Quiz questions closer to exam

Question 1

Which of the following statements regarding cystic fibrosis is FALSE?

a) CF is an autosomal recessive disorder that causes the production of thick mucus
b) CF requires a specialist referral for management
c) The respiratory tract is the only body system affected by CF
d) Initial presentation of CF may appear as a meconium ileus

Answer 1

Ans: C

C is false. CF is a multi-system disease

Question 2

You examine a 1 month old girl whose parents are worried that she is not eating well. Aside from some mild spitting up, they do not report symptoms of nausea, or vomiting. Although the child’s temperature is normal, you observe that her lips and fingernails have a blue tint. To diagnose the most likely condition, which auscultatory area should you listen to?

a) Aortic
b) Tricuspid
c) Mitral
d) Pulmonic

Answer 2

Ans: B Tricuspid

The infant’s cyanosis and poor diet are most likely due to a VSD which is associated with a holosystolic murmur that is best heard at the tricuspid area; LLSB.

The mitral area is inappropriate bc it is in the LRSB.

The aortic and pulmonic areas are in the upper parts of the body and therefore also unsuitable for diagnosing a VSD.

Question 3

Your patient comes in for a check. His past medical history indicates that his heart has an inability to contract, which results in decreased cardiac output, a condition for which he takes captopril. The patient now also presents with an irregular and rapid heart beat. Which of the following pharmacologic options would treat the patient’s new condition?

a) Enalapril
b) Benazepril
c) Thiazide diuretic
d) Anticoagulants

Answer 3

Ans: D Anticoags for the treatment of A-Fib

This patient has heart failure which has been treated with an ACE inhibitor. A, and B are also ACE inhibitors which will not manage new symptoms. Atrial Fib is treated with anticoag therapy.

Thiazides would help the patient’s heart failure, but these do not treat A-Fib

Question 4

Which of the following is suspected of causing intussusception?

a) C. diff
b) Adenovirus
c) Chronic constipation
d) Influenza virus

Answer 4

Ans: B Adenovirus

Research has shown a possible link between adenovirus and intussusception which suggest that it is possible that patients with adenovirus may have an altered immune and/or anatomic status predisposing them to intussusception.

the others have no suggested link to intussusception

Question 5

You are performing the first physical exam of Terry, a first time mother-to-be in her first trimester. She knows that pregnancy induced hypertension occurs during 12% of all pregnancies and is concerned. Which of the following conditions is a contributing or predisposing factor to PIH?

a) Diabetes
b) Sudden weight gain
c) Hyperthyroidism
d) Herpes

Answer 5

Ans: A Diabetes

DM is one of the many factors that can contribute to PIH along with pre-existing HTN, renal, and CVD. Neither hyperthyroidism nor herpes is associated with PIH.

Sudden weight gain is a symptom that pertains to preeclampsia, another pregnancy complication but is not associated with PIH.

Question 6

Which of the following is responsible for determining how the goals set forth by the Healthy People 2020 initiative are met?

a) Patient safety organizations
b) State governments
c) Communities
d) Health insurance companies

Answer 6

Ans: C Communities

Communities as well as individuals and organizations are responsible for determining how the goals of Health People 2020 are met.

Question 7

You have been treating Bernie, 43, through his anemia which resulted from a poor diet. To treat Bernie, you will need to comprehensively understand the measurements regarding anemia. For the Mean Corpuscular Hemoglobin levels, normal readings are found between which min and max pictograms per cell?

a) 17 and 20
b) 21 and 25
c) 26 and 34
d) 35 and 39

Answer 7

Ans: C 26 and 34

Mean corpuscular hemoglobin is defined as an expression of the average amount of hemoglobin contained in an individual RBC. The normal level is between 26 and 34 pg.

Question 8

Beth, 31, comes to clinic with a six-month history of receiving her menses more often than usual, sometimes every 2 weeks but the amount and time bled seems normal. Which of the following terms best describes the patient’s sign or symptom?

a) Menorrhagia
b) Polymenorrhea
c) Menometrorrhagia
d) Metrorrhagia

Answer 8

Ans: B Polymenorrhea

Polymenorrhea is the too frequent occurrence of a woman’s menstrual cycle.

Menorrhagia patients have regular cycles but bleed heavily and longer
Menometrorrhagia have more frequent cycles with heavy bleeding that is prolonged
Metrorrhagia is bleeding between cycles

Question 9

A 47 year old male comes to clinic from the ED. His wife states that she rushed him to the ED because he started shaking, passed out cold, and started shaking again. She adds that he continued to experience the seizure throughout the ambulance ride and calmed down after 15 minutes. Which of the following seizures did the patient likely have?

a) Absence seizure
b) Tonic clonic seizure
c) Status epilepticus
d) Simple partial seizure

Answer 9

Ans: C Status epilepticus

Status epilepticus is characterized by a series of tonic-clonic seizures lasting longer than 10 minutes duration.

Tonic clonic seizures typically last 2-5 minutes

Question 10

A woman in week 28 of her pregnancy presents to clinic complaining of frequent headaches which are causing vision problems. You note that her weight has gone up 15 pounds in 30 days. Her symptoms are most consistent with which of the following conditions?

a) Hemolysis, elevated liver enzymes, and low platelets
b) Pregnancy induced hypertension
c) Preeclampsia
d) Eclampsia

Answer 10

Ans: C Preeclampsia

Elevated BP is present in both PIH and preeclampsia and is what is probably causing her headaches and vision disturbances. Eclampsia includes a seizure. HELLP includes nausea and jaundice and extreme fatigue.

Question 11

Newly single Samantha, 45, comes to clinic worried about the unsightly toenails on her feet. Upon assessment, you see that her toenails are thick and yellow. Some nails are even crumbling and coming off at the nail bed. Which of the following antifungals would be the best to prescribe?

a) Miconazole
b) Griseofulvin
c) Metronidazole
d) Itraconazole

Answer 11

Ans: D Itraconazole

This patient has tinea unguium. Itraconazole is an oral antifungal used to treat this condition. Miconazole is a topical antifungal that is used predominantly for tinea pedis and tinea manuum but not tinea unguium. Griseofulvin is usually used to treat serious skin fungal infections such as tinea capitus.
Metronidazole is an antibiotic used to treat moderate infections such as rosacea (facial redness).

Question 12

A 35 year old female has recently been diagnosed with myasthenia gravis. Which of the following is a treatment for this condition?

a) Antispasmodics
b) Interferon therapy
c) Edrophonium
d) Plasmapheresis

Answer 12

Ans: D

Plasmapheresis is a treatment used for both MG and MS.
Antispasmodics and interferon therapy are used to treat MS.
Edrophonium is used to differentiate between a myasthenia gravis crisis and a cholinergic crisis and does not treat either of those conditions.

Question 13

Joe, 37, presents with dyspnea and sputum production. His history indicates that he has been smoking for the past 15 years. Which of the following additional findings would help the NP diagnose his condition as chronic bronchitis?

a) Mild, clear sputum
b) Increased chest anterioposterior diameter
c) Productive cough for 3 months in the past 2 years
d) Blunting or shadowing of the costophrenic angle

Answer 13

Ans: C

Chronic bronchitis is characterized by excessive secretions of bronchial mucus and this productive cough must occur for 3 months over a period of 2 consecutive years.

Mild clear sputum in increased chest AP diameter are more characteristic of emphysema or COPD.
Blunting of the costophrenic angle is present with pleural effusion which is a restrictive not obstructive condition

Question 14

Tanner stage II in males includes:

a) The penis elongates
b) Nocturnal emission begins
c) Testes and scrotum become larger
d) Glans develops and rugae appear

Answer 14

Ans: C

In tanner II, the testes and scrotum start to become larger.
Tanner III is when the penis gets longer
Tanner IV it gets thicker and the glans develops, and rugae appear.

Question 15

Kathy is a 3 year old who has bronchopulmonary dysplasia. Kathy has already received her pneumococcal vaccine during her first year, and she is in need of more because of her condition. What is the next step that should be taken by the NP?

a) Wait 3 years to administer the Pneumovax vaccine
b) Wait at least 6 weeks to administer another dose of pneumococcal vaccine
c) Do not administer the Pneumovax vaccine
d) Administer the Pneumovax now.

Answer 15

Ans: D Give it now

Due to her bronchopulmonary dysplasia, the NP should give 23PS (Pneumovax) right away. The 23PS vaccine can be given 24-59 months after the PCV13 (Prevnar) vaccines. The PCV13 vaccine is still active and should not be redosed.

Question 16

A mom brings her 2 month old girl because the baby’s legs spasm from time to time, and there is swelling in her hip area. You decide to conduct the Ortolani test. Which of the following is the diagnostic use of this test?

a) Dislocates the head of the femur from the hip joint
b) Reduces hip joint dislocation
c) Screens for unequal knee height
d) Screens for unequal leg length

Answer 16

Ans: B
Ortolani maneuver reduces hip joint dislocation that is often caused when doing the Barlow test which pops the hip out. Barlow diagnoses hip dysplasia by popping the hip out of the joint.

Allis is leg length and Galeazzi is knee height. Inequality suggests hip displacement

Question 17

A 5 year old boy comes to clinic with his parents. They are concerned because he frequently appears pale and tired. Labs reveal enlargement of both the liver and spleen. Which of the following is NOT consistent with these findings?

a) Leukemia
b) Thalassemia
c) Sickle cell disease
d) Iron deficiency anemia

Answer 17

Ans: D Iron deficiency anemia

Although his pale and tired appearance is consistent with iron deficiency anemia, this condition is not accompanied by hepatosplenomegaly. SSA, Thalassemia, and leukemia ALL cause hepatosplenomegaly.

Question 18

Your patient comes to clinic for symptoms of wheezing. He indicates that the symptoms occurred soon after his treatment for an MI. If heart failure is this patient’s condition, which type of heart failure would this patient most likely have?

a) Chronic
b) Diastolic
c) Acute
d) Systolic

Answer 18

Ans: C Acute
Acute heart failure occurs when an abrupt onset follows an acute MI or valve rupture.

Chronic HF develops as a result of inadequate compensatory mechanisms that have been employed by the body to improve cardiac output

Diastolic HF is when the heart is unable to relax and fill and leads to decreased CO
Systolic HF occurs when the heart is unable to contract which also results in decreased CO

Question 19

Paul, 36, complained of headaches during his routine exam last week. Over the course of just a few days, he has experienced palpitations, weakness, and tachycardia, although he has no history of heart problems. Which of the following is NOT a common cause of what you suspect is his condition?

a) Folate deficiency
b) Hematopoietic neoplasm
c) Malabsorption of folic acid
d) Malabsorption of B12

Answer 19

Ans: B Hematopoietic Neoplasm

Neoplasms are tumors formed in the marrow that lead to leukemia, not anemia.

Iron deficiency anemia is the most common form of anemia resulting from insufficient intake of iron to meet the body’s needs.
Folic acid deficiency is a deficiency of folic acid (macrocytic)
Pernicious anemia is malabsorption of B12 due to a lack of intrinsic factor.

Question 20

Jackie has just graduated from college and is worried about PID and the infertility it can cause. Jackie wants to be sure that she does not have the disease. You tell her that there are many signs and symptoms that indicate PID. A finding that is NOT typically associated with PID however, is:

a) Lower abdominal pain
b) Vomiting
c) Loss of elasticity of the skin around the pelvis
d) Nausea

Answer 20

Ans: C Loss of elasticity of the skin around the pelvis

Elasticity loss is associated with menopause rather than PID.

Lower abd pain, nausea and vomiting are related to PID. If the patient has a family history of the condition, she should monitor herself for such symptoms.

Question 21

You are evaluating 7 month old Marcy who babbles and smiles at her mother. The lack of which of the following signs would be most concerning at this stage in her development?

a) Understands “no”
b) Crawling
c) Pulling to stand
d) Sitting up with support

Answer 21

Ans: D

It would be a red flag if this child could not sit up with support at the age of 7 months

Question 22

You perform the Lachman’s test on a 47 year old male. This means that you are assessing for an injury of which of the following?

a) Anterior and posterior cruciate ligament
b) Medial collateral ligament
c) Meniscus
d) Lateral collateral ligament

Answer 22

Ans: A Ant and post cruciate ligaments

Question 23

During a routine PAP smear, an overall healthy 29 year old female complains of mood swings and nausea. You suspect these may be side effects of her birth control. What type of birth control should you ask if she is using?

a) Diaphragm
b) Oral contraceptives
c) Implanon
d) NuvaRing

Answer 23

Ans: B oral contraceptives

Question 24

A woman brings her husband to you. She explains that the two of them were at the mall when he began exhibiting erratic behavior, including yelling and screaming for no clear reason. You eventually conclude that prescribing an antipsychotic medication is appropriate. According to the patient’s history, he is susceptible to liver and kidney failure. Which of the following antipsychotic meds should you avoid prescribing because of its very low therapeutic index?

a) Lithium
b) Depakote
c) Phenytoin
d) Clozapine

Answer 24

Ans: A Lithium

Question 25

Thomas, 72, comes to clinic for a check. Upon examination, you see bruises on his legs. His past medical history does not indicate any conditions or disorders that would cause the bruising. When asked, Thomas was hesitant at first to provide any explanation but later said, “I fell”. After assessing the patient, which of the following actions is the most appropriate to take?

a) Verify the patient’s claims with family members
b) Report the findings to social services
c) Refer the patient to an internal medicine physician
d) Report possible abuse to the police

Answer 25

Ans: B Report the findings to social services

Question 26

Hemolysis, elevated liver enzymes, and low platelet syndrome is a severe complication of what pregnancy disorder?

a) Preeclampsia
b) Placenta previa
c) Abruption placentae
d) Ectopic pregnancy

Answer 26

Ans: Preeclampsia

Question 27

You see 46 year old Tammy in clinic for what she believes is bacterial vaginosis. She is familiar with this condition because she has been diagnosed with it before. She states she suspects this condition because she has been experiencing vaginal spotting. If this is the diagnosis, which should you expect to find in the patient’s labs?

a) Motile trichomonads
b) Clue cells
c) Pseudohyphae
d) Gram-negative diplococci

Answer 27

Ans: B Clue cells

Question 28

Your 53 year old patient presents with severe dyspnea, an S4 heart sound while at rest, and fatigue with exertion. His signs and symptoms are similar to angina but much more severe. Which of the following is the patient’s most likely diagnosis?

a) Hypertensive emergency
b) Myocardial infarction
c) Hypertensive urgency
d) Venous thrombosis

Answer 28

Ans: B MI

Question 29

Which of the following policies protects the patient’s right to refuse care?

a) Danforth Amendment
b) Good Samaritan Statutes
c) Comprehensive Omnibus reconciliation act
d) Blunt Amendment

Answer 29

Ans: A Danforth Amendment

Question 30

All of the following conditions are detectable in the cerebral spinal fluid taken with lumbar puncture except:

a) Multiple sclerosis
b) Encephalitis
c) Meningitis
d) Muscular dystrophy

Answer 30

Ans: D Muscular dystrophy

Question 31

Your patient comes in for a checkup. His past medical history indicated that his heart has an inability to contract, which results in decreased cardiac output, a condition for which he takes catopril. The patient now also presents with an irregular and rapid heartbeat. Which of the following pharmacologic options would treat the patient’s new and most likely condition?

a) Enalapril
b) Benazepril
c) Thiazide diuretic
d) Anticoagulants

Answer 31

Ans: D Anticoagulants for A fib

Question 32

Which of the following bacteria would be the most common cause of acute otitis media?

a) Moraxella catarrhalis
b) Streptococcus pneumoniae
c) Haemophilus influenzae
d) Staphylococcus aureus

Answer 32

Ans: B S. pneumoniae

Question 33

As she begins to undergo strenuous marathon training, Clarie, 25, inquires about medications that reduce the effects of her menstrual cycle. You know that birth control can achieve this effect. Which of the following birth control methods may result in decreased menstrual loss and dysmenorrhea?

a) Depo-Provera
b) NuvaRing
c) Implanon
d) Progestin-releasing intrauterine device

Answer 33

Ans: D Progestin releasing IUD

Question 34

A 51 year old patient comes to clinic complaining of moderate episodes of shortness of breath. He is producing copious amounts of sputum and his coughing fits have become disruptive to his work and sleep. These episodes have become so severe that theses are even beginning to cause marital problems. You suspect chronic bronchitis. Which of the following should you NOT prescribe to help him manage his condition?

a) Streptomycin
b) Discontinuation of smoking
c) Avoidance of irritants or allergens
d) Inhaled ipratropium bromide

Answer 34

Ans: A Streptomycin

Question 35

Ray comes to clinic complaining of intermittent numbness in the lateral aspect of his foot. He explains that he does very labor intensive work that requires him to lift heavy objects. Which of the following is NOT a finding typically associated with the patient’s condition if it is the result of one of the most often cited causes of missed work days?

a) Diminished reflexes
b) Sexual dysfunction
c) Pain along the sacral curve
d) Pain along the scapula

Answer 35

Ans: D Low back pain does not manifest as Pain along the scapula

Question 36

In adults, infarction of the bony epiphysis of the femoral head, resulting from idiopathic avascular necrosis, is known as Chandler’s disease. What is the name for this condition when it appears in children?

a) Panner’s disease
b) Legg-Calve-Perthes disease
c) Osgood Schlatter disease
d) Haas’ disease

Answer 36

Ans: B Legg-Calve-Perthes Disease

Question 37

A 32 year old male comes to the emergency room with a gunshot wound on his arm. He states that the bullet grazed him, leaving a minor injury. The patient adds that he and his friends were hunting when the accident occurred and that there was no foul play. After assessing the patient, what is the next appropriate step?

a) Report to local authorities
b) Discharge the patient
c) Notify the patient’s next of kin
d) Confirm the accident story with the patient’s friends

Answer 37

Ans: A Report to the local authorities

Question 38

A 60 year old man reports to the emergency room with severe epigastric pain. On exam, you note that the patient’s abdomen if “board-like”, and you hear absent bowel sounds. You ask the patient what he was doing when the onset of pain occurred and he replied, “I was having dinner with my family and suddenly there was a severe pain in the upper part of my stomach”. These signs and symptoms are most indicative of which of the following conditions?

a) Gastric ulcer with perforation
b) Gastroenteritis
c) Duodenal ulcer with perforation
d) Gastroesophageal reflux disease

Answer 38

Ans: A Gastric ulcer with perforation

Question 39

You have a patient with anemia which resulted from a poor diet. To treat him, you will need to comprehensively understand the measurements regarding anemia. For the mean corpuscular hemoglobin levels (MCH), normal reading are found between which min and max pictograms per cell?

a) 17 and 20
b) 21 and 25
c) 26 and 34
d) 35 and 39

Answer 39

Ans: C 26-34

Question 40

When obtaining a pedigree history, how many generations must be included?

a) 1
b) 2
c) 3
d) 4

Answer 40

Ans: C 3

Question 41

Earl comes to clinic very distressed by the blisters on his face. The blister are unsightly as many of them have popped and dried into honey-colored crusts. He works behind the desk of a very classy hotel and he knows that this is affecting his business and how he greets guests. What is the best treatment for Earl at this time?

a) Bactroban
b) UV Light
c) Miconazole
d) Betamethasone

Answer 41

Ans: A Bactroban

Question 42

A patient threatens to sue you for invasion of privacy because his health insurance company increased his premiums due to the updated patient information that was provided. You know that:

a) A patient’s medical information should be released only if the patient authorizes the release
b) You did not invade the patient’s privacy
c) The patient should sue the health insurance company for discrimination
d) You inadvertently slandered the patient

Answer 42

Ans: B You did NOT invade this patient’s privacy

Question 43

Your patient comes to clinic for outpatient management of his asthma. He is somewhat overweight and would like to take up running but is afraid to do so because of his symptoms. Which medication would you initially prescribe to this patient?

a) A Short-acting beta2-agonist
b) Anticholinergics
c) Long-acting beta2-agonists
d) Anitleukotrienes

Answer 43

Ans: A First line treatment is a SABA

Question 44

Lyme disease is a spirochetal disease and is the most common vector-borne disease in the US. The symptoms are seen in three stages. Which of the following symptom profiles best describes stage 2 of the disease?

a) Joint and periarticular pain, subacute encephalopathy, and acrodermatitis chronicum atrophicans
b) Headache, stiff joints, migratory pains, and cardiac symptoms
c) Flu-like symptoms
d) Circular rash at the site of the tick bite

Answer 44

Ans: B Headaches, stiff joints, migratory pains, and cardiac symptoms

Question 45

A 24 year old woman comes to clinic concerned that she has acquired a sexually transmitted disease. Her complaints include lower abdominal pain, painful intercourse, painful urination, and other symptoms consistent with gonorrhea. Of the following treatments, which one would be best for her?

a) Doxycycline
b) Ceftriaxone
c) Acyclovir
d) Podophyllin

Answer 45

Ans: B Ceftriaxone

Question 46

Now that he has turned 60 years old, Terry visits yo to get a full physical. Knowing that his father had prostate cancer, there would be cause for concern if the prostate surface antigen was at least over which level?

a) 2.5
b) 3.5
c) 4
d) 4.5

Answer 46

Ans: D Less than 4.5

Age/Level should be less than
40-49/2.5
50-59/3.5
60-69/4.5
70-79/6.5

Question 47

There are organic causes of enuresis that should be ruled out by laboratory and diagnostic testing. Which of the following conditions is an organic cause of enuresis?

a) UTI
b) Behavioral issues
c) Hepatitis
d) Hypospadias

Answer 47

Ans: A Urinary tract infection

Question 48

After presenting with a white vaginal discharge as well as vulvovaginal erythema with pruritus, you diagnose 38 year old Tess with candidiasis vulvovaginitis. Tess wants the condition to be treated as soon as possible. Which of the following is the best treatment?

a) Metronidazole 500 mg po bid x 7 days or 2 gm. by mouth single dose or gel 5 gm. intravaginally bid x 5 days
b) Metronidazole 2 gm. po x 1 or 500 mg po bid x 7 days
c) Miconazole or clotrimazole 5 gm. intravaginally HS x 7 days
d) Clindamycin vaginal cream 5 gm. intravaginally HS x 7 days or 300 mg po bid x 7 days

Answer 48

Ans: C Miconazole or clotrimazole 5 gm intravaginally HS x 7 days

Question 49

Your patient presents to the emergency room with nausea, vomiting, and umbilical pain that has shifted to his right lower quadrant in the last hour. A physical exam reveals a low grade fever. Which of the following tests should your order to confirm the most likely diagnosis?

a) Ultrasound
b) Colonoscopy
c) Sigmoidoscopy
d) Endoscopy

Answer 49

Ans: A Ultrasound

Question 50

A comprehensive history of a newborn should include a detailed assessment. When dealing with prenatal care, which of the following should NOT be assessed in prenatal history?

a) Course of prenatal care
b) Xenobiotic use during the gestational period
c) Birth size and weight
d) Health problems during pregnancy

Answer 50

Ans: C Birth size and weight are part of the perinatal history not prenatal

Question 51

A 23 year old female comes to your office complaining of debilitating, throbbing pain that always occurs on the right side of her head. She states that the pain builds gradually and lasts for several hours. She had tried to endure it, but she decided to visit clinic after she started vomiting and seeing flashes of lights when she closed her eyes. She adds that this is the first time that she has ever experienced a “really bad headache”. Of the following choices, what should your first course of action be?

a) Prescribe daily prophylactic therapy
b) Run baseline studies
c) Advise the patient to engage in relaxation and or stress management
d) Order sumatriptan

Answer 51

Ans: B Run baseline studies. This is initial onset and a better history needs to be taken to determine HA cause/treatment

Question 52

Infants with Down Syndrome have a specific appearance at birth such as intercanthal folds, hypotonia, and a protruding tongue. But there are findings that go beyond the appearances of the patient. Which of the following are NOT a finding of Down’s Syndrome?

a) Congenital heart defects
b) Failure to thrive
c) Seizures
d) Hearing and/or vision impairment

Answer 52

Ans: B Down syndrome children do not suffer from failure to thrive.

Question 53

With nuptials ahead, Cassie wants to try a new type of birth control. She asks about Ortho-Evra. It does have a -2% failure rate and is easily reversible, which is especially important if Cassie decides to have a child. What is a disadvantage of Ortho-Evra you must inform Cassie about?

a) Menstrual irregularities
b) Delayed return of fertility
c) Irregular menstrual periods
d) Reduced effectiveness when used with certain antibiotics

Answer 53

Ans: D Reduced effectiveness when used with certain antibiotics

Question 54

Your elderly patient Jim has recently been diagnosed with hyperthyroidism. After informing him, he explains that his brother has the same condition and has “always been fine”. You tell Jim that hyperthyroidism can be asymptomatic, but it may also cause a number of problems. Which of the following is the most likely complication of this disorder?

a) Thyroid storm
b) Tachycardia
c) Weight gain
d) Thyroid cancer

Answer 54

Ans: B

Hyperthyroidism can cause tachycardia, exacerbated osteoporosis, eye problems (blurring, exopthalmia, photophobia),

thyrotoxic crisis- a sudden intensification of symptoms leading to fever, tachycardia and even delirium and is a result of hyperthyroidism which makes this a poor question for an exam

Question 55

When determining whether or not an individual is obese, which of the following factors would NOT be a factor?

a) Serum calcium
b) Decreased energy expenditure
c) Diet high in simple carbohydrates
d) Body mass index

Answer 55

Ans: A Serum calcium is not a factor in diagnosing obesity

Question 56

Clari comes to clinic concerned about her fingernail. She states, “it looks as though it is about to come off!” You notice that the area around the nail is red and swollen and indeed that the nail appears detached. When you touch the infected area, Clari pulls away and screams in pain. What treatment option would be the most effective to provide for Clari at this time?

a) Clindamycin
b) Ultraviolet B light
c) Miconazole
d) Betamethasone

Answer 56

Ans: A Clindamycin

Question 57

Psoriasis is a common, benign, hypoproliferative inflammatory skin disorder. Which of the following statements regarding psoriasis is true?

a) Psoriasis presents with lesions that are red, sharply defined plaques that are covered with silvery scales
b) Patients with psoriasis have severe erythema and vesicles that are treated with Burow’s compresses.
c) Psoriasis presents with papules, vesicles, and crusts
d) Psoriasis will resolve completely with high-potency, topical steroidal treatment

Answer 57

Ans: A

Psoriasis presents with lesions that are red, sharply defined plaques that are covered with silvery scales.

Question 58

Which of the following statements is true regarding the management of testicular torsion?

a) Patients who have surgery within 6 hours of torsion have a nearly 100% chance of salvaging the testicle
b) Patients must have urologic consultation even if it involves waiting until the next morning
c) Suspected cases of torsion should be followed up within 2 weeks
d) Patients should be referred to a urology clinic

Answer 58

Ans: A

Patients who have surgery within 6 hours of torsion have a nearly 100% chance of salvaging the testicle

Question 59

You have been treating Daniel 41, for asthma for the past 10 years. He has rarely experienced any symptoms but lately, he has noticed some shortness of breath. You determine a X-ray should be part of the exam. Which of the following findings should you expect?

a) Kerley’s B Lines
b) Increased density
c) Sporadic consolidation
d) Hyperinflation

Answer 59

Ans: D Hyperinflation

Question 60

A woman in her 28th week of pregnancy comes to clinic with frequent headaches, which she feels are causing vision problems. You also observe that her weight gain, 15 pounds in 30 days, is sudden and substantial. Her symptoms are most consistent with which of the following conditions?

a) Hemolysis, elevated liver enzymes, and low platelet syndrome
b) Pregnancy induced hypertension
c) Preeclampsia
d) Eclampsia

Answer 60

Ans: C

these symptoms are most consistent with Preeclampsia

Question 61

A school-aged child is diagnosed with a hordeolum on her left eyelid. Which of the following would be the most appropriate means of management?

a) Cool compresses to affected eyelid
b) Ophthalmology referral if no resolution in 48 hours
c) Penicillin administered orally
d) Incision and drainage in the primary care clinic

Answer 61

Ans: B

Without resolution of the hordeolum in 48 hours, this child needs a referral. I&D is outside the scope of care in the primary care clinic.

Question 62

Your 42 year old patient presents with complaints of calf pain, numbness in his feet and hands and pain while at rest. Your patient’s past medical history included T2DM, smoking for the past 20 years, and hyperlipidemia. Upon exam, you note shiny, hairless skin on his extremities, pallor and cyanosis in the extremities. Which of the following tests should you administer to diagnose his most likely condition?

a) Serum lipid panel
b) Blood glucose
c) Arteriography
d) Exercise echocardiogram

Answer 62

Ans: C

Arteriography: the most likely diagnosis is Peripheral Vascular Disease with dependent rubor and elevational pallor

Question 63

There is a break in immunizations from the recommended schedule. What should the NP do?

a) Conduct tests to see which vaccines were already administered
b) Refer to an immunologist
c) Resume immunizations according to the child’s current age, regardless of the vaccines previously missed
d) Administer all vaccines that the child has not received

Answer 63

Ans: C

Resume immunizations according to the child’s current age, regardless of the vaccines previously missed.

Question 64

Maria, a 22 year old patient just gave birth to a boy. You conduct a general physical exam on the baby. Based on the weight, length, and head circumference, which of the following would NOT be average measurements?

a) Length 21 inches; weight 7 pounds; Head circ 13 inches
b) Length 19 inches; weight 6.8 pounds; Head circ 12.5 inches
c) Length 21.5 inches; weight 7.2 pounds; Head circ 13.2 inches
d) Length 20.5 inches; weight 7.1 pounds; Head circ 14 inches

Answer 64

Ans: B

Question 65

You conduct an exam on an infant. During the exam, you flex the infant’s knees in the supine position so that his ankles touch his buttox. You note that his knees are not level. What should you note this finding as?

a) Barlow’s sign
b) Ortolani sign
c) Galeazzi sign
d) Genu varum

Answer 65

Ans: C

Galeazzi kneezie

Question 66

Katherine, 33, has recently been diagnosed with uncomplicated hyperthyroidism. She arrives in clinic complaining of muscle cramps, anxiety, heat intolerance. Of the following choices, which is the most appropriate medication to prescribe?

a) Propranolol
b) Metformin
c) Thyroid hormone replacement therapy
d) levothyroxine

Answer 66

Ans: A

Propranolol is a beta blocker that is used to manage the symptoms of hyperthyroidism including nervousness, heart racing, anxiety, heat intolerance.

Question 67

A patient from years ago has come to clinic for the first time in years. Shanna, 52, has recently started experiencing menopause. She mentions that she is concerned about bone loss. To determine the risk-to-benefit ratio of prescribing hormonal replacement therapy, Shanna’s history of myocardial infarction and coronary artery disease must be considered. Another factor that also needs to be considered, if present, is Shanna’s history with:

a) Colon cancer
b) Uterine cancer
c) Cervical cancer
d) Ovarian cancer

Answer 67

Ans: B Uterine cancer

Consider the effect of HRT on the lining of the uterus with the fact that HRT is primarily Estrogen with progesterone.

Question 68

Which of the following confirms and grants hospital privileges to the NP?

a) The state board of licensure
b) Department of Risk management
c) Credential committee
d) Collaborating physician

Answer 68

Ans: C Credentials committee

The hospital committee grants privileges to the NP

Question 69

Your middle-aged patient complains of a sensation of motion causing nausea and vomiting. The patient asks you what could be the cause. You tell him that he likely has vertigo and explain that there are many causes for which he should be tested. Which of the following tests should you NOT consider?

a) Computed tomography scan
b) Venereal disease research laboratory test
c) Western Blot
d) Hearing examination

Answer 69

Ans: C Western Blot

Western Blot is confirmatory primarily for HIV

Question 70

The father of a 2-year old boy informs you that his son has a rash on his palms and soles, a fever that has lasted 6 days. On exam, you discover that he also has erythematous, cracked lips as well as “strawberry tongue”. What is the most likely diagnosis based on this history and physical exam?

a) Rheumatic fever
b) Group A beta-hemolytic streptococcus infection
c) Kawasaki Disease
d) Scarlet Fever

Answer 70

Ans: C Kawasaki Disease

Question 71

A 35 year old female has recently been diagnosed with myasthenia gravis. Which of the following is a treatment for this condition?

a) Antispasmodics
b) Interferon therapy
c) Edrophonium
d) Plasmapheresis

Answer 71

Ans: D Plasmapheresis

Question 72

Marge visits clinic asking about a vaccination for her 13 year old daughter. Her daughter is about to enter high school. Marge, being realistic, is asking about the Gardasil vaccination for HPV. Marge asks how young someone can be for the vaccine. What can you tell her is the youngest age that a patient can receive the HPV vaccine?

a) Age 9
b) Age 11
c) Age 16
d) Age 18

Answer 72

Ans: A

Gardasil can be administered to patients as young as 9 years old.

Question 73

The NP is treating 12 year old Ben for T2DM. In addition to dietary and lifestyle management, the NP is looking to add an oral anti-diabetic medication to his regimen. Which ofthe following medications would be the most appropriate for Benny?

a) Dipeptidyl-peptidase 4 inhibitors
b) Glucagon-like peptide 1 agonists
c) Metformin
d) Thiazolidinediones

Answer 73

Ans: C

Metformin (biguanide) is the first step in the management of T2DM

Question 74

A 45 year old woman has diagnosed herself with depression through her internet search. She complains of feeling tired throughout the day, even though she sleeps for more than half the day. She also complains of feelings of worthlessness, everyday indecisiveness over the littlest things, and weight gain. Which of the following additional signs and symptoms would confirm that the patient indeed has depression?

a) Alternating episodes of insomnia and hypersomnia
b) Anhedonia
c) Psychomotor agitation
d) Suicide ideation

Answer 74

Ans: B

Anhedonia

Question 75

In the hospital in which you work, a patient dies unexpectedly during the course of treatment. The hospital declares the incident a sentinel event and orders immediate response. As an NP, which of the following are you most expected to do next?

a) Root cause analysis
b) Policy change addressing the event
c) Assessment of risks and benefits
d) Documentation of remediation

Answer 75

Ans: A
Root cause analysis

RCA analyzes the cause of the problem and is the first step

Question 76

What is the most commonly used initial screening test for HIV?

a) Western Blot
b) Polymerase chain reaction
c) ELISA
d) CBC

Answer 76

Ans: C
ELISA for screening/Western Blot for confirmation

Enzyme-Linked ImmunoSorbent Assay uses antibodies and color change and is a Wet-Lab

Question 77

Your patient Frank comes in for an exam. He says that he was exercising and suddenly felt an onset of chest discomfort. When asked to describe the discomfort, he clenches his fist. Which of the following medications should you prescribe for the patient’s symptoms?

a) Nitroglycerine
b) Thiazide diuretics
c) Benzodiazepines
d) Angiotensin II receptor blockers

Answer 77

Ans: A

Nitroglycerine

Clenched fist is called Levine’s Sign and is characteristic of angina

Question 78

A mom brings in her 10 year old son who has begun eating and drinking excessively but not gaining weight. During the interview, the NP learns that Wendell has also been urinating excessively. Based on these symptoms, the NP suspects a diagnosis of T1DM which is confirmed by fasting blood tests. What should the NP do first?

a) Check for the presence of ketones and then give 70/30 mix of insulin
b) Assess hemoglobin count and then give 60/40 mix of insulin
c) Weigh the patient and then give 70/30 mix of insulin
d) Refer the patient to an endocrinologist

Answer 78

Ans: D

pediatric T1DM need to be managed by a specialist and establishing treatment for new pedi T1DM is outside the scope of NP primary care practice.

Question 79

A 37 year old patient presents with dyspnea and sputum production. His history indicates that he has been smoking for the past 15 years. Which of the following additional findings would help the NP diagnose the patient’s condition as chronic bronchitis?

a) Mild clear sputum
b) Increased chest anteroposterior diameter
c) Productive cough for three months in the past two years
d) Blunting or shadowing of the costophrenic angle

Answer 79

Ans: C

Productive cough for three months in the past two years establishes a diagnosis of chronic Bronchitis

Question 80

Tanner stages help providers understand sexual development in an adolescent child. Which of the following best describes Tanner stage II in males?

a) The penis elongates
b) Nocturnal emission begins
c) Testes and scrotum become larger
d) Glans develops and rugae appear

Answer 80

Ans: C

In Tanner II, the testes and scrotum become larger
Tanner III the penis elongates
Tanner IV the penis thickens
Tanner I is a baby
Tanner V is the adult

Question 81

Yousee a 17 year old female with inflammation in her pharynx and tonsils. You also note a fever of 100.5. You suspect that the patient may be infected with Group A Beta hemolytic streptococcus (GABS). Which of the following further signs or symptoms would fulfill the Centor criteria for GABS?

a) Lack of cough
b) Headache
c) Malaise
d) Anorexia

Answer 81

Ans: A Lack of Cough

FLEA: 
Fever
Lack of cough
Pharyngeal Exudate
Anterior lympadenopathy

Question 82

A mother comes to clinic with her toddler girl Monica. Monica is still in diapers, but the mom is anxious to begin toilet training as soon as possible. She asks you when might be the right time to begin toilet training Monica. what is your best advice?

a) By the time children are 12 months old, they have control over their bladder
b) Some children are not ready to toilet train until 30 months
c) Children should be ready to toilet train by 18 months
d) Most children are not dry until age 4

Answer 82

Ans: B

Some children are not ready to toilet train until 30 months

Question 83

You have already seen Grant, a sex addict, for treatment of a few sexually transmitted diseases. This time, you observe several lesions on his trunk and genitals that are 1-1.5 mm in length. Furthermore, you chart that these are smooth, rounded, and possess flesh-colored to pearly white papules. What is the best treatment for this case?

a) Trichloroacetic acid
b) Electrocautery
c) Laser therapy
d) Liquid nitrogen

Answer 83

Ans: D Liquid nitrogen

This patient has probable Molluscum Contagiosum; a viral disorder with this presentation. Liquid nitrogen is used to remove the rounded shiny flesh colored lesion with minimal scaring

Question 84

Kathy is a 3 year old patient who has bronchopulmonary dysplasia. Kathy has already had her pneumococcal vaccines during her first year and she is in need of more because of her condition. What is the next step that should be taken by the NP?

a) Wait at least 3 years to administer Pneumovax vaccine
b) Wait at least 6 weeks to administer another dose of pneumococcal vaccines
c) Do not administer the Pneumovax vaccine
d) Administer the Pneumovax vaccine now.

Answer 84

Answer: D Give her the vaccine now.

Pneumovax is 23 valent
Prevnar is 13 valent

Children 24-59 months who are immunocompromised or have chronic pulmonary disease, can get a dose of 23PS at or after 24 months if they have completed the PCV13

Question 85

A mom brings in her 2 month old girl because the baby’s legs spasm, from time to time, and there is swelling in her hip area. You decide to conduct the Ortolani Test. Which of the following is the diagnostic use of this test?

a) Dislocates the head of the femur from the hip joint
b) Reduces hip joint dislocation
c) Screens for unequal knee height
d) Screens for unequal leg length

Answer 85

Ans: B Reduces hip joint dislocation

Barlow pops it out
Ortolani clicks it back in

knee height is Galeazzi
Leg length is Allis

Question 86

A 5 year old comes to the clinic with his parents who are concerned that their son frequently appears pale and tired. Lab tests reveal enlargement of both the spleen and liver. Which of the following diagnoses is NOT consistent with these findings?

a) Leukemia
b) Thalassemia
c) Sickle Cell Disease
d) Iron Deficiency Anemia

Answer 86

Ans: D Iron deficiency anemia

All of the others present with possible Hepatosplenomegaly but Iron deficiency does not.

Question 87

You have been treating a 62 year old woman with osteoarthritis in her left knee. At first, she was not having too much trouble with movement but as the months passed, the condition became more severe and movement became more difficult. She asks you to provide her with a cane which you do. You should teach her to hold the cane on which side?

a) Right side
b) Left side
c) Alternating every other day
d) Either side will work though not to excess

Answer 87

Ans: A Right side

The right side is the proper side to use the cane. It should be used on the side opposite the OA leg which in this case is the left.

Question 88

A 34 year old female comes to clinic with a purplish bruise on her face. She was hurt playing football the day prior and she wants to make sure that she was not seriously injured. You note that the bruised area is not palpable. You can tell her that she has which type of minor bruising?

a) Laceration
b) Hematoma
c) Abrasion
d) Contusion

Answer 88

Ans: D

Contusion

Question 89

Your patient has syphilis and presents to clinic with a rash on her palmar and plantar surfaces. She also complains of swollen lymph nodes and malaise. With which of the following clinical stages of syphilis would you diagnose her?

a) Primary
b) Secondary
c) Latent
d) Tertiary

Answer 89

Ans: B

She has secondary syphilis

Question 90

A physical exam on an 18 year old male reveals tenderness over the tibial tubercle. Proximal tibial swelling and tenderness is also noted. When asked to stand, the patient experiences a “weak feeling” in his quadriceps. Which of the following signs or symptoms is consistent with the patient’s presentation?

a) Diminished patellar reflex
b) Feeling as though “standing on a pebble” under his toes
c) Pain originating from the heel and radiating to the toes
d) Painful lump below the kneecap

Answer 90

Ans: D

Painful lump below the kneecap

Diminished patellar reflex is Low back injury at L3/4
Standing on a pebble is Morton’s Neuroma
Pain originating in the heel is Plantar Fasciitis

Question 91

You are assessing a dehydrated and malnourished 56 year old woman who was found wandering in the desert. She had gotten lost during a business picnic to days ago. She is very confused and does not seem to know her identity or where she is. She is muttering nonsense and does not answer any of your questions. When her husband comes in, he says that she has never acted this way before. Of the following choices, which is the most likely diagnosis?

a) Alzheimer’s disease
b) Delirium
c) Dementia
d) Psychosis

Answer 91

Ans: B

Delirium

Question 92

Which of the following choices correctly lists the common factors of anemias?

a) Blood loss, bone marrow failure, impaired production, hemolysis, or destruction of red blood cells
b) Islet cell antibodies and human leukocyte antigens
c) Cortisol, aldosterone, and androgen deficiency in addition to an autoimmune destruction of the adrenal gland
d) Atrial fibrillation, endocarditis, and valve disease

Answer 92

Ans: A

Causes of anemias are:
Blood loss, Bone marrow failure, impaired production, hemolysis or destruction of red blood cells

Question 93

Chlamydia is the most common bacterial sexually transmitted disease in the US, with over 40 million infections occurring annually. Which of the following most accurately describes how chlamydia can be spread?

a) Vaginal, anal, or oral intercourse
b) Physical contact with a toilet seat
c) Kissing
d) Vaginal intercourse

Answer 93

Ans: A

Vaginal, anal, or oral intercourse

Question 94

A 43 year old patient presents to the ED complaining of sudden, severe pain in his epigastrium. The patient has a slight fever. Upon exam, you note right upper quadrant tenderness and pain under the right rib cage upon inhalation. Which of the following is the most likely diagnosis?

a) Peptic ulcer disease
b) Irritable bowel syndrome
c) Cholecystitis
d) Ulcerative colitis

Answer 94

Ans: C Cholecystitis

This is a positive Murphy Sign

Question 95

A pregnant woman is diagnosed with chlamydia. She wants to know if the baby is at risk for any conditions because of her diagnosis. Which of the following most accurately states the risk?

a) Baby at risk for ophthalmia neonatorum
b) Baby at risk for deafness
c) Baby at risk for in utero death
d) Baby at risk for mental or growth retardation

Answer 95

Ans: A

Baby at risk for ophthalmia neonatorum

Question 96

You have been monitoring the blood glucose levels of Alex, a 32 year old T2DM over the past three months. Based on your recorded averages, you determine that she has an elevated A1c. Which of the options below would be the best initial advice to give?

a) Exercise more
b) Insulin therapy
c) Oral anti-diabetics
d) Refer to an endocrinologist

Answer 96

Ans: A

Exercise is the first step to give good results for lowering the HgA1c

Question 97

George is complaining of tender, red bumps on his armpits. These bumps have irritated him for a week and he is now seeking help after his wife noted his poor mood the other day. When you look closely, you notice that there are also blackheads. An even closer examination reveals that some of the red bumps have broken and are leaking pus. Given your most likely suspicion, what treatment would be the best to give to George?

a) Clindamycin
b) UV Light
c) Miconazole
d) Betamethasone

Answer 97

Ans: A
Clindamycin

this is the presentation of Hidradenitis suppurativa; a staph infection commonly in the groin or axilla

Question 98

Your patient comes in for a check for symptoms of wheezing. He indicates that the symptoms occurred soon after his treatment for a myocardial infarction. If heart failure is this patient’s condition, which type of heart failure would this patient most likely have?

a) Chronic
b) Diastolic
c) Acute
d) Systolic

Answer 98

Ans: C Acute heart failure

follows an MI and with pulmonary symptoms, he is having left failure and his blood is backing up into the lungs.

Question 99

Based on a friend’s recommendation, 21 year old Kathy is interested in using the NuvaRing as a birth control method. With its 92-99.7% effective rate based on a once a month insertion, it is an attractive choice. What is a disadvantage you must inform Kathy about?

a) Menstrual irregularities
b) Increased vaginal discharge
c) Prolonged menses
d) Cramping and pain

Answer 99

Ans: B

Increased vaginal discharge

Question 100

You are treating 52 year old Mark who has been a smoker for the past 15 years. Even after being treated for an upper respiratory infection two weeks ago, he continues to smoke. Today, he presents with decreased breath sounds and a fever. Which of the following is most likely responsible for Mark’s signs?

a) Pneumonia
b) Asthma
c) Acute bronchitis
d) Chronic Bronchitis

Answer 100

Ans: A Pneumonia

Bronchitis does not present with a fever and decreased breath sounds. These point to consolidation in the lungs consistent with pneumonia

Question 101

A life insurance company sends your office a written request for verification of a patient’s record to review for possible fraud. The letter informs you that the company will be checking the patient’s record against various third party sources. The company requests that you call to verify the dates of patient procedures. After verifying the legitimacy of the letter, and the patient’s medical release, you should respond by:

a) Informing the company that it is illegal to share the patient’s information
b) Asking the company to check with the patient
c) Talking with office administrators
d) Providing the requested information

Answer 101

Ans: D

Provide the requested information

the documentation has been verified and the patient has given permission to release the records. All is in good shape here.

Question 102

The pathology of which of the following conditions includes the detection of islet cell antibodies in approximately 90% of patients within the first year of diagnosis?

a) T1DM
b) Hyperthyroidism
c) T2DM
d) Hypothyroidism

Answer 102

Ans: A
T1DM

Type 1 DM is characterized by islet of langerhan antibodies. This is an autoimmune disease where the body makes antibodies against the Islets where insulin is produced.

Question 103

Paul, 36, was complaining of headaches during his routine exam last week. Over the course of just a few days, he has experienced palpitations, weakness, and tachycardia although he has no history of heart problems. Which of the following is NOT a common cause of what you suspect is Paul’s condition?

a) Folate deficiency
b) Hematopoietic neoplasm
c) Malabsorption of folic acid
d) Malabsorption of B12

Answer 103

Ans: B

This is not the presentation of Hematopoietic neoplasm. The presence of this neoplasm is the cause of leukemia which presents differently.

All of these symptoms are suggestive of poor absorption of the B vitamins.

Question 104

Tim is 38 and he says that he does not want to comply with medical intervention you recommend. Which of the following key ethical principles require you to respect the patient’s individual thoughts and actions?

a) Fidelity
b) Veracity
c) Autonomy
d) Beneficence

Answer 104

Ans: C Autonomy

Fidelity is faithful
Veracity is truthfulness
Beneficence is to have the welfare of the patient as a prime goal
Autonomy is the patient’s freedom to make a fully informed decision about his care.

Question 105

Jax just graduated from college and is worried about PID. Her cousin has the condition and Jax knows that it can cause infertility. Since having a family is very important to her, she want to know the signs and symptoms that come with PID. A finding that is NOT typically associated with PID is:

a) Lower abdominal pain
b) Vomiting
c) Loss of elasticity of the skin around the pelvis
d) Nausea

Answer 105

Ans: C

Loss of elasticity of the skin around the pelvis is associated with menopause. The rest of these symptoms are associated with PID

Question 106

When examining a patient’s retina, the artery-to-vein ratio is usually 4:5. which other ratio represents a normal variation of the artery-to-vein ratio within the eye?

a) 1:3
b) 4:6
c) 2:3
d) 5:6

Answer 106

Ans: C

a ration of 2:3

directly out of Bark

Question 107

A concerned mother tells you that her son has threatened to commit suicide. She states that it alarmed her, but she thinks that he may just have been acting overdramatic. In response you explain:

a) 10% of those who state an intent to commit suicide do
b) 20% of those who state an intent to commit suicide do
c) 50% of those who state an intent to commit suicide do
d) 80% of those who state an intent to commit suicide do

Answer 107

Ans: D

80% of those who state an intent to commit suicide actually follow through on the attempt.

Question 108

A 67 year old female is brought to your clinic by her adult son after she crashed her car into a pole. The son tells you that when the police arrived on the scene, his mother was unable to tell them what happened. The mother says that she was just “shaken up” but when you ask her to tell you what happened, she has great difficulty putting the words together saying, “I don’t know” then gets very upset and stops speaking for more than 30 seconds. This verbal difficulty should be charted as:

a) Aphonia
b) Apraxia
c) Aphasia
d) Agnosia

Answer 108

Ans: C

Aphasia is “without words”
Aphonia is the inability to produce voice
Apraxia is the inability to do perform an action when asked
Agnosia is the inability to recognize objects, persons, sounds, shapes

Question 109

Your hospital risk management team is concerned with establishing legal defense in the case of a sentinel event. Which of the following action-taking initiatives is most important to ensure this goal?

a) Documentation
b) Prevention
c) Departmental coordination
d) Correction

Answer 109

Ans: A

Documentation

Question 110

A diabetic patient comes in complaining of dry mouth and fatigue. You also note a moderate fever. You conduct a number of tests which reveal a state of greatly elevated serum glucose, hyperosmolality, and severe dehydration without ketone productions. Which of the following complications of diabetes is indicated by the patient’s signs and symptoms?

a) Diabetic ketoacidosis
b) Hyperthyroidism
c) Hyperglycemic hyperosmolar non-ketosis
d) Hypothyroidism

Answer 110

Answer: C

HHNK

Question 111

You are seeing a 4 year boy who appears pale and listless. His parents have brought him in with a two day history of fever and painful limbs. Upon exam, you notice petechiae on the legs and abdomen as well as a bulging and immobile tympanic membrane. The painful limbs appear to be due to joint pains. After the exam, what should be your next step?

a) Start the patient on antibiotics
b) Order a complete blood count
c) Encourage fluids and start the patient on NSAIDs
d) Order a prothrombin time and partial thromboplastin time test

Answer 111

Ans: B

We need more information before we choose a treatment.

Question 112

Your patient comes in for a check. His past medical history indicates that his heart has an inability to contract, which results in decreased cardiac output, a condition for which he takes captopril. The patient now also presents with an irregular and rapid heartbeat. Which of the following pharmacologic options would treat the patient’s new, and most likely condition?

a) Enalapril
b) Benazepril
c) Thiazide diuretic
d) Anticoagulants

Answer 112

Ans: D Anticoagulants

This patient has Atrial Fib and the treatment is anticoags

Question 113

A 28 month old girl is brought to you for examination with a three day history of runny nose, non-productive cough, and a mildly elevated temperature. Her grandmother is worried because the child’s temp has increased to 101.9F after being awake all night with a persistent cough. Upon examination, you note a palpable liver and spleen. Which of the following findings would indicate a severe form of the most likely diagnosis?

a) Altered sensorium
b) Pulsus paradoxus above 12 mmHg
c) Bloody stools
d) Salt-tasting skin

Answer 113

Ans: A Altered Sensorium

what does this kid have?

Question 114

Which of the following is suspected as a cause of intussusception?

a) Clostridium difficile
b) Adenovirus
c) Chronic constipation
d) Influenza virus

Answer 114

Ans: B
Adenovirus
Intussusception has also been linked to the Rotavirus vaccine that is given up to but not beyond 8 months of age. Intussusception presents within approx 3-14 days after the initial dose of the vaccine which is given at age 2, 4, and 6 months.

Question 115

You see a 24 year old woman who states that she cannot receive the flu vaccine because she experiences a severe allergic reaction to eggs (respiratory distress, angioedema) requiring the use of epinephrine. The most appropriate response is:

a) Recommending vaccination with Live Attenuated influenza vaccine (LAIV)
b) Recommend vaccination with the recombinant influenza vaccine (RIV)
c) No recommending the flu vaccine until allergy testing is completed
d) Recommend the quadrivalent influenza vaccine every other year

Answer 115

Ans: B

Recommend vaccination with recombinant influenza vaccine (RIV). RIV is egg-free and indicated for persons 18-49 who exhibit an allergic reaction to eggs.

If the patient experiences egg related:
Hives: use the IIV or RIV

Question 116

Secondary preventions is best defined as a focused effort to:

a) Prevent a health problem from occurring
b) Detect disease in an early, asymptomatic state to minimize its impact
c) Initiate treatment prior to a definitive diagnosis based on clinical experience and observations
d) Optimize current treatment regimens to minimize negative disease-induced outcomes

Answer 116

Ans: B

Detect disease in an early, asymptomatic state to minimize its impact

Question 117

You see a 76 year old woman living at home who is accompanied by her homecare provider. She has COPD and T2DM. An example of secondary prevention is:

a) Administering the seasonal influenza vaccine
b) Checking her blood glucose levels
c) Screening for physical or financial abuse
d) Adjusting her insulin dosing regimen

Answer 117

Ans: C

Screening for physical or financial abuse
secondary prevention is screening

Question 118

Three suicides have occurred at the university leading up to finals week. The student health center is offering one-to-one and small group counseling to any student who is feeling stressed. Meeting with students who are anxious and showing signs of stress is an example of:

a) Primary prevention
b) Secondary prevention
c) Community action
d) Tertiary prevention

Answer 118

Ans: D

Tertiary prevention
Care is directed toward individuals or small groups who are already showing signs of stress. Tertiary strategies are aimed at reducing the risk of stress-related acts that may be detrimental to the health of the students.

Question 119

According to recommendations by the USPSTF, a 52 year old woman should undergo a mammogram:

a) Every year
b) Every 2 years
c) Annually beginning after age 55 years
d) Every 5 years

Answer 119

Ans: B
Every 2 years.

women between the ages of 50-74 are screened q2 years (biennially)

The American Cancer Society recommends an annual mammogram beginning at age 40

Question 120

AMong men with no symptoms of prostate cancer, the USPSTF recommends:

a) Annual PSA based screening starting at age 40
b) Biennial PSA based screening starting at age 45
c) Annual PSA based screening beginning at age 50
d) Against PSA based screening for prostate cancer

Answer 120

Ans: C

Against PSA-based screening for prostate cancer

Grade D recommendation suggests that there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. These recommendations apply to men with no symptoms of prostate cancer regardless of age, race, or family history.

Question 121

According to USPSTF, screening adults for depression should occur:

a) Annually
b) Immediately following significant life events (unemployment, loss, illness)
c) When staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up
d) Only for patients with multiple risk factors for depression

Answer 121

Ans: C

When staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up

Question 122

Which of the following statements is true regarding screening adolescent and adult males for testicular cancer:

a) Screening is not recommended
b) Screening by self-exam offers significant health benefits
c) Screening by a clinician offers significant health benefits
d) Screening for testicular cancer should be conducted every 5 years starting at age 18

Answer 122

Ans: A

Screening is not recommended due to inadequate evidence that asymptomatic patients experience health benefits given the very low incidence and high cure rate of even advanced testicular cancer. Potential harms of screening include false positives, anxiety, and harm from diagnostic tests or procedures.

Question 123

Which of the following is unlikely to be noted in a person with psoriasis vulgaris?

a) The face is typically involved
b) Lesions are often seen as well-demarcated plaques on the knees
c) Aggravating factors include stress, alcohol abuse, and cigarette smoking
d) Most milder cases can be successfully managed with a topical corticosteroid or vitamin D derivative cream

Answer 123

Ans A The face is NOT typically involved

Psoriasis is most often seen on extensor surfaces like knees and elbows, but can show up in discrete lesions on the trunk and limbs. The condition does not customarily affect the face.

Question 124

A punch biopsy is best presented to the pathologist when it is obtained from:

a) The center of the lesion
b) The darkest spot of the lesion
c) The border between the lesion and unaffected skin
d) Any area of the lesion in question

Answer 124

Ans: C The border between the lesion and unaffected skin.

The pathologist is evaluating the difference between normal and abnormal cells; therefore, a biopsy that contains both cell types is most valuable for examination

Question 125

A reasonable alternative diagnosis for an adult with acne vulgaris would be:

a) Rosacea
b) Tinea facialis
c) Hidradenitis suppurativa
d) Seborrheic dermatitis

Answer 125

Ans: A Rosacea

Acne vulgaris and rosacea are characterized by similar morphologies and distributions and are both frequently on the same list of differentials.

Question 126

When counseling for melanoma risk and reduction, the NP advises the patient:

a) Avoid the sun between 9am and 3pm
b) That family history is not a significant risk factor
c) That serious burns in middle age confer the greatest risk
d) To use sunscreen with sun protection factor of 45 or higher

Answer 126

Ans: A

Avoid the sun between the hours of 9am and 3pm.

Damage from the sun is greatest when the sun is directly overhead as this is when UV exposure is greatest. Best to avoid the sun when “your shadow is shorter than your height”

Question 127

Therapies for the treatment of rosacea in an otherwise healthy 54 year old woman include topical administration of all of the following except:

a) Clindamycin cream
b) Azelaic acid gel
c) Corticosteroid Cream
d) Tretinoin Cream

Answer 127

Ans: C
corticosteroid cream

The goal for rosacea management is to control flares rather than cure the condition. Topical therapies used for treatment include metronidazole cream or gel, sulfur creams, clindamycin, erythromycin, tretinoin, azelaic acid and benzoyl peroxide. Topical corticosteroids should be avoided on the face as it can produce a rosacea-like syndrome and can worsen pre-existing rosacea

Question 128

The presence of abnormally shaped red blood cells is known as:

a) Anisocytosis
b) Reticulocytopenia
c) Poikilocytosis
d) Hypochromic RBCs

Answer 128

Ans: C Poikilocytosis

Poikilocytosis is the presence of abnormally shaped RBCs

Anisocytosis refers to an increase in the normal variation of RBC size

Question 129

One week into treatment for iron deficiency anemia, you anticipate which of the following clinical responses?

a) Increase in hemoglobin level by 2g/dL
b) Normal ferritin
c) 12% increase in hematocrit
d) Reticulocytosis

Answer 129

Ans: D Reticulocytosis

Treatment of iron deficiency may take several months to replenish the iron reserves. With treatment, reticulocyte production will peak in about 6 days. With every 3 weeks of treatment, Hg levels will increase at 2g/dL and Hct will increase 6%. Ferritin levels will reach normal levels 3-6 months after normal hemoglobin levels are reached.

Question 130

Concerning the evaluation of a red blood cell folate level, which of the following is true?

a) Potentially falsely lowered in person with rapidly developing folate deficiency
b) Influenced by dietary intake over the 24 hours prior to the test
c) Remains stable throughout the lifespan of the RBC
d) Evaluates Vitamin C deficiency in a chronically ill person

Answer 130

Ans: C
The folate level in an RBC remains stable throughout the entire life of the RBC.

Folate is incorporated into the RBC during development. The folate level in RBCs is not influenced by diet. Common causes of folate deficiency include inadequate dietary intake (elders, alcoholics), decreased ability to absorb folate (malabsorption syndromes), and a high demand state for folate such as in pregnancy.

Question 131

The most common cause of pernicious anemia is:

a) Occult blood loss
b) Intestinal Malabsorption
c) Dietary deficiency of vitamin B12
d) Reduced intrinsic factor production

Answer 131

Ans: D
Reduced intrinsic factor production in the stomach.

Pernicious anemia is a deficiency of B12 which is needed for RBC production. The reduction in intrinsic factor production is caused by an autoimmune response that attacks the parietal cells lining the stomach which interferes with the B12 being absorbed in the small intestine.

Question 132

Which of the following is most consistent with anemia of chronic disease?

a) Macrocytic RBCs
b) Elevated MCHC
c) Hct >24%
d) Decreased levels of serum ferritin

Answer 132

Ans: C Hct > 24%

ACD is characterized by a reduced erythropoietin response that results in RBC hypoproliferation. Lab findings with ACD include a Hct >24%, decreased levels of Iron, normal to elevated serum ferritin, normo to slightly microcytic RBCs, and NL MCHC.

Question 133

In the person with reactive thrombocytosis, clotting risk is typically absent until a platelet count of:

a) > or = to: 400,000 mm3
b) > or = to: 800,000 mm3
c) > or = to: 1 million mm3
d) > or = to: 2 million mm3

Answer 133

Ans: C
> or = to 1 million mm3

Cause of reactive thrombocytosis: acute bleeding, allergic reactions, cancer, infections, splenectomy, some meds. Risk of blood clots can occur once the platelet count is greater than 1 million (normal 150,000-450,000)

Question 134

Criteria for “incident to” billing services include all of the following except:

a) An integral part of the patient’s treatment course
b) Associated with an expense
c) Of a type commonly furnished in an office or clinic rather than an institutional setting
d) Normally rendered for a minimal fixed fee

Answer 134

Ans: D
Normally rendered for a minimal fixed fee.

“Incident to” services are defined as those services that are furnished incident to professional services in the office or in a patient’s home. To qualify as an “incident to” service, it must meet 4 criteria: the service is an integral part of the patient treatment course; it is commonly rendered without additional charge; it is of a type commonly furnished in a clinic or office (non institutional); and there is an expense for the service.

Question 135

All of the following are required Medicare terms and conditions for paying NP services except:

a) The services are within the NP scope of practice as defined by state law
b) The services performed are those for which a physician would be able to bill Medicare
c) The services are performed in collaboration with a physician
d) Separate charges are billed for NP services and facility charges

Answer 135

Ans: D

Separate charges are billed for NP services and facility charges

For Medicare to pay:
NP meets medicare qualification requirements
The practice accepts Medicare payments
Services performed are “Physician services”
The services are performed in collaboration with the MD
the services are within the NP scope of practice
No facility or other provider is paid or charges for the billed patient services (double billed)

Question 136

Match each of Peplau’s Interpersonal Nursing Roles with its appropriate description:

a) Active Leadership Role
b) Teaching Role
c) Counseling Role
d) Resource Role

Answer 136

Never heard of this….look it up is you need to feel fully informed otherwise, guess!

Question 137

You see a 54 year old man with chronic bronchitis and who has smoked for the past 10 years. During this visit, he states, “I set a quit date after my son’s wedding in 2 weeks”. According to Prochaska and DeClementi’s stages of change model, this patient is at which stage of change?

a) Precontemplation
b) Contemplation
c) Preparation
d) Action

Answer 137

Ans: C Preparation

Precontemplation: no intent to change
Contemplation: starting to think about maybe changing
Preparation: Made the decision and is planning on acting within 30 days
Action: Implementation of change
Maintenance: where the goal is to sustain change

Question 138

Which of the following is not a criterion for a level 4 office visit?

a) At least four elements of HPI, + or – responses to at least 2 ROS questions; at least 1 notation about past hx, family hx, or social hx
b) At lease 12 elements of Physical exam
c) Medical decision making of moderate complexity
d) Patient must be seen by a physician at some point in the visit.

Answer 138

Ans: D

There is no requirement for the patient to be seen by a physician during a level 4 visit

Question 139

In severe eczema, patients tend to prefer ____ but providers should provide ____.

a) Ointment/Lotion
b) Cream/Gel
c) Lotion/Ointment
d) Gel/cream

Answer 139

Ans: C
Patients prefer lotion because it is soothing and easy to apply but providers prefer ointment because it has a greater concentration of drug delivered to the affected area.

Question 140

When evaluating a patient being treated for seizure disorder with Phenytoin, which of the following findings would warrant immediate assessment of a phenytoin level?

a) Headache
b) Gingival hyperplasia
c) Alopecia
d) Bradycardia

Answer 140

Ans: D Bradycardia

Phenytoin is an anti-eipleptic med that when toxic, causes bradycardia
Phenytoin can cause headache and gingival hyperplasia, but these occur in therapeutic doses.
Phenytoin is actually said to improve hair growth

Question 141

Abigail, a 21 year old college student with meningococcal meningitis. You inform the school officials that:

a) Individuals with household-type or more intimate contacts should receive antimicrobial prophylaxis
b) Asymptomatic nasopharyngeal carriage of the causative organism is rare
c) All on-campus student need antimicrobial prophylaxis
d) This type of meningitis is not contagious

Answer 141

Ans: A
a) Individuals with household-type or more intimate contacts should receive antimicrobial prophylaxis

Meningococcal meningitis is contagious and is spread via nasopharyngeal droplets

Question 142

A unilateral, pulsing headache preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm and lasting approximately 20 minutes is most typical of:

a) Migraine with aura
b) Cluster headache
c) Transient ischemic attack
d) Tension-type headache

Answer 142

Ans: A Migraine with aura

Question 143

The NP is seeing a 19 year old male for follow-up. The patient has been suffering from cluster headaches and has unsuccessfully tried several therapeutic modalities. A positive response to which of the following interventions supports the diagnosis of cluster headaches?

a) Oxygen therapy
b) Beta adrenergic blockade
c) Tricyclic antidepressants
d) Dietary reduction of amines

Answer 143

Ans: A Oxygen therapy

Oxygen therapy has been recognized as beneficial to cluster headache sufferers and is most effective when used at the onset of the HA. Oxygen therapy has not shown to be effective for migraines whereas Beta Blockers, tricyclics, and amine reduction in the diet are approached for the management of migraines

Question 144

The results of Feverfew use can include which of the following:

a) Proinflammatory activity
b) Antiplatelet effect
c) Dopaminergic activity
d) Norepinephrine inhibition

Answer 144

Ans: B Antiplatelet effect

Feverfew is used for migraines and other types of headaches as well as dizziness, RA, fever, and abd pain. Its effect is to cause vasodilation but it also inhibits platelet aggregation. Who knew?!

Question 145

A 34 year old man is being evaluated for a potential diagnosis of a panic disorder. You would expect to find all of the following as part of his clinical presentation except:

a) Report of chest pain during panic attack
b) Concomitant thought disorder
c) History of agoraphobia
d) Peak symptoms approximately 10 minutes into the panic attack

Answer 145

Ans: B Concomitant thought disorder

Panic attacks present with chest pain and symptoms peak about 10 minutes into the attack. There is frequently a history of agoraphobia but there is not the presence of thought disorders.

Question 146

Patient presentation common to both anxiety and depression can include:

a) Dry mouth
b) Worthlessness
c) Sleep disorder
d) Appetite disturbance

Answer 146

Ans: C Sleep disorder

While anxiety and depression are distinctly different, there are several symptoms that are often found in both: sleep disorders, difficulty concentrating, irritability, fatigue, and psychomotor agitation are among them. Conversely, dry mouth is seen in anxiety but not depression; while worthlessness and appetite disturbances are seen in depression but not in anxiety

Question 147

Which of the following is most accurate in describing characteristics of bupropion?

a) T1/2 >= 5 days
b) Adjunct in the treatment of bulimia
c) Potentially energizing
d) High potential for abuse

Answer 147

Ans: C Potentially energizing

Bupropion is potentially energizing and often used in patients with low libido. It is not a potential for abuse and is actually good option for patients with addiction. It can exacerbate addictive disorders and consequently is not an adjunct for bulimia. How do these last two sentences work together?

Question 148

Joanne is being treated for major depressive disorder. She started on Sertraline 2 weeks ago and presents today for her first follow-up visit. At this visit, the NP is assessing primarily for:

a) Remission of symptoms
b) Suicidal ideation
c) Medication tolerance
d) Readiness for counseling

Answer 148

Ans: C Medication tolerance

Remission of symptoms will not likely occur for 4-6 weeks. At 2 weeks, the NP should evaluate for how the patient is tolerating the medication.

Question 149

A 76 year old woman reports increasing difficulty reading road signs while driving. She does not report any change in close vision problems (newspaper reading) and her peripheral vision is normal. The most likely diagnosis is:

a) Presbyopia
b) Age related maculopathy
c) Senile cataracts
d) Open angle glaucoma

Answer 149

Ans: C Senile cataracts

Cataracts are a clouding of the lens leading to difficulty with night and distance vision.

Presbyopia results in close vision problems
Untreated open angle glaucoma can result in the loss of peripheral vision

Question 150

All of the following are associated with or are complications of allergic rhinitis except:

a) Asthma
b) Bacterial pharyngitis
c) Otitis media
d) Sinusitis

Answer 150

Ans: B Bacterial pharyngitis

Patients with allergic conditions often have more than one condition. Like allergic rhinitis, asthma has an allergic component. Acute bacterial OM and sinusitis often occur as a consequence of pathogen trapping in the sinuses with allergic inflammation. GABS is most commonly transmitted by close contact with infected persons or secretions.

Question 151

According to the ARIA guidelines and the JTForce on practice parameters for Rhinitis, first line therapy for patients with moderate to severe persistent allergic rhinitis symptoms is a(n):

a) Antihistamine
b) Mast cell stabilizer
c) Intranasal corticosteroid
d) Decongestant

Answer 151

Ans: C Intranasal corticosteroid

Allergic rhinitis is a consequence of inappropriate release of inflammatory mediators. Proper management of allergic rhinitis must include a primary strategy for LT control of inflammatory mediators, and intranasal corticosteroids are identified to be superior in terms of clinical outcomes.

Question 152

You see a 38 year old woman with moderate persistent asthma who is otherwise healthy. Which of the following would you most likely find during an asthma flare from this patient?

a) Crackles
b) Inspiratory wheezing
c) Expiratory wheezing
d) Bradypnea

Answer 152

Answer: C Expiratory wheeze

During an asthma flare, the airways become swollen and air is trapped by narrowing of the bronchial tubes. Signs of a flare include expiratory wheeze, coughing, sob and chest tightness along with low Peak Expiratory Flow

Question 153

A 52 year old with a 40 pack year history of smoking had a 3-day hospitalization for the treatment of CAP. He is now being seen 2 days post hospital discharge. He is without fever, well hydrated, less short of breath, and feeling better. Chest auscultation reveals bilateral crackles. The NP considers ordering a chest X-ray:

a) Today
b) In about 6 weeks
c) In about 2 weeks
d) In 3-5 days

Answer 153

Ans: B in 6 weeks

This patient is recovering. An X-ray is to evaluate for the presence of an underlying abnormality such as lung cancer that could have precipitated the case of acute pneumonia. It takes at least 6 weeks for complete radiographic resolution of the acute infectious process so that baseline structures can be visualized.

Question 154

For a 37 year old non-smoker with CAP who is otherwise well and has no reported medication allergies and no recent systemic antimicrobial use, you prescribe:

a) Azithromycin
b) Amoxicillin
c) TMP-SMZ
d) Cefpodoxime

Answer 154

Ans: A Azithromycin

The primary treatment targets in CAP for an otherwise healthy patient are S pneumoniae and atypical pathogens. Atypicals are not responsive to beta-lactams such as amox and cefpodoxime. TMP-SMZ is no longer recommended for lower respiratory tract infections. A macrolide or doxy is indicated for these targets.

Question 155

A 37 year old non smoker with CAP who took an antibiotic for a UTI 3 weeks ago, you prescribe:

a) TMP-SMZ
b) Azithromycin
c) Moxifloxacin
d) Cefpodoxime

Answer 155

Ans: C Moxifloxacin

The guidelines state that the primary treatment target is S pneumoniae and atypical pathogens. However, this patient has DRSP risk which requires a high dose betalactam given WITH a macrolide or doxy), or a resp fluoroquinolone

Question 156

All of the following are used to routinely assess the impairment domain of asthma severity and control except:

a) Pulse Oxymetry
b) Asthma control test
c) Spirometry
d) Frequency of short acting beta2-agonist use for symptom relief

Answer 156

Ans: A Pulse Oximetry

Published guidelines for the assessment, classification, and evaluation of asthma control include Spirometry and frequency of use of SABA. Pulse Ox is not used to determine asthma severity and control.

Question 157

Match each type of asthma med with its mechanism of action:
SABA
LABA
LAMA
ICS
a)	Bronchodilator
b)	Anti-inflammatory
c)	Mucolytic activity
d)	Reduce the production of leukotrienes

Answer 157

Ans:
SABA: Bronchodilator
LABA:  Bronchodilator
LAMA:  Bronchodilator
ICS:  Anti-inflammatory

Short and long acting beta2 antagonists are bronchodilators
LAMA is a long acting antimuscarinic agent and has anticholinergic effects that relax smooth muscles and broncho dilate
ICS is an anti-inflam
Leukotriene modifiers block the action of leukotriene on the smooth muscle receptor and is an inflammatory mediator that contributes to broncho constriction

Question 158

Sharon is 29 with moderate persistent asthma. She is not using prescribed inhaled corticosteroids but is using albuterol as needed to relieve her cough and wheeze. Currently, she uses about 2 albuterol inhalers per month and is requesting a prescription refill. You respond that:

a) Theophylline should be added to her treatment plan
b) She should also use salmeterol to reduce her albuterol use
c) Albuterol use can continue at its current level
d) Excessive albuterol use is a risk factor for asthma-related death

Answer 158

Ans: D Excessive albuterol use is a risk factor for asthma-related death

She needs a more aggressive controller of her asthma. It is important to have her use her inhaled ICS as prescribed then she can be further assessed for added meds.

Question 159

Match each bacterial organism with its predominant mechanism of bacterial resistance:
a)	S. pneumoniae
b)	H. influenzae
c)	M. Catarrhalis
resistance choices:
a)	Beta-lactamase production
b)	Alteration of protein binding sites
c)	Failure of DNA gyrase reversal

Answer 159

Ans:

Strep Pneumo: Alteration of protein binding sites
H. Flu: beta lactamase production
M. Catarrhalis: beta lactamase production

Failure of DNA Gyrase reversal is a resistance mechanism for fluoroquinolones.

Question 160

Principles of therapy in Rheumatoid arthritis include:

a) Starting with an NSAID and then escalating therapy in a step-wise approach
b) Rapid relief with hydroxychloroqine use
c) Early treatment with disease modifying therapy to minimize joint damage
d) Pain relief as the main goal

Answer 160

Ans: C Early treatment with DEMARDs to minimize joint damage

Question 161

The most common site of osteoporosis-related fracture is:

a) Wrist
b) Hip
c) Vertebrae
d) Ankle

Answer 161

Ans: C Vertebrae

The single most common site is the vertebrae. the second most common site is the wrist followed by hip fractures and the ankle is least common.

Question 162

Risk factors for analgesic-induced nephropathy include all of the following except:

a) Male gender
b) Age > 50
c) Concomitant alcohol use
d) Presence of a chronic painful condition

Answer 162

Ans: A male gender

This condition is from the overuse of OTC NSAIDs and tylenol. While age >50 and alcohol use and chronic pain are all risk factors, the condition is actually more common in women

Question 163

Kevin is a 46 year old male who was diagnosed with gout and managed with colchicine for acute pain. He returns for follow-up 2 weeks later and is much improved symptomatically. Which of the following finding would warrant the addition of a new medication for Kevin?

a) Elevated serum uric acid
b) Continued edema and erythema of the joint
c) Impaired renal function
d) Recurrence of joint pain

Answer 163

Ans: A Elevated serum uric acid

Colchicines is for pain management. In order to reduce the likelihood of further episodes, serum uric acid levels need to be maintained within normal range. If Kevin has elevated serum uric acid following a gouty attack, a medication to facilitate excretion of uric acid should be considered.

Question 164

Which of the following combination of supplements is a possible preventative treatment option for migraines?

a) Calcium and Vitamin B12
b) Magnesium and riboflavin
c) Zinc and Vitamin C
d) Aluminum and Niacin

Answer 164

Ans: B Magnesuim and riboflavin

but I am not sure about this

Question 165

A 72 year old woman with newly diagnosed major depressive disorder comes to clinic. She also has a history of mitral valve disease and is currently taking Warfarin. The best choice of a selective serotonin reuptake inhibitor for Ms. Tines is:

a) Citalopram
b) Fluvoxamine
c) Fluoxetine
d) Paroxetine

Answer 165

Ans:

Citalopram?

Question 166

Which of the following medication prescribed for insomnia has the shortest therapeutic half life?

a) Flurazepam (dalmane)
b) Eszopicloone (Lunesta)
c) Zaleplon (Sonata)
d) Zolpidem (Ambien)

Answer 166

Ans:

Sonata?

Question 167

Benzodiazepine withdrawal syndrome is best characterized as:

a) Bothersome but not life-threatening
b) Rare with protracted use
c) Associated with seizure risk
d) Most often seen with medications with a longer half life

Answer 167

Ans: C Associated with seizure risk

???

Question 168

When considering possible drug-herb interactions, the clinician considers that St. John’s Wort is a potential cytochrome P450:

a) 3A4 inhibitor
b) 2D6 inducer
c) 2C9 inhibitor
d) 3A4 inducer

Answer 168

Ans: D

St. John’s Wort is a CP450-3A4 inducer
and it diminishes clinical effectiveness of substrates such as OC and alprazolam

Question 169

When evaluating a patient with low back pain without radiculopathy, the NP will most likely identify:

a) Discomfort to direct palpation of paraspinal muscles
b) A positive straight leg raise
c) Recent history of strain
d) Pain relief with lumbar flexion

Answer 169

Ans: A

a patient with low back pain and without radiculopathy means that there is no nerve root compression. We assume then that the problem is MSK and the patient will feel pain upon palpation of sore muscles

Question 170

Sulfonurias and meglitinides are characterized by their impact on:

a) Insulin release
b) Insulin receptor site activity
c) Hepatic glucose production
d) Renal glucose excretion

Answer 170

Ans: A

insulin release

Question 171

a 22 year old man presents for hepatitis screening. He is without symptoms but needs the testing for a job in the foodservice industry. Lab results are as follows:
Anti-HCV and HCV RNA
HBsAG = positive
Anti HAV = negative
You advise the patient that he:
a) Has chronic Hep A, B, and C
b) Is immune to Hep A and B but has Hep C
c) Has chronic Hep B and C and needs immuniz against Hep A
d) Had Hep A in the past, is immune to Hep B and has chronic Hep C

Answer 171

Ans: C

The Anti HAV = negative means that he has not had Hep A and needs immunization.

Question 172

The preferred pharmacologic management of recurrent cough in a 25 year old woman with acute uncomplicated bronchitis would most likely include:

a) Antibiotic therapy to cover atypical pathogens
b) An inhaled anticholinergic
c) An inhaled corticosteroid
d) A dextromethorphan based cough suppressant

Answer 172

Ans: B

Patients with bronchitis have excessive secretions. an inhaled anticholinergic will reduce those secretions.

Question 173

Medicare part A coverage includes:

a) Limited care in a skilled nursing facility
b) Outpatient care with the primary care provider
c) 120 days in a skilled nursing facility
d) Outpatient medication prescriptions

Answer 173

Ans: A

Limited care in a skilled nursing facility

Question 174

Which diagnosis should be considered when there is a report of a “cold spot” on a thyroid scan?

a) Malignancy
b) Autoimmune disease
c) Iodine deficiency
d) Necrosis

Answer 174

Ans: A

Malignancy

Question 175

To reduce incidence of flushing when starting a patient on Niacin, the nurse practitioner should advise pretreatment with:

a) Aspirin
b) Hormone therapy
c) An ACE inhibitor
d) Exercise

Answer 175

Ans: A

Aspirin

Question 176

A new 27 year old female patient presents for a health maintenance exam as required by her employer. She says that she has had a heart murmur “all her life’ and has been told that it is an innocent murmur. Anticipated findings include:

a) A harsh late systolic snap
b) A soft systolic murmur that disappears when in a standing position
c) A diastolic murmur best heard at the base of the heart
d) A High-pitched murmur that is synchronous with the carotid pulse

Answer 176

Ans: B

Stills murmurs are systolic and change in tone with position changes

Question 177

A new patient presents for a check up. He has no complaints but admits that he has been smoking 2 packs per day for 40 years. Spirometric assessment reveals an FEV1/FVC ratio of 67%. Which additional finding would be consistent with a diagnosis of chronic bronchitis:

a) Markedly increased chest AP diameter
b) Pleuritic chest pain
c) Excessive mucus production
d) FEV1 improving by 20% after albuterol treatment

Answer 177

Ans: C Excessive mucus production

Focus on the diagnosis of Bronchitis

the rest are COPD changes

Question 178

When prescribing drug therapy for an older adult, if possible, avoid:

a) Low protein binding drugs
b) Drugs with a long half life
c) Liquid oral formulations
d) Topical application drugs

Answer 178

Ans: B

Drugs with long half lives

Question 179

One site for atopic dermatitis usually only noted during infancy is the:

a) Face
b) Antecubital fossa
c) Buttox
d) Hands

Answer 179

Ans: A

Babies sometimes present with atopic dermatitis on the face

Question 180

In advising a woman with menstruation-related migraine and combined oral contraceptive use, the NP considers that:

a) A high dose estrogen pill should be prescribed
b) Uninterrupted use can help minimize headache frequency and severity
c) Headache severity is likely to increase
d) Cardiovascular risk is markedly increased

Answer 180

Ans: B

Uninterrupted use can help minimize headache frequency and severity

Question 181

Which of the following is most consistent with the diagnosis of Herpes Zoster?

a) Papules in a dermatomal distribution
b) Low grade fever and malaise prior to eruption
c) Presence of pustules and honey crusted lesions
d) A 1-2 day prodrome of pain prior to lesions erupting

Answer 181

Ans: D

a 1 to 2 day prodrome of pain prior to lesions erupting

malaise and low grade fever should not be part of this issue. Herpes are vesicles, not papules, and honey crusted pustules is staph.

Question 182

A 52 year old man presents for evaluation of fatigue. His exam is significant only for intention tremor and asymptomatic pharyngeal redness. He reports a history of recurrent gastritis. Lab exam results are as follows:
Hg 14.3, Hct 48%; MCV 109; HDL 58; LDL 118; TG 318.
These findings are most consistent with:
a) Pernicious anemia
b) Iron deficiency anemia
c) Alcohol abuse
d) Normal findings

Answer 182

Ans: C

Alcohol abuse

Macrocytic anemia with pharyngeal redness, probably GERD, tremor, and gastritis.

Question 183

Unless contraindicated or other concomitant conditions present, antiretroviral therapy should be initiated in all patients with documented HIV infection and CD4 counts of:
a)

Answer 183

Ans: A

Question 184

When a 20 month old presents with a diffuse macular rash that occurs after several days of high fever, the most likely diagnosis is:

a) Roseola
b) Rubeola
c) Scarlet fever
d) Rubella

Answer 184

Ans: A

Roseola: the regular measles

Question 185

Actinic Keratoses can be described as:

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

Answer 185

Ans: D

Slightly rough pink or skin colored lesions on the face

Question 186

The mechanism of action of metformin includes:

a) Attenuation of insulin resistance
b) Promotion of renal glucose excretion
c) Increase in insulin release
d) Decrease in gastric emptying

Answer 186

Ans: A
Attenuation of insulin resistance
Metformin increases the sensitivity of the insulin receptors thereby making the body respond better to its insulin.

Question 187

Medicare B coverage includes:

a) Healthcare for individuals over the age of 65 with limited income
b) Hospitalization for citizens over the age of 65
c) Reimbursement for outpatient services
d) Payment for inpatient medications.

Answer 187

Ans: C

Medicare part B provides reimbursement for primary care services and outpatient services

Question 188

Of the total daily pancreatic insulin release,how much is basal?

a) 10%
b) 25%
c) 50%
d) 75%

Answer 188

Ans: C 50%

Question 189

Your patient has been on oral contraceptives for 4 years and now is ready to start a family. She asks how long she should wait after stopping her pills. You advise that it is safe to conceive:

a) Immediately
b) After 1-2 months
c) After 3-4 months
d) After 2 normal menstrual cycles

Answer 189

Ans: A

Immediately

Question 190

Which of the following is true concerning acute bacterial prostatitis?

a) Gram positive organisms are the most common cause of infection
b) Length of antibiotic therapy is usually 1 week
c) Perineal pain with defecation is a common complaint
d) Cephalosporins are first-line therapy

Answer 190

Ans: C

Perineal pain with defecation is a common complaint. Anything that puts pressure in that area such as valsalva, will cause pain.

Question 191

Developmental assessment of a healthy 11 month old born at 32 weeks gestation is expected to reveal an infant who:

a) Follows a 2-step command
b) Plays Peek-a-boo
c) Feeds himself
d) Imitates “bye bye”

Answer 191

Ans: B

11 months less 2 = 9 months

these kids don’t catch up until 2 years

Question 192

Prophylactic treatment options for migraine include:

a) Ergotamine
b) Sumatriptan
c) Gabapentin
d) Naproxen Sodium

Answer 192

Ans: C Gabapentin

????? ARe ergots and triptans abortive?

Question 193

Which of the following medications provides the best relief from acute nasal congestion?

a) Anticholinergic nasal spray
b) Decongestant nasal spray
c) Corticosteroid nasal spray
d) Saline nasal spray

Answer 193

Ans: B Decongestant nasal spray

Question 194

A 15 week old infant presents with a fever of 100.5F, bilateral erythematous TMs. The infant is alert with excellent skin turgor, no evidence of difficulty breathing, acknowledges her mother’s face, and is wearing a wet diaper. Her parents report that she is vigorously nursing every 3 hours without vomiting or excessive stooling. The appropriate management would be to:

a) Counsel the mother to observe for 72 hours and return to clinic if there is no improvement
b) Start topical therapy with otic antibiotic drops
c) Initiate a sepsis workup
d) Begin a systemic antibiotic regimen

Answer 194

Ans: C

Initiate antibiotics because of the fever.

I think I would have given this kid tylenol and watched him…..what do you think?

Question 195

The NP is counseling a female patient who is trying to become pregnant. The patient should be encouraged to increase her intake of:

a) Vitamin C
b) Folic Acid
c) Iron
d) Vitamin E

Answer 195

Ans: B Folic acid

Folic acid deficiency leads to neural tube defects

Question 196

Clinical presentation in severe anorexia nervosa includes all of the following except?

a) Hyponatremia
b) Somnolence
c) Hyperkalemia
d) Bradycardia

Answer 196

Ans: Hyperkalemia

actually, they suffer from HYPOkalemia

Question 197

The NP is counseling a patient who is new to insulin therapy. The patient is advised that when injecting short-acting formulation such as insulin aspart, the peak risk time for hypoglycemia is:

a) 15-60 minutes after injection
b) 1-3 hours after injection
c) 3-4 hours after injection
d) 4-5 hours after injection

Answer 197

Ans: B

1-3 hours after injection

look up insulin aspart? I did not do a typo
Insulin aspart is a fast-acting insulin analog

Question 198

A 32 Year old woman presents with a recent onset of copious green-yellow vaginal discharge. Microscopic exam reveals many WBCs and large motile organisms. Visual examination of the cervix is likely to reveal:

a) Scattered vesicles
b) Strawberry spots
c) Purulent discharge from the cervical os
d) Cervical ectropion

Answer 198

Ans: B

this presentation is consistent with Trichomonas and is often accompanied by Strawberry Spots on the cervix

Question 199

The primary complaint of the patient with BV is usually:

a) Copious discharge
b) Painful intercourse
c) Intense pruritus
d) Profound vaginal odor

Answer 199

Ans: D

Profound vaginal odor: Malodorous “fishy” copious discharge most evident after intercourse. Labs show clue cells. Cultures are not useful because G. vaginalis is part of the normal flora

Question 200

Two weeks ago, the NP saw a 2 year old in clinic. The child has not had a well child check up since he was 4 months old and received a number of “catch up” vaccines. Today, his mom calls to report that he has a flat, pink rash all over his body but appears otherwise well. The NP suspects that this is a normal reaction to which of the following vaccines?

a) Varicella
b) MMR
c) dTap
d) influenza

Answer 200

Ans: B MMR

After 6-10 days, the MMR vaccine may cause a fever, a measles like rash and loss of appetite

3-4 weeks after vaccine, mumps-like symptoms of swollen glands may appear in some kids

Rubella may cause a brief rash and slight fever at about 12-14 days.

Question 201

A 51 yr old woman presents with a 1 day history of fever, pain and vomiting. The diagnosis of acute cholecystitis would be confirmed by:

a) Isolated lymphocytosis
b) Elevated amylase and lipase
c) Right upper quadrant abdominal ultrasound
d) Abdominal plain films

Answer 201

Ans: C

US is the least expensive/least invasive means of identifying gall bladder disease after a positive Murphy’s Sign.

Abd films may show gallstones but an US is the most effective imaging test

Question 202

Combined OC use is not advised in which of the following:

a) An otherwise well woman > 35 years
b) A 19 year old cigarette smoker
c) A 32 year old with hepatic adenoma
d) A 35 year old with well-controlled HTN

Answer 202

Ans: C

OC are absolutely contraindicated in patients with thromboembolic disorders, hepatic or gyn cancers.

Question 203

A CPT is an acronym for:

a) Clinical practice template
b) Current procedural terminology
c) Current practice terms
d) Clinical procedural testing

Answer 203

Ans: B

Current Procedural terminology
These codes were developed by the AMA and are used to describe and bill for medical, surgical, and diagnostic services.

Question 204

A 52 year old woman presents as a new patient. She reports a long history of high blood pressure and admits she does not take her medicine regularly. which of the following is an anticipated funduscopic finding?

a) Narrowing of vessels
b) In increased Cup:Disk ratio
c) Macular degeneration
d) Cotton-wool spots

Answer 204

Ans: A

With grade 1 HTN, there is narrowing of the terminal branches of the vessels in the eyes with no vision change

Cup/Disk ratio changes with glaucoma
Cotton wool spots are seen in malignant hypertension

Question 205

The process of absorption, distribution, metabolism, and elimination of a drug is known as:

a) Pharmacokinetics
b) Therapeutic transformation
c) Pharmacodynamics
d) Drug interactions study

Answer 205

Ans: C PharmacoKinetics

PK is what the body does to the drug: ADME
absorption
distribution
metabolism
elimination
PD is what the drug does to the body

Question 206

During a 12 month well child visit, the NP notices that the child is not walking independently. The mother is very concerned and insists that her other three children were all walking by the age of 1. The most appropriate action would be to:

a) Tell the mother that while, on average, many children are walking by age 1, many children do so later; schedule a follow up appointment in 1-2 months to assess progress
b) Reassure the mother that children with older siblings often do not start walking until later; schedule the next routine well child checkup in 3 months
c) Counsel the mother that while there is no need to panic, this does represent a developmental delay and the child should see a pediatric orthopedic specialist
d) Request a radiographic assessment of the spinal cord, pelvis, and femurs to rule out structural bony anomalies that frequently delay walking.

Answer 206

Ans: Tough call between A and B

I would go with B because at the age of 12 months, normal visits are scheduled for every 3 months. This is not a dev. red flag so why ask for an extra office visit.

What do you think?

Question 207

A 72 yr old man presents with a history of numbness of the fingertips and oral irritation for several months.  The PE is significant for pale conjunctiva and a hemic murmur.  Hemogram results are as follows:
Hg 6.2
Hct 20%
MCV 136
RDW 21%
The most likely cause of this anemia is:
a)	Folate deficiency
b)	B12 deficiency
c)	Iron deficiency
d)	Chronic disease

Answer 207

ANs: B

B12 deficiency is macrocytic with a high RDW

Question 208

The NP is providing a follow up visit for a patient who is being managed with an HMG-CoA reductase inhibitor. Lab assessment should include an initial measurement of:

a) LDL
b) ALT
c) ALP
d) GGT

Answer 208

Ans: ALT

Initial hepatic enzymes prior to initiating statins is needed to establish a baseline.

Question 209

A 75 yr old woman presents for evaluation. She enjoys good health and her medical history is significant only of OA and a remote history of diverticulitis. She recently joined a senior jazz class and is concerned because the workouts make her really dizzy. Physical exam shows a 3/6 systolic murmur heard best at the base of the heart with radiation to the neck. With these findings, the NP suspects:

a) Aortic stenosis
b) Aortic regurgitation
c) Mitral regurgitation
d) Mitral stenosis

Answer 209

Ans: A Aortic Stenosis

Mr Ass
Base = top = aortic
Systolic murmur

Question 210

The preferred therapeutic option in grave’s disease is:

a) Non cardioselective beta blockade
b) Surgical resection of hyperfunctioning nodule
c) Radioactive ablation of overactive thyroid tissue
d) Levothyroxine suppression therapy

Answer 210

Ans: C

Radioactive ablation of overactive thyroid tissue

Question 211

Non-contraceptive benefits of oral contraceptives include a decrease in all of the following except:

a) Ovarian cancer
b) Iron deficiency anemia
c) C. Trachomatis cervicitis
d) PID

Answer 211

Ans: C C. Trachomatis cervicitis

Oral contraceptives do not protect against STD
Interestingly, the use of OC can help prevent PID, iron deficiency anemia, and ovarian cancers.

Question 212

a 47 year old man presents for eval of erythematous, papular lesions on his forehead and chin. Which of the following differential diagnoses is the most likely?

a) Acne rosacea
b) Tinea facialis
c) Hidradenitis suppurativa
d) Atopic dermatitis

Answer 212

Ans: A Acne rosacea

Acne rosacea is a skin disorder limited to the nose, cheeks, and chin and typically appears during adulthood. The skin becomes oily, red and bumpy with small blood vessels sometimes visible. sometimes, the nose may appear very red and bulbous.
Atopic Dermatitis is known as Atopic eczema

Question 213

Managed care is best defined as a:

a) Collaborative approach to provide coordination of the healthcare services to a defined population
b) System for determining what health care services are reimbursable
c) Process of reviewing the appropriateness of select healthcare interventions
d) Method of review to ensure adherence to evidence-based practices

Answer 213

Ans: A

Managed care is defined as an approach to reduce the cost of providing health benefits and to improve quality of care.

Question 214

A Patient presents for evaluation of a fever. She reports that 3 days ago, she went to the urgent care and was diagnosed with acute bacterial rhinosinusitis (ABRS). She was given a prescription for antibiotics which she is taking as ordered, but is concerned because she has a fever today. Which of the following finding suggests a serious complication of ABRS?

a) Tender preauricular lymph nodes
b) Foul tasting post nasal drip
c) Facial tenderness
d) Eyelid erythema and edema

Answer 214

Ans: D Eyelid erythema and edema

ABRS is an infection of the sinuses and parasinuses usually following a viral URI.

Question 215

Actinic keratosis can be a precursor to:

a) Malignant melanoma
b) Acanthosis nigricans
c) Basal cell carcinoma
d) Squamous cell carcinoma

Answer 215

Ans: D Sq cell carcinoma

Seborrheic keratosis on the other hand, is rarely precancerous but have been reported in the literature.

Question 216

a 36 yr old man with asthma has been treating his asthma with albuterol once or twice a week for the last few years. He reports that for the last month or so, he has had to use it much more often but “not every day but most”. the NP should consider all of the following except:

a) Administering an asthma control questionnaire
b) Spirometric assessment
c) A complete symptom assessment
d) Adding an inhaled LABA/inhaled corticosteroid medication.

Answer 216

Ans: D Adding a LABA or an inhaled corticosteroid is premature. An assessment needs to be more complete to rule out other causes such as bronchitis, common cold, etc.

Question 217

When a patient is seen by the NP, the visit can be charged to medicare using “incident to” billing. If the criteria for this type of visit are fulfilled, then anticipated reimbursement is at what percentage of the physician rate?

a) 75%
b) 80%
c) 90%
d) 100%

Answer 217

Ans: D 100%

Question 218

The mechanism of action of nasal cromolyn is as a(n):

a) Anti-IgE antibody
b) Vasoconstrictor
c) Mast cell stabilizer
d) Leukotriene inhibitor

Answer 218

Ans: C

Nasal cromolyn MOA is as a mast cell stabilizer

Question 219

Gastropariesis is a contraindication to the use of which of the following medications in T2DM:

a) Exenatide
b) Pioglitazone
c) Acarbose
d) Glyburide

Answer 219

Ans: A Exenatide

Exenatide is an incretin mimetic which stimulates insulin production.. It slows gastric emptying and often leads to appetite suppression. It causes N and v and not indicated for patients with impaired gastric emptying.

Question 220

When a 20 month old presents with a diffuse macular rash that occurs after several days of high fever, the most likely diagnosis is:

a) Roseola
b) Rubeola
c) Scarlet fever
d) Rubella

Answer 220

Ans: A Roseola ( care is supportive)

DIscrete rosy-pink macular rash that appears after several days of a high fever. Agent is Human Herpes Virus ((HHV6).

Question 221

The NP has diagnosed acute bacterial rhinosinusitis and is considering antibiotic choices. He recognizes that the most common causative pathogen is:

a) H. flu
b) S. aureus
c) S. pneumoniae
d) M. Catarrhalis

Answer 221

Ans: C

the most common pathogen for ABRS is strep pneumoniae

Question 222

The NP is evaluating lab studies in a patient with newly diagnosed T2DM. Which lipid abnormality is most likely?

a) Low total cholesterol
b) High triglycerides
c) Low HDL-C
d) High HDL-C

Answer 222

Ans: B High triglycerides

High TG are a component of metabolic syndrome. other components include elevated BG, HTN, Low HDL and excessive belly fat.

Question 223

At what age is a child most at risk for developing iron deficiency anemia?

a) 6 months
b) 18 months
c) 30 months
d) 36 months

Answer 223

Ans: B 18 months

at 6 mo, they are still breastfeeding
at 30-36 months they are no longer taking a bottle and are eating regular foods
at 18 months, many are bottle dependent and over-intake cow’s milk (>32 oz/day)

Question 224

A 3 yr old patietn presents at an inner city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate?

a) Throat culture
b) Sputum culture
c) Mantoux PPD test
d) Cold agglutinin test

Answer 224

Ans: B Sputum test

Question 225

Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion?

a) Olopatadine (Patanol)
b) Cromolyn ophthalmic
c) Timolol
d) Gentamicin optic

Answer 225

Ans: D Gentamycin Ophthalmic

Question 226

A routine lab assessment of a 12 year old patient with a history of Thalassemia and anemia reveals a Tanner II presentation and Hct = 35%. In addition to a CBC, the NP should order which of the following:

a) Serum folic acid
b) Vitamin B12
c) Hemoglobin electrophoresis
d) 24-hour urine creatinine

Answer 226

Ans: C
Hemoglobin electrophoresis

Hg electrophoresis is a test performed to measure levels of different types of oxygen carrying protein in the blood.
It is used to identify SSA and thalassemia

Question 227

Which of the following would be an appropriate alternative to erythromycin therapy in an 18 year old patient with mycoplasma pneumoniae infection?

a) Azithromycin
b) Cephalexin
c) Amoxicillin
d) Clindamycin

Answer 227

Ans: A

Azithromycin is in the same class as erythromycin: they are both macrolides

I was not sure what this question was asking….did alternative mean another drug that covered m pneumoniae? or a drug in the same class…..tricky

Question 228

Initial therapy for a 3-week old infant with uncomplicated symptoms of GI reflux disease includes which of the following?

a) Prone position and rotate formulas in order to find one that causes less reflux
b) Erect position and start pre-thickened formula in smaller amounts
c) Semi-supine position and offer more ounces of formula less frequently
d) Lateral position and start small amounts of solid food with formula

Answer 228

Ans: B

Erect position and start pre-thickened formula in smaller amounts

Question 229

A 66 yr old patient presents with bilateral otitis media with effusion and white patches in the mouth that do not rub off when wiped with a 4x4. The patient should be evaluated for:

a) HIV infection
b) Myelodysplastic syndrome
c) Congenital lymphoproliferative disease
d) Non-hodgkin’s lymphoma

Answer 229

Ans: A

HIV infection

Question 230

All 50 states require the reporting of which of these conditions in the newborn?

a) PKU
b) Galactosemia
c) Hemoglobinemias
d) Congenital hypothyroidism
e) Trisomy 21
f) Trisomy 18

Answer 230

Ans:  A, B, C, and D
PKU
Galactosemia
Hemoglobinemias (SSA)
Congenital hypothyroidism-do TSH and T4

Question 231

Higher-functioning adolescents with autism are at increased risk for:

a) Significant phobias
b) Panic attacks
c) Substance abuse
d) Obsessive compulsive disorder

Answer 231

Ans: D Obsessive compulsive disorder

Question 232

Testing for testicular torsion in children warrants the use of which test:

a) Positive Prehn’s test
b) Positive Psoas test
c) Inguinal torsion test
d) Positive Obturator sign

Answer 232

Ans: A Prehn’s sign

Prehn’s sign is positive when pain of torsion is relieved when the scrotum is lifted. This differentiates torsion from epididymitis but Prehn’s sign is inferior to Doppler ultrasound to rule out torsion.

Question 233

Which of the following is associated with the physiological differences in children rather than adults?

a) Their circulatory system compensates during hypovolemic shock, giving a false impression of normalcy
b) A limited store of glycogen with higher relative metabolism puts children more at risk for hyperglycemia
c) The children’s airway is narrow and angular, which always requires a tracheotomy for airway-constriction relief
d) The smaller lungs in children make them less vulnerable to aerosolized biological and chemical agents

Answer 233

Ans: A

Their circulatory system compensates during hypovolemic shock, giving a false impression of normalcy

Question 234

A 12 year old girl comes to you in distress. She says that she is pregnant and wants to know what her options are. You tell her that it first must be determined if she has the capacity for informed consent. Which of the following abilities is NOT a component required for informed consent?

a) Reason
b) Differentiate
c) Communicate
d) Prioritize

Answer 234

Ans: D

Prioritize

Question 235

An NP is seeing a 2 month old and hears a heart murmur. The NP explains to the mother that the murmur is most likely harmless and does not refer her to a cardiologist. Which of the following might the NP’s rationale be?

a) The murmur is heard in diastole and is of no concern
b) The child appears healthy and the murmur is likely a patent ductus arteriosus that is closing
c) The murmur is loudest when the child is standing
d) The murmur is systolic, Grade I and has no thrill

Answer 235

Ans: D

the murmur is systolic, Grade I and has no thrill

Question 236

AN 11 year old has a 2 day history of chills and cough that produces green-tinted sputum. His temp today is 102.8F. Auscultation reveals wet lung sounds. You order a chest film. Which of the following bacteria is the most likely pathogen if patchy infiltrates and pleural effusion are seen on film?

a) Pneumocystis pneumonia
b) Streptococcus pneumoniae
c) Klebsiella
d) E. Coli

Answer 236

Ans: D
E. coli

the high fever, chills and purulent sputum indicate bacterial pneumonia. Patchy infiltrates and pleural effusion suggest E. coli.

Klebsiella and S. pneumoniae usually present as lobar consolidation. Pneumocystis pneumonia presents as diffuse infiltrates in the upper lobes.

Question 237

A mom comes to the ED with a very ill 9 month old son. The baby is pale and he has a 3 day history of jelly like stools, vomiting, and inconsolable crying. On exam, the NP notes abdominal distention, a sausage-shaped mass in the RUQ, and blood in the child’s rectum. Which of the following tests should you order to confirm the suspected diagnosis?

a) X-Ray
b) Abdominal US
c) MRI
d) CT Scan

Answer 237

Ans: A X-ray

The findings point to intussusception and Radiography and a barium enema are the most definitive tools for confirmation. Barium might gunk up a possible surgical field, so an Xray would be my choice. Abd US are most useful in the diagnosis of solid organs of the abdomen such as the liver and pancreas. MRI and CT are more advanced diagnostic tools and not necessary to make this diagnosis

Question 238

Which of the following statements is true about an infant with a fever?

a) Temps over 101.8 F may result in febrile fevers
b) Fever is common in the first few months of life
c) A fever in an infant is defined as a rectal temp of 100.4
d) A temp of 101.8 can be meaningless in an infant

Answer 238

Ans: C

A fever in an infant is defined as a rectal temp of 100.4 F

According to the literature, febrile fevers occur at 102 but they can happen at lower temps so I suppose B is also accurate

Question 239

Alison comes in for a check-up. She knows “mama and Dada” and sits independently to play. She cannot yet walk or speak many other words but communicates by reaching and pointing. Ali recognizes you, her NP, from previous visits, and she smiles at seeing you. She sees the pen in your coat and reaches for it. What would you estimate Alison’s age to be?

a) 13-18 months
b) 6-9 months
c) 19-24 months
d) 10-13 months

Answer 239

Ans: D 10-13 months

Saying Mama and Dada, recognize people, and move purposefully to get desired objects suggest that Ali is 10-12 months.

19-24 months can walk up and down stairs
6-9 months is babbling and newly sitting alone but responds to her name
13-18 months has 4-10 word vocabulary and can scribble with a crayon, walk alone, and speak in long jabbering sentences.

Question 240

You are seeing Ali for a well check. Ali is 8 years old and has significant breast development,(areola and nipple projection as secondary mound) and recently began her menses. This child’s development is best classified as which of the following?

a) Premature puberty
b) Precocious puberty
c) Normal puberty
d) Delayed puberty

Answer 240

Ans: B
Precocious puberty

Premature and normal are not a term used to describe pubertal development

The development of secondary sex characteristics is defined as precocious when they occur at age 8

Question 241

Chris is 17 and has T2DM. He manages his DM with a controlled diet. His family informs the NP that he has been recently abusing alcohol and he admits that he likes to drink with his friends at parties. Given this information, which of the following is the least appropriate as an oral antidiabetic medication to prescribe?

a) Dipeptidyl-peptidase 4 inhibitors
b) Alpha-glucosidase inhibitors
c) Insulin
d) Biguanides

Answer 241

Ans: D Biguanides

Biguanides should not be given to heavy alcohol users or to those prone to hypoxia. Patients who take biguanides can become sick if they consume more than two to four alcoholic drinks per week

Dipeptidyl peptidase 4 inhibitors and alpha-glucosidase inhibitors do not adversely interact with alcohol and are therefore safe.
Insulin is not given orally and is not currently indicated in this patient.

Question 242

You are seeing a 4 year old boy who appears pale and listless. He has a 2 day history of fever and painful limbs. On exam, you notice petechiae on his legs and abdomen as well as a bulging and immobile tympanic membrane. The painful limbs appear to be caused by joint pains. Which of the following indicates the most appropriate next step for this patient?

a) Antibiotics
b) CBC
c) X-ray of the affected limbs
d) PT and PTT tests

Answer 242

Ans: B

The fever, painful limbs, and petechiae are all indicators of possible leukemia. The first step should be a CBC

Question 243

The NP is conducting an interview with a patient. The patient describes a number of symptoms she feels. In the middle of describing her symptoms, she jokingly says, “if this turns out to be something bad, I don’t want you to tell me”. If the NP accedes to this request, the NP would be in violation of which ethical principle?

a) Fidelity
b) Veracity
c) Beneficence
d) Justice

Answer 243

Ans: B
Veracity

The duty to be honest with a patient about serious conditions is known as the duty to veracity.

Fidelity is faithful
Beneficence is about the duty to prevent harm
Justice is about “fair”
this is a tough one for me and could have been more clear in the question

Question 244

A newborn is found to have one undescended testicle and hypospadias. Which of the following actions should you take?

a) No action is needed at this point
b) The testicle will need to be surgically brought down if it doesn’t drop by age 1 yr.
c) Order a chromosomal and endocrinology evaluation
d) Refer to a Urologist

Answer 244

Ans: D
Refer to a urologist

A newborn with hypospadias warrants a referral.
Hypospadias is a uro referral if the testicle has not descended by 1 year. Interestingly, if a child has bilateral undescended testes, that warrants a referral for chrom analysis.