Fitzgerald Review

Question 1

A 26-year-old woman with a history of seasonal allergies asks if there is anything she can take to prevent symptoms. Her biggest complaints are nasal congestion and scratchy throat. The NP recommends which of the following as a first-line agent?
Oral decongestant
Decongestant nasal spray
Corticosteroid nasal spray
Oral leukotriene modifier

Answer 1

Corticosteroid nasal spray

Question 2

Which of the following describes the ethical principle of beneficence?
The right of the competent person to choose a personal plan of life and action
The obligation of the healthcare provider to help people in need
The responsibility of the healthcare provider to treat all in the same fair manner
The duty of the healthcare provider to do no harm

Answer 2

The obligation of the healthcare provider to help people in need

Question 3

An appropriate treatment option for community-acquired pneumonia in a 45-year-old woman with no significant comorbidities, no known drug allergies, and a history of hysterectomy 3 years ago is:
Ampicillin.
Doxycycline (Doryx®).
Cefuroxime (Ceftin®).
Moxifloxacin (Avelox®).

Answer 3

Doxycycline

Question 4

You ask a patient to follow your finger, while not moving her head, through the positions of gaze. This is in part an evaluation of cranial nerves:
II, III, VI.
I, II, III.
V, VI, VII.
III, IV, VI.

Answer 4

III, IV, VI.

Question 5

A 33-year-old woman comes to your office and reports that she fears that she is “having a stroke.” She has no medical history and no significant risk factors for cerebrovascular disease, but today she has sudden onset of inability to tightly close her eyelid and to frown or smile on the right side of her face. Her physical examination is otherwise within normal limits, without limb weakness or difficulty with speech. The nurse practitioner recognizes that this likely represents paralysis of cranial nerve (CN):
IV.
V.
VI.
VII.

Answer 5

VII.

Question 6

A 28-year-old man presents with a 2-day history of fever, perineal pain, and painful urination. Suspecting acute bacterial prostatitis, which of the following findings is most likely upon examination?

Scrotal swelling
Tender, boggy prostate
Absence of the Prehn sign
Firm prostate with palpable nodule

Answer 6

Tender, boggy prostate

Question 7

A 47-year-old woman presents with a complaint of a 3-week history of new-onset headache. She reports that the headaches occur nearly every day and can last between 2 and 8 hours. She has taken acetaminophen and ibuprofen with little effect. Which of the following findings would be the strongest indicator to support the need for head imaging?

Headache with unilateral, pulsating quality
Weight gain of nearly 10 lbs (4.5 kg) over the past 6 months
Feeling of dread just prior to start of headache
History of breast cancer

Answer 7

hx breast cancer

Question 8

The mechanism of action of GLP-1 receptor agonists (e.g., exenatide [Byetta®]) includes:

Increase in hepatic glucose utilization.
Stimulation of insulin production in response to glucose rise.
Facilitation of renal glucose excretion.
Enhancement of insulin receptor site activity.

Answer 8

Stimulation of insulin production in response to glucose rise.

Question 9

Thyroid stimulating hormone (TSH) levels are suppressed in all of the following except:

Graves’ disease.
Toxic adenoma.
Acute viral thyroiditis.
Subacute hypothyroidism.

Answer 9

Graves

Question 10

Who among the following patients is at the greatest risk for suicide?
A 95-year-old female whose only child died last week
An 85-year-old male who lives alone
A 15-year-old female who has been using marijuana
A 12-year-old male who is having academic difficulty

Answer 10

An 85-year-old male who lives alone

Question 11

A 52-year-old woman presents to your office as a new patient. She reports a long history of high blood pressure and admits she does not regularly take her medication. Today’s BP=168/98 mm Hg, and she states she last took her BP medication about 1 week ago. Which of the following is an anticipated funduscopic finding?

Narrowing of arterioles
An increased cup:disk ratio
Macular degeneration
Cotton-wool spots

Answer 11

Narrowing of arterioles

Question 12

Performing Weber and Rinne tests is part of the evaluation of cranial nerve (CN):

V.
VI.
VII.
VIII.

Answer 12

VIII

Question 13

First-line treatment of community-acquired pneumonia for a 57-year-old man with type 2 diabetes mellitus and a history of alcohol use disorder can include:

Oral high-dose amoxicillin.
Oral doxycycline.
IM ceftriaxone.
Oral moxifloxacin.

Answer 13

Oral moxifloxacin

Question 14

A 22-year-old man presents for hepatitis screening. He is without symptoms but needs the testing for a job in the food service industry. Laboratory results are as follows: Anti-HCV with HCV RNA present, HBsAg=positive, Anti-HAV=negative. You advise the patient that he:

Has chronic hepatitis A, B, and C.
Is immune to hepatitis A and B but has hepatitis C.
Has chronic hepatitis B and C and needs immunization against hepatitis A.
Had hepatitis A in the past, is immune to hepatitis B, and has chronic hepatitis C.

Answer 14

Has chronic hepatitis B and C and needs immunization against hepatitis A.

Question 15

A 24-year-old woman with bipolar disorder will be initiated on antipsychotic medication. She expresses a concern about weight gain while taking this class of medication The NP considers that, when on this therapy, the patient should have periodic evaluation of:

Hepatic enzymes.
Electrolytes.
A1C.
Renal function.

Answer 15

A1C

Question 16

A 43-year-old man is diagnosed with gastroesophageal reflux disease and is prescribed a proton pump inhibitor (PPI). Over the next several weeks, he is titrated to the maximum prescription dose taken twice daily but reports little to no improvement in symptoms. The nurse practitioner recommends:

Testing for H. pylori.
Switching to a daily H2-receptor antagonist with antacid PRN.
Performing an abdominal ultrasound.
Referral to GI specialist for upper endoscopy.

Answer 16

Referral to GI specialist for upper endoscopy.

Question 17

Laboratory assessment of a patient with hypothyroidism is likely to reveal:

TSH=32 mIU/L (0.4–4.0 mIU/L); free T4=1.2 pmol/dL (10–27 pmol/L ).
TSH=2.6 mIU/L (0.4–4.0 mIU/L); total T3=310 ng/dL (95–190 ng/dL).
TSH=7.7 mIU/L (0.4–4.0 mIU/L); free T4=22 pmol/L (10–27 pmol/L).
TSH=0.2 mIU/L (0.4–4.0 mIU/L); free T3=1.7 ng/dL (0.2–0.5 ng/dL).

Answer 17

TSH=32 mIU/L (0.4–4.0 mIU/L); free T4=1.2 pmol/dL (10–27 pmol/L ).

Question 18

One week into sertraline (Zoloft®) therapy, a 34-year-old woman complains of a recurrent dull frontal headache that is relieved with acetaminophen. You advise her that:

This is a common, transient adverse effect of SSRI therapy.
Bupropion (Wellbutrin®) should be substituted.
Desipramine (Norpramin®) should be added.
She should discontinue the medication.

Answer 18

This is a common, transient adverse effect of SSRI therapy.

Question 19

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

Recurrent diarrhea and cramping
Difficulty initiating sleep
Diminished cognitive ability
Consistent early morning wakening

Answer 19

Consistent early morning wakening

Question 20

A 32-year-old woman presents with a recent onset of copious, green-yellow vaginal discharge. Physical examination reveals “strawberry spots” on the cervix. The NP anticipates finding the following on microscopic examination.

Pseudohyphae
Large, motile organisms
Few WBC
Scant lactobacilli

Answer 20

Large, motile organisms

Question 21

A 36-year-old man presents with a 12-h history of anorexia, nausea, and right lower quadrant abdominal pain. A white blood cell count with differential demonstrates:
–TWBC=16,500 cells/mm3
–Neutrophils=66%
–Bands=8%
–Lymphocytes=22%.
Considering a working diagnosis of acute appendicitis, expected physical examination findings include:

Murphy’s sign.
A palpable left lower quadrant mass.
Periumbilical ecchymosis.
A positive obturator sign.

Answer 21

A positive obturator sign.

Question 22

A 52-year-old man presents for evaluation of fatigue. His physical examination is significant only for intention tremor and asymptomatic pharyngeal redness. He reports a history of recurrent gastritis. Laboratory examination results are as follows:
-Hb=14.3 g/dL (143 g/L)
-Hct=48% (0.48 proportion)
-MCV=109 fL
-HDL-C=58 mg/dL (1.5 mmol/L)
-LDL-C=118 mg/dL (3.06 mmol/L)
-Triglycerides=318 mg/dL (3.59 mmol/L)
These findings are most consistent with:

Pernicious anemia.
Iron deficiency anemia.
Alcohol use disorder.
Normal findings

Answer 22

Alcohol use disorder.

Question 23

A 52-year-old female with a BMI=24 kg/m2 is diagnosed with new-onset hypertension. She has no significant medical history, no concomitant health problems, and takes no medications. Along with therapeutic lifestyle changes, therapy should begin with which of the following classes of drug?

Aldosterone antagonist
Beta-adrenergic antagonist
Centrally-acting agent
Thiazide diuretic

Answer 23

Thiazide diuretic

Question 24

You are examining a 21-year-old man who is seeking a sports clearance physical examination. He is generally healthy with an unremarkable medical history. During cardiovascular examination, you identify a physiologic split S2 and realize that this:

Is usually first noticed in early adulthood.
Can progress to a pathologic condition during adulthood.
Will be more pronounced with inspiration.
Is associated with S4 heart sound.

Answer 24

Will be more pronounced with inspiration.

Question 25

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

A hard, immobile induration.
A bilateral enlargement.
A painful flocculent lesion.
A rubbery gland with central depression.

Answer 25

A hard, immobile induration.

Question 26

Actinic keratoses can be described as:

Hyperpigmented macules on sun-exposed areas.
Vesicular lesions along a dermatomal distribution.
Ulcerating lesions in groin folds.
Slightly rough, pink or flesh-colored lesions on the face.

Answer 26

Slightly rough, pink or flesh-colored lesions on the face.

Question 27

CPT is an acronym for:

Answer 27

Current Procedural Terminology.

Question 28

The nurse practitioner is evaluating a 71-year-old man with a 10-year history of type 2 diabetes mellitus. His current A1C is 8.8% and requires escalation of therapy. He lives alone and needs a cane when walking. In considering adding an antihyperglycemic medication, which of the following should be avoided?

Exenatide (Byetta®)
Canagliflozin (Invokana®)
Sitagliptin (Januvia®)
Glyburide (Glynase®)

Answer 28

Glyburide

Question 29

Meeting the eligibility requirements for national NP certification signifies that the nurse practitioner:

Answer 29

Has achieved select prerequisites determined by a nongovernmental professional organization

Question 30

Metformin should not be used in the patient with a GFR <30 mL/min/1.73 m2 because of the risk of:

Hypokalemia.
Worsening renal function.
Hypocalcemia.
Lactic acidosis.

Answer 30

Lactic acidosis.

Question 31

A 38-year-old woman reports having 3–5 migraine episodes each month that can last 1–3 days. Her medical history is otherwise unremarkable other than bilateral tubal ligation (BTL) 6 years ago. She asks if there is any medication that can help to prevent these migraines. An appropriate prophylactic treatment option to offer this patient is:

Ergotamine (Ergomar®).
Sumatriptan (Imitrex®).
Topiramate (Topamax®).
Verapamil (Verelan®).

Answer 31

Topiramate (Topamax®).

Question 32

Risk factors for the development of type 2 diabetes in women include:

History of early menarche.
Cigarette smoking.
Personal history of polycystic ovary syndrome.
Caucasian race.

Answer 32

Personal history of polycystic ovary syndrome.

Question 33

The nurse practitioner is counseling a patient who is new to insulin therapy. The patient is advised that when injecting a short-acting, rapid-onset formulation such as insulin aspart, the time of greatest risk for hypoglycemia is:

Answer 33

1–3 hours after injection.

Question 34

The nurse practitioner knows that all patients with an acute eye complaint should have:

Answer 34

Assessment of visual acuity.

Question 35

One of the preferred pharmacologic options of persistent cough in an otherwise well 25-year-old woman with acute uncomplicated bronchitis would most likely include:

Antibiotic therapy to cover atypical pathogens.
An inhaled short-acting muscarinic antagonist.
An inhaled corticosteroid.
A dextromethorphan-based cough suppressant.

Answer 35

An inhaled short-acting muscarinic antagonist.

Question 36

A 24-year-old male returns from a camping trip with itchy, weeping blisters covering approximately 20% of total body surface, including the face and genitals. He states that “the itching is becoming unbearable.” Suspecting phytodermatitis, the nurse practitioner recommends treatment with:

Topical low- to medium-potency corticosteroid.
Oral corticosteroid.
Oral antihistamine.
Topical imiquimod.

Answer 36

Oral corticosteroid.

Question 37

A 66-year-old man presents for a “check-up.” He has no complaints and admits he’s been smoking 2 packs a day for 40 years. Which additional finding would be consistent with a diagnosis of chronic obstructive pulmonary disease?

Markedly increased chest AP diameter
Pleuritic chest pain
FEV1:FVC ratio <0.70 post SABA use
FEV1 improving by 50% with use of SAMA

Answer 37

FEV1:FVC ratio <0.70 post SABA use

Question 38

A 27-year-old woman was diagnosed with acute bacterial rhinosinusitis and prescribed oral cefpodoxime due to a mild-to-moderate beta-lactam allergy. She returns 4 days later with worsening symptoms. The NP recommends:

Continue with current course as it can take up to 7 days for symptom improvement.
Switch to amoxicillin-clavulanate.
Switch to azithromycin.
Switch to levofloxacin.

Answer 38

Switch to levofloxacin

Question 39

A palpable thyroid nodule is found on a 54-year-old woman with no apparent signs or symptoms. Labs reveal her TSH is 2.1 mIU/L (NL = 0.4 to 4.0 mIU/L) and a thyroid ultrasound identifies a single, solid nodule with distinct boundaries of about 2 cm in diameter. The most appropriate next course of action is:

Schedule a follow-up visit in 3 months to see if any changes to the nodule occur.
Schedule for a neck CT scan.
Check for presence of TPO antibodies.
Schedule for fine needle aspiration biopsy.

Answer 39

Schedule for fine needle aspiration biopsy.

Question 40

A mother brings in Jackson, her 4-year-old son, for evaluation after reporting that she stayed up all night with him because he was experiencing somewhat labored breathing and had a loud “barking-like” cough. The child has a hoarse voice, is without acute respiratory distress, and a temperature of 101.6°F (38.7°C). The NP recommends treatment with:

Short-term systemic corticosteroid.
Nebulized beta2-agonist.
Inhaled corticosteroid.
Guaifenesin.

Answer 40

Short-term systemic corticosteroid.

Question 41

When counseling a mother on how to assess if a newborn is nursing adequately, the NP advises that the newborn should:

Be able to sleep 2–3 hours between feedings.
Have at least 1–2 bowel movements per day.
Have 6–8 wet diapers per day.
Cease wanting to nurse after about 10 minutes of feeding.

Answer 41

Have 6–8 wet diapers per day.

Question 42

An appropriate time to educate parents about floor safety (i.e., potential dangers of what a child can find on the floor) is:

Prior to the time when a child learns to walk.
Prior to the time when the child can roll from tummy-to-back and back-to-tummy.
Around the time the baby can pull to stand.
Prior to child being able to sit solo.

Answer 42

Prior to the time when the child can roll from tummy-to-back and back-to-tummy.

Question 43

he mother of a 12-month-old son is expected to bring him to clinic for vaccinations later that day. She asks if she can give him some ibuprofen prior to the visit to minimize pain and fever from the vaccinations. The NP responds:

Answer 43

Antipyretic use is not recommended prior to vaccinations as there is a potential risk to blunt the immunologic impact of the immunization.

Question 44

A mother who is breastfeeding her 2-day-old daughter expresses concern because the child makes a “clicking sound” when nursing. On physical examination of the baby, the NP notices that she is able to thrust her tongue beyond the lip margins with ease. The NP explains that the noise is most likely due to:

Answer 44

An incomplete latch.