. a nurse practitioner renew a prescription for a friend after she mentions that her medication is running out
4. a nurse practitioner recommends a specific urologist when a colleague mentions that his mother is having incontinence issues

Answer 97

a nurse practitioner has a prescription for a friend after she mentions that her medication is running out

Question 98

The most important component of the initial assessment of an asthma exacerbation includes a:

1. Comprehensive Health history
2. objective measurement of lung function
3. chest x-ray
4. arterial blood gas

Answer 98

objective measurement of lung function

peak flow

Question 99

Under ordinary circumstances, how many drug half-lives are usually needed to reach steady-state?

1. 0.5-1
2. 2-3
3. 3-5
4. 6-7

Answer 99

3-5

Question 100

When a pregnant woman takes a teratogenic drug, the fetal effects are usually seen in:

1. certain Target organs in a predictable manner
2. random body systems without a predictable pattern
3. select organ systems with random outcomes
4. a pattern of systemic injury

Answer 100

certain Target organs in a predictable manner

Question 101

You see a twenty-six-year-old Well Woman of African ancestry. Hemogram results are as follows hemoglobin 10 (12-14) hematocrit 30 (36-42) MCV 69 (80-96) RDW 13% (11-15%) RBC 5.4 million (3.2-4.3). The most likely diagnosis is:

1. acute blood loss
2. beta thalassemia minor
3. iron deficiency anemia
4. Cooley’s anemia

Answer 101

beta thalassemia minor

Question 102

Which of the following is likely to have the greatest anticholinergic effects?

1. Venlafaxine
2. citalopram
3. Fluoxetine
4. nortriptyline

Answer 102

nortriptyline

Question 103

A 36 year old man with asthma states that he has had excellent control of wheezing using albuterol two Puffs three to four times a day. You consider prescribing:

1. a long-acting beta-2 Agonist
2. an oral Theophylline
3. no medication as he has adequate symptom control
4. an inhaled corticosteroid

Answer 103

an inhaled corticosteroid

Question 104

Which of the following individuals with untreated vision problems best describes a person with angle closure glaucoma?

1. 42 year old who reports having difficulty reading small print
2. 62 year old with poorly controlled hypertension and reports double vision
3. 54 year old with a long history of type 2 diabetes who reports seeing floaters
4. 57 year old who reports periorbital pain and seeing Halos around objects

Answer 104

57 year old who reports periorbital pain and seeing Halos around objects

Question 105

Thyroid stimulating hormone is produced by the:

1. thyroid
2. adrenals
3. anterior pituitary
4. hypothalamus

Answer 105

anterior pituitary

Question 106

A father presents his 4 week old daughter that was born healthy at 40 weeks gestation. He reports that she has had multiple vomiting episodes, cries uncontrollably, and has passed some blood and mucus in the stool. Physical examination reveals a tender abdomen and a palpable abdominal Mass. A likely diagnosis is:

1. pyloric stenosis
2. intussusception
3. ingestion of a foreign object
4. Clostridium difficile infection

Answer 106

intussusception

Question 107

Combined oral contraceptive use can deplete which of the following vitamins?

1. D
2. B6
3. A
4. E

Answer 107

B6

Question 108

One of the preferred treatment options for uncomplicated chlamydia trachomatis infection in pregnancy include oral:

1. ofloxacin
2. azithromycin
3. clarithromycin
4. doxycycline

Answer 108

azithromycin

Question 109

Laboratory studies in a middle-aged man reveal the following: AST=52 (0-40), ALT=110 (0-50) HAV IgG=present. These results are consistent with:

1. continued risk for contracting hepatitis A
2. acute hepatitis A
3. evidence of Prior hepatitis A infection
4. chronic hepatitis A

Answer 109

evidence of Prior hepatitis A infection

Question 110

Which of the following is a first-line therapy for the treatment of acute bacterial rhinosinusitis in an otherwise healthy 6 year old with no recent antimicrobial use and no known drug allergies and who has been experiencing persistent symptoms for 10 days?

1. clarithromycin
2. levofloxacin
3. trimethoprim-sulfamethoxazole
4. amoxicillin

Answer 110

amoxicillin

Question 111

Which of the following is true about the MMR vaccine?

1. this vaccine contains live virus
2. it’s use is contraindicated in persons with a history of egg allergy
3. revaccination of an immunized person is associated with risk of allergic reaction
4. one dose is recommended for young adults who have not been previously immunized

Answer 111

this vaccine contains live virus

Question 112

Physical examination findings in Graves disease likely include:

1. muscle tenderness
2. hyperreflexia
3. dry skin
4. cold intolerance

Answer 112

hyperreflexia

Question 113

A 46 year-old woman presents with complaints of fatigue, dizziness, and shortness of breath. She also mentions occasionally feeling numbness or tingling in her fingertips. Her medical history shows that she has had gastric bypass surgery two years ago. Physical examination reveals pale conjunctiva and a hemic murmur. Hemogram results are as follows: Hgb-6.2 (12-16), Hct-20% (36-42%), MCV - 132 (80-96), RDW - 19% (11-15). the most likely cause of this anemia is:

1. hemolysis
2. vitamin B12 deficiency
3. iron deficiency
4. alpha thalassemia

Answer 113

vitamin B12 deficiency

Question 114

A 27 year old woman presents complaining of pain on her upper thighs related to spilled hot coffee on her lap. Physical examination reveals a burn site that is red and dry but without blisters. The nurse practitioner categorizes this burn as:

1. 1st degree
2. second degree
3. third degree
4. fourth degree

Answer 114

first degree

Question 115

The S3 sound is heard during:

1. early systole
2. late systole
3. late diastole
4. early diastole

Answer 115

early diastole

Question 116

The nurse practitioner is evaluating a 17 year old female for vulvovaginitis. On microscopic is game there are >10 clue cells per HPF. The nurse practitioner knows that this is indicative of:

1. chlamydia
2. gonorrhea
3. bacterial vaginosis
4. trichomoniasis

Answer 116

bacterial vaginosis

Question 117

The most appropriate management option for a three-week-old infant with pyloric stenosis is:

1. watchful observation to see if it spontaneously resolves in 24 hours
2. oral amoxicillin with or without clavulanate
3. pneumatic enema
4. surgical correction

Answer 117

surgical correction

Question 118

When evaluating a 54 year-old woman for a potential thyroid disorder, which of the following laboratory assessments would be least helpful?

1. total T4
2. free T4
3. TSH
4. TPO antibodies

Answer 118

total T4

Question 119

Monica is a 25 year old woman who presented to the clinic for treatment of a lower urinary tract infection. She was prescribed the appropriate antibiotic therapy and was taught strategies to decrease urinary tract infection. When evaluating her understanding, the nurse practitioner knows that Monica needs more instruction when she says:

1. I will drink plenty of fluids while taking my medications
2. I will be sure to go urinate after I have intercourse
3. I will empty my bladder as soon as it feels full
4. I will be sure to wipe front to back after urinating

Answer 119

I will be sure to wipe front to back after urinating

Question 120

Jennifer is a 27-year-old female who presents for family planning. she has no significant medical history and her only medication is a daily OTC multivitamin. The only form of contraception she has ever used his comments. Jennifer reports that her periods have been regular at 28 day intervals almost since the first one at age 14. she has recently started a sexual relationship with any male partner. She has considered all types, and wants to begin with a combined oral contraceptive pill to see how her body responds to warm up. Jennifer’s history and physical examination are within normal limits, and last for this was two weeks ago. The first day of her last menstrual cycle was 7 days ago. the most appropriate action for the nurse practitioner would be to provide a prescription for COC and instructs Jennifer to begin to start the COC prescription:

1. today to ensure contraceptive protection this month
2. today and use an additional backup method for 1 week to ensure contraceptive protection this month
3. on the first day of her next menstrual cycle
4. on the first Sunday after her next menstrual cycle begins

Answer 120

today and use an additional backup method for 1 week to ensure contraceptive protection this month

Question 121

The nurse practitioner knows that the most episodes of low back pain are caused by:

1. muscle or ligament strain
2. disk herniation
3. an acute precipitating event
4. nerve impingement

Answer 121

muscle or ligament strain

Question 122

Which of the following is at greatest risk of developing iron deficiency anemia?

1. 62 year old woman with rheumatoid arthritis
2. healthy 42 year old man who does not eat red meat
3. 27 year old man with celiac disease
4. 54 year old man with a gastro duodenal ulcer

Answer 122

54 year old man with a gastro duodenal ulcer

Question 123

When considering an end-of-life decision for a terminally ill person who cannot communicate, all of the following can be used as an advance directive except:

1. testimony from a family member or close friend
2. a living will
3. a do not resuscitate order
4. a durable power of attorney for health care

Answer 123

testimony from a family member or close friend

Question 124

Which of the following is a common contributing bacterial pathogen in the development of an acute exacerbation of chronic obstructive pulmonary disease in a 59 year old man with an fev1=60% of predicted?

1. Haemophilus influenzae
2. streptococcus pyogenes
3. staphylococcus aureus
4. klebsiella pneumoniae

Answer 124

haemophilus influenzae

Question 125

A 21 year old female patient presents with a chief complaint of a 4-day history of rhinorrhea, scratchy throat, headache, and cough. The patient is diagnosed with a viral upper respiratory infection and is sent home with recommendations for OTC symptom control measures. She returns to the office one week later and reports that her cough and sore throat result a few days ago, but in the past 24 hours, she has developed a low-grade fever, worsening nasal discharge, and a sharp pain on the left side, including a pressure headache above her left eye. This patient has likely developed:

1. a superimposed bacterial sinusitis
2. orbital cellulitis
3. dacryocystitis
4. scleritis

Answer 125

a superimposed bacterial sinusitis

Question 126

At which of the following ages in a young child’s life is parental anticipatory guidance about temper tantrums most helpful?

1. 8 to 10 months
2. 10 to 12 months
3. 12 to 14 months
4. 14 to 16 months

Answer 126

12 to 14 months

Question 127

Treatment for reactive arthritis (reiter’s syndrome) in a sexually active man usually includes:

1. Non-biologic DMARDs
2. antimicrobial therapy
3. acetaminophen
4. cyclosporine

Answer 127

antimicrobial therapy

Question 128

A fifty-one-year-old post-menopausal woman asks about initiating hormone replacement therapy to help her hot flashes. The nurse practitioner considers that all of the following are contraindications for post-menopausal estrogen therapy except:

1. unexplained vaginal bleeding
2. acute liver disease
3. history of cluster headaches
4. thrombotic disease

Answer 128

history of cluster headaches

Question 129

All of the following are risk factors for death from asthma except:

1. rural residence
2. low economic status
3. greater than 3 emergency department visits for asthma
4. use of more than two canisters of short-acting beta-2 Agonist per month

Answer 129

rural residence

Question 130

A 16 year old presents with a 2-day history of fever, headache and a stiff neck. Which of the following would most support a diagnosis of meningitis?

1. absence of wbc’s in CSF
2. presence of bacteria in urine
3. positive obturator and psoas signs
4. positive brudzinski and kernig signs

Answer 130

positive brudzinski and kernig sign

Question 131

The placenta is best described as:

1. capable of impeding substances with MW <300 Da.
2. ineffective drug barrier
3. allowing the transfer of lipophilic substances
4. poorly permeable

Answer 131

allowing the transfer of lipophilic substances

Question 132

When considering the use of emergency contraception following unprotected intercourse, all of the following are true except:

1. levonorgestrel is available without a prescription for women 17 years and older
2. copper containing IUD can be inserted within 5 days of unprotected intercourse for emergency contraception
3. ulipristal acetate will not impact embryo implantation when used within 5 days following unprotected intercourse
4. menstrual bleeding should occur within 3 to 4 weeks following emergency contraception use

Answer 132

ulipristal acetate will not impact embryo implantation when used within 5 days following unprotected intercourse

Question 133

Tammy, a 24 year old woman, presents with a 1-week history of thin green yellow vaginal discharge. Microscopic examination reveals greater than 20 WBC per hpf pH=5.5 and large motile organisms.

for Tammy in the above question and appropriate treatment option would be:

1. oral Ketoconazole
2. clindamycin vaginal cream
3. oral metronidazole
4. oral azithromycin

Answer 133

oral metronidazole

Question 134

The most common cause of hypothyroidism is:

1. radioactive iodine exposure
2. thyroid neoplasia
3. primary pituitary failure
4. autoimmune thyroiditis

Answer 134

autoimmune thyroiditis

Question 135

A 68 year old man of Asian ancestry presents with his daughter for evaluation. He has little comprehension of the English language. When considering the use of an interpreter, the nurse practitioner realizes:

1. a family member should be used if possible
2. The Interpreter should match the gender and age as close as possible
3. the nurse practitioner should directly look and speak to The Interpreter
4. The Interpreter should be seated next to the patient

Answer 135

The Interpreter should match the gender and age as close as possible

Question 136

Which of the following is most consistent with a person presenting with myocardial infarction?

1. continuous chest pressure lasting 15 minutes that occurs at rest
2. a 10-minute episode of chest tightness brought on by activity
3. retrosternal pain for 30 minutes with diaphoresis
4. localized chest pain that persists for 24 hours

Answer 136

retrosternal pain for 30 minutes with diaphoresis

Question 137

When evaluating a 61 year old males response to Alpha blocker treatment for benign prostatic hypertrophy, the nurse practitioner expects with which of the following findings?

1. report of an increase in force of stream
2. an increase in strength of erection
3. a decrease in prostate pain
4. a softer prostate to digital exam

Answer 137

report of an increase in force of stream

Question 138

Clinical findings in a patient with moderate to severe hypercalcemia can include all of the following except:

1. muscle weakness
2. nausea and vomiting
3. frequent urination
4. insomnia

Answer 138

insomnia

Question 139

Which of the following is most likely found in a woman with ectopic pregnancy?

1. intrauterine gestational Sac visible on transvaginal ultrasound
2. negative urine HCG
3. pregnancy located in fallopian tube
4. quantitative HCG >15,500

Answer 139

pregnancy located in fallopian tube

Question 140

One of the preferred antihypertensive agents for a 52 year old woman of European ancestry with type 2 diabetes mellitus is:

1. clonidine
2. Furosemide
3. Trandolapril
4. Atenolol

Answer 140

Trandolapril

Question 141

A woman who is planning a pregnancy should increase her intake of which of the following:

1. vitamin C
2. folic acid
3. iron
4. niacin

Answer 141

folic acid

Question 142

A 17 year old patient with a 6 cm abscess on the left upper arm presents one week post incision and drainage for a follow-up appointment. The area is still much improved, but has some residual erythema and discomfort. The nurse practitioner correctly interprets that:

1. the healing process is proceeding normally and she should continue to monitor progress
2. the presence of discomfort one week after incision and drainage suggest residual infection and antibiotics should be started
3. the wound should be packed with iodoform gauze and irrigated with normal saline twice-daily
4. topical Mupirocin should be initiated and monitored for development of systemic symptoms

Answer 142

the healing process is proceeding normally and she should continue to monitor progress

Question 143

Which of the following is not a Criterion for a level 3 office visit?

1. at least one element of history of present illness and at least one positive or negative response to review of systems questions
2. at least six elements of physical examination
3. patient is seen by a physician
4. medical decision-making of low complexity

Answer 143

patient is seen by a physician

Question 144

When prescribing a medication, the clinician considers that A drugs Half-Life is the amount of time needed to decrease its serum concentration by:

1. 25%
2. 50%
3. 75%
4. 100%

Answer 144

50%

Question 145

The following ECG illustrates which of the following characteristics that is indicative of myocardial injury?

1. pathologic Q wave
2. tall R wave
3. T wave inversion
4. ST segment elevation

Answer 145

T wave inversion

Question 146

Patient education for a person using Permethrin for the treatment of Scabies should include the following information:

1. it’s use is associated with neurotoxicity risk
2. itch often persist for a few weeks after successful treatment
3. a marked reduction in lesions is noted within 48 hours
4. the medication should be rinsed off within 2 hours of application

Answer 146

itch often persist for a few weeks after successful treatment

Question 147

Hemoglobin electrophoresis of a healthy 29 year-old woman of Asian ancestry with mild anemia reveals alpha thalassemia minor. Follow up care for this patient should include:

1. vitamin B12 supplementation
2. offering genetic counseling prior to pregnancy
3. repeat of hemoglobin electrophoresis every 5 years
4. annual fecal occult blood testing

Answer 147

offering genetic counseling prior to pregnancy

Question 148

Which of the following is most consistent with subclinical hypothyroidism?

1. low total T4 with normal TSH
2. elevated total T4 with normal TSH
3. elevated TSH with normal free T4
4. low TSH elevated free T4

Answer 148

elevated TSH with normal free T4

Question 149

At which of the following ages in a young child’s life is Parental anticipatory guidance about protection from Falls most helpful?

1. at Birth
2. 2 months
3. 4 months
4. 6 months

Answer 149

at birth

Question 150

Which of the following is an abnormal finding in a woman in the third trimester of pregnancy?

1. diastolic murmur
2. symphysis pubis tenderness
3. symmetric thyroid enlargement
4. early to mid systolic murmur

Answer 150

diastolic murmur