SM 3

Question 1

What Erikson stage is ages 1.5 to 3 years?

Answer 1

Autonomy v Shame & Doubt

gaining self confidence and control over themselves

Question 2

What Erikson stage is 5 to 12 years?

Answer 2

Industry v Inferiority

gain competence and taking initiative/pleasure in work

Question 3

What is stage 1 hypertension?

Answer 3

130-139/80-89

Question 4

What is stage 2 htn?

Answer 4

> 140/90

Question 5

What are the lung cancer screening guidelines?

Answer 5

Adults 50 to 80 years who have a history of 20 pack year history and currently a smoker OR quit in the past 15 years

screening annually

Question 6

In conductive hearing loss, the weber test lateralizes to the…..

Answer 6

bad ear

Question 7

in sensorineural hearing loss, the weber test lateralizes to the….

Answer 7

Good ear

Question 8

When can an HIV positive women deliver vaginally?

Answer 8

When the HIV RNA count is <1000

she should receive antiviral medication before, during and after delivery

Question 9

A patient is having excruciating pain in the side of their face and is placed on carbamazepine (Tegretol) for this condition. The nurse practitioner understands which cranial nerve is affected?
CN IV
CN V
CN VI
CN VII

Answer 9

CN V

trigeminal neuralgia

Question 10

Which of the following cranial nerves, when infected with the herpes zoster (shingles) virus, may cause blindness?
CN II
CN V
CN X
CN IV

Answer 10

CN 5 trigeminal nerve

Question 11

All of the following diagnoses are considered to be examples of obstructive airway disease except:
Asthma
Cystic fibrosis
Chronic bronchitis
Sarcoidosis

Answer 11

Sarcoidosis

Question 12

A 35 year old female with a history of lupus has a positive direct Coombs test. This finding is commonly associated with which of the following?
a. Hemolytic anemia
b Sjorgren’s syndrome
c Myasthenia gravis
d Lupus nephritis

Answer 12

Hemolytic anemia

A patient diagnosed with systemic lupus erythematosus (SLE) is at an increased risk for an autoimmune hemolytic anemia. A direct Coombs test can indicate a hemolytic anemia in which the red blood cells are being destroyed prematurely.

Question 13

What is diagnostic of T2DM?

Answer 13

A1c >6.5%
OGTT >200
random plasma glucose >200

Question 14

What is pyelo normally tx with?

Answer 14

cipro

Question 15

The nurse practitioner is evaluating a hepatitis panel with results as follows: + HBsAg, +IgM Anti-HBc, - IgG Anti-HBc, and - HBsAb. Which of the following is the correct interpretation of these results?
a Never infected, susceptible
a Immune due to previous infection
b Immune due to vaccination
c Acute infection
d Chronic infection

Answer 15

acute infection

Question 16

The nurse practitioner is evaluating a hepatitis panel with the following results: - HBsAg, + IgG Anti-HBc, - IgM Anti-HBc, +HBsAb. Which of the following is the correct interpretation of these findings?
a Never infected, susceptible
b Immune due to previous infection
c Immune due to vaccination
d Acute infection
e Chronic infection

Answer 16

Immune d/t previous infection

HBsAb (sometimes called the Anti-HBs) is used to detect the surface antibody which indicates the patient has immunity from Hepatitis B

Question 17

What are complications of hemochromatosis?

Answer 17

diabetes
pigmentation changes
arthritis

Question 18

Which of the following opportunistic infections and/or cancers is least likely to appear in a patient with AIDS?
Pneumocystis jiroveci pneumonia
Toxoplasma gondii
Cervical cancer
Breast cancer

Answer 18

Breast cancer

Question 19

A 34 year old African American patient with metabolic syndrome presents to the clinic today with a blood pressure of 141/85 mmHg. Which of the following medications would be the most appropriate medication to initiate for this patient?
a Lisinopril (Prinivil)
b Losartan (Cozaar)
c Hydrochlorothiazide (Microzide)
d Amlodipine (Norvasc)
e Metoprolol (Lopressor)

Answer 19

Amlodipine (Norvasc)

In Black patients, first line treatment is generally calcium channel blockers or thiazide diuretics due to their genetics. Thiazide diuretics have the side effects of hyperglycemia, hyperlipidemia, and hyperuricemia. Therefore, they are not first line options in patients with metabolic syndrome.

Question 20

A 41 year old female patient was recently diagnosed with diabetes and has been taking metformin (Glucophage) for the last month. At today’s visit, the patient states her friend with diabetes has started taking a daily Aspirin (Zorprin) and wonders if she should also be taking one. Which of the following statements is incorrect in regards to this patient’s question?
a “Aspirin is no longer routinely prescribed to patients with diabetes unless they are at an increased risk of cardiovascular events.”
b “Aspirin can be used in diabetic patients who have a history of coronary artery disease, ischemic strokes or angina.”
c “Aspirin is typically prescribed to diabetic patients who are older than 50 and have at least one major risk factor for heart disease.”
d “Aspirin is routinely prescribed to all diabetic patients once they are 60 years old as the cardiovascular risk increases two fold at that time.”

Answer 20

“Aspirin is routinely prescribed to all diabetic patients once they are 60 years old as the cardiovascular risk increases two fold at that time.”
While Aspirin was once routinely prescribed to those with diabetes, this guidance changed by the American Diabetes Association in 2019. The current recommendation is that diabetic patients can receive Aspirin if they are at an increased cardiovascular risk, typically after the age of 50, as long as they receive education on the risks versus the benefits.

Question 21

Which of the following is the preferred treatment option in those with Cushing’s disease?
Surgical removal of the tumor
Medical management with steroids
Life-long insulin injections
Radiation therapy

Answer 21

surgical removal

Question 22

What can radioactive iodine lead to?

Answer 22

swollen salivary glands
bone marrow suppression
infertility

Question 23

You are seeing a 31 year old patient who is 28 weeks pregnant for a routine check up. She reports doing well, however her routine urine screen came back positive for leukocytes and nitrites. What is the most appropriate plan for this patient?

Answer 23

Cephalexin (Keflex)

Question 24

A patient with an active shingles outbreak presents to the office today. The patient is 55 years old and their friend recently told them they got a vaccine to prevent shingles, called Shingrix. They are wondering if they could get that vaccine today. Which of the following is the most appropriate response by the nurse practitioner?
a “The shingles vaccine is only for those who have not had Varicella (chicken pox) so if he has had that in the past, he does not need the vaccine.”
b “You qualify for the vaccine, but since you are having an active outbreak, you can not receive it today.”
c “You must be at least 65 to receive Shingrix.”
d “You only need to be 50 to receive Shingrix, so you can get it today.”

Answer 24

B

“Shingrix (shingles vaccine) is a 2-dose recombinant vaccine that is given to adults 50 and older to prevent shingles. It can not be given during an active outbreak, but may be administered afterwards.

Question 25

Which of the following conditions is not able to be potentially treated with the use of Ciprofloxacin (Cipro)?
a Cutaneous anthrax
b Genital gonorrhea
c Typhoid fever
d Streptococcus pneumoniae

Answer 25

Streptococcus pneumoniae

It is preferred that those with a streptococcus pneumoniae infection are treated with a respiratory fluoroquinolone such as Levaquin (levofloxacin). Ciprofloxacin is not considered to be a respiratory fluoroquinolone. As a whole, Ciprofloxacin can be used to treat a wide variety of issues including anthrax, prostatitis, gonorrhea, typhoid fever, salmonella, urinary tract infections, etc.

Question 26

A 68 year old male patient presents to the clinic with a new urinary complaint. Which of the following symptoms would make you refer the patient to urology?
His urine is bright red after being started on rifampin (rifadin) and he is very concerned
a The patient noticed a tiny spot of blood on his briefs and there is microscopic hematuria on his urinalysis results. However, the patient is not having any discomfort
b He is complaining of dysuria, pain with ejaculation, and a positive Prehn’s sign is noted
c He is complaining of dysuria and discomfort. d His prostate is also noted to be warm and boggy on exam

Answer 26

The patient noticed a tiny spot of blood on his briefs and there is microscopic hematuria on his urinalysis results. However, the patient is not having any discomfort
Painless hematuria is a sign of bladder cancer, especially in older male patients. We would want this patient referred to urology as well as to send the urine for both culture and cytology. Red excretions are a common side effect of being on rifampin and the patient should be educated to expect this. A warm and boggy prostate is suspicious of prostatitis in this patient. Prostatitis can be treated by primary care typically with antibiotics like Bactirm, Ciprofloxacin or Doxycycline. A positive Prehn’s sign is associated with epididymitis and in older adults it is typically caused by bacteria buildup in the urine secondary to BPH. This can also be managed by primary care in most cases.

Question 27

What can prostatitis be treat with?

Answer 27

Bactrim
Cipro
Doxycycline

Question 28

The nurse practitioner orders a urine dipstick test for an elderly diabetic patient to assess their renal function. Which of the following results is the most sensitive for renal function on a urine dipstick specifically?
a Glomerular filtration rate (GFR)
b Albuminuria
c Microalbuminuria
d Blood urea nitrogen levels (BUN)

Answer 28

Microalbuminuria

“Glomerular filtration rate (GFR) and blood urea nitrogen (BUN) are both measured through blood work. Albuminuria is best measured through a 24-hour-urine collection, while microalbuminuria is best detected in a urine dipstick. Diabetic patients should be screened at least annually for microalbuminuria as it can be a first sign of chronic kidney disease. “