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AANP Certification Questions and Answers: A Guide for Nursing Students, Exams of Nephrology

A collection of questions and answers related to the aanp certification exam, covering various topics relevant to nursing practice. It offers insights into common medical conditions, diagnostic procedures, and treatment approaches, providing valuable study material for nursing students preparing for their certification exams.

Typology: Exams

2024/2025

Available from 11/24/2024

Alliviaexaminer
Alliviaexaminer 🇺🇸

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AANP Certification QUESTIONS AND

ANSWERS

If your patient is in the catarrhal stage of pertussis, upon examination you would find which of the following? - ANSWER>>You would find mild upper respiratory symptoms with cough. And mild conjunctival injection. It is really indistinguishable from the common cold.

What would NOT be considered a typical finding in a geriatric patient? - ANSWER>>Low frequency hearing loss. A typical finding in a geriatric patient would be a high frequency hearing loss. The speaking voice is high frequency. Degenerative changes of the ossicles, fewer auditory neurons and atrophy of the hair cells results in sensorineural hearing loss.

Typical findings in a geriatric patient? - ANSWER>>Thinner epidermis, dermis and subcutaneous layers of skin, bright purple-colored patches on the forearms and hands, opaque white ring at the periphery of the cornea

Risk factors for age-related macular degeneration - ANSWER>>Tobacco use, aging, sun exposure and family history

Underweight BMI - ANSWER>><18.

Normal BMI - ANSWER>>18.5-24.

Overweight BMI - ANSWER>>25-29.

Obese BMI - ANSWER>>30-39.

Grossly obese BMI - ANSWER>>>

Pregnancy Category A Drugs - ANSWER>>Vitamins and levothyroxine

Pregnancy Category B Drugs - ANSWER>>Acetaminophen, ibuprofen, penicillins, cephalosporins, and azithromycin and erythromycin antibiotics.

A geriatric patient who has a 40 pack-year smoking history complains of painful cramping in the leg muscles that occurs after walking for 20 minutes. After taking a complete history and

performing a physical exam, an NP decides that the most likely diagnosis is? - ANSWER>>Intermittent claudication

What is a common cause of acne? - ANSWER>>Increase in androgens

In a 19-year-old who presents with a sore throat and anterior cervical adenopathy, which causative agent would be suspected? - ANSWER>>Group A beta-hemolytic Streptococcus

When completing the initial assessment for depression in geriatric adults, the NP should evaluate? - ANSWER>>Mental status exam

What is the most common risk factor for developing severe hyperbilirubinemia in the newborn?

  • ANSWER>>Blood incompatibility with the mother

Which trimester of pregnancy is a woman with a fundal height measurement at the umbilicus? - ANSWER>>Second

Which of the following conditions exacerbate urinary incontinence? - ANSWER>>Impacted stool and atrophic vaginitis

An adult patient presents with a 2-day history of intermittent stabbing chest pain that worsens with deep breaths. The patient reports a nonproductive cough and no fever for several days, and denies trauma, palpitations or GI symptoms. VS normal. Lungs are clear, heart sounds normal. PE reveals localized chest wall tenderness at the costal margin. EKG and CXR normal. The most likely diagnosis is? - ANSWER>>Costchondritis

The most common skin cancer is? - ANSWER>>Basal cell carcinoma

What is true regarding depression in the elderly? - ANSWER>>Depression can be induced by prescribed and OTC medications

Acute otitis media has what characteristics? - ANSWER>>Loss of ossicular landmarks on the TM

What constellations of symptoms, lasting more than 3 months, is MOST common in fibromyalgia? - ANSWER>>Diffuse pain, sleep abnormality, fatigue

An adult male is seen for an initial visit. He denies tobacco, drug, or ETOH use. He has a sedentary lifestyle and no family history of DM. VS normal, BMI = 31. What diabetes screening tests would an NP order? - ANSWER>>Fasting plasma glucose

An adolescent presents for a preparticipation athlete exam. In determining clearance for participation in sports, what should be considered? - ANSWER>>Characteristics of the sport

Urinary and bowel dysfunction, saddle anesthesia, and leg weakness or foot drop are signs of? - ANSWER>>Cauda equina syndrome

The NP would suspect what person to be at the highest risk for Rocky Mountain spotted fever?

  • ANSWER>>A 40-year old male who is living in a wooded area raising dogs

What condition is associated with the development of type 2 DM? - ANSWER>>Delivery of a neonate weighing 9 lb or greater

What condition is a risk factor for development of DVT and PE? - ANSWER>>Visceral malignancy

Research studies indicate that ED in geriatric patients is a common complication in? - ANSWER>>Vascular disease

What neuro signs are characteristic of the patient with AD? - ANSWER>>Gait disorder and impaired stereognosis

A frail elderly male patient complains of difficulty with urination. The International Prostate Symptom Score can assist with decisions regarding the diagnosis of BPH. What symptom is consistent with the items on this scale? - ANSWER>>Nocturia

The best medication for a patient who complains of IBS with cramping is? - ANSWER>>Dicyclomine (Bentyl)

Major causes of CKD include? - ANSWER>>Amyloidosis and SLE

A risk factor postmeno osteoporosis is? - ANSWER>>History of tobacco use

An NP considering referral of a frail elderly patient for hospice care understands that? - ANSWER>>Documentation of limited life expectancy is a prerequisite

The sound intensity of a grade III/VI hear murmur is typically described as? - ANSWER>>Medium intensity

What is associated with decreased risk of breast cancer? - ANSWER>>Breast feeding

An adult patient present with complaints of nausea, fatigue, and myalgia. The patient reports a history of untreated hep B 30 years ago. What hep B serology testing results would indicate that the patient has chronic hepatitis? - ANSWER>>HBsAG = positive, IgM anti-HBc = negative

A geriatric patient with anemia, back pain, osteoporosis, and elevated ESR should be evaluated for? - ANSWER>>Multiple myeloma

An older adult female presents with severe pain. She reports malaise, and periodic itching and burning on her chest wall. PE reveals a small area of hyperesthesia in a linear fashion. The most likely diagnosis is? - ANSWER>>Herpes zoster

An adult female presents complaining of an increase in a malodorous vaginal discharge that worsens after intercourse. Exam and testing reveal a vaginal pH of 5.5, presence of clue cells on the wet mount, and a positive whiff test. The most appropriate diagnosis is? - ANSWER>>BV

An adult patient presents with a painless ulcer in the genital area and enlarged lymph nodes in the groin. The NP suspects? - ANSWER>>Syphilis

An elderly retired farmed presents with a dome-shaped, pearly, firm nodule with telangiectasia on the side of his nose. An NP would recognize the nodule as a? - ANSWER>>Basal cell carcinoma

A child presents wit a reddened right eye. His mother states that he has been complaining of watering eyes with no purulent drainage. On exam, an enlarged preauricular node is identified. The NP should suspect: - ANSWER>>Viral conjunctivitis

A late adolescent football player presents to the UC with an acute knee injury. He heard a pop when his knee buckled. The NP notes a positive anterior drawer test. The most likely diagnosis is injury to the? - ANSWER>>ACL

A geriatric female complains of problems with urination. She reports that whenever she feels the need to urinate, she is unable to "make it to the bathroom in time," and wets herself. Which type of incontinence is most likely? - ANSWER>>Urge

An early adolescent patient who plays football presents to clinic after a football practice complaining of limping due to anterior left knee pain. The pain has gradually increased over the past 2 weeks but is relieved with rest. The patient denies any trauma, prior surgeries, or medical history. PE reveals tenderness and swelling of the tibial tubercle and reproduction of pain with resisted knee extension. The H&P exam findings are most consistent with a diagnosis of? - ANSWER>>Osgood-Schlatter disease

A late adolescent male presents with complaint that his left breast appears larger than the right one. He has a recent 10-lb weight gain and admits to MJ use. On exam, the area is diffuse and nontender, The primary diagnosis is? - ANSWER>>Fatty gynecomastia

An adult female patient present to the ED for sudden onset of severe lower abdominal pain. She describes the pain as stabbing. She denies nausea, vomiting, fever, or chills. The pain does not radiate. To confirm the diagnosis of an ectopic pregnancy, the NP should order what imaging study? - ANSWER>>US

A geriatric male, who is a 30-packs a year smoker, present with wheezing and dyspnea. His CXR shows a flattened diaphragm and an increased retrosternal chest space. There are decreased vascular markings. The most likely diagnosis is? - ANSWER>>COPD

A geriatric patient present with a bump on the vulva, associated with pruritis and malodorous drainage. Exam reveals a raised, ulcerated lesion. The most likely diagnosis is? - ANSWER>>Vulvar cancer

A pediatric patient presents with a painful, enlarged parotic gland. The most likely diagnosis is?

  • ANSWER>>Mumps

A geriatric female presents with tremors and a 20 lb weight loss over 2 months. An NP's lab eval should include a? - ANSWER>>TSH and free T-

A pregnant adult patient is diagnosed with a chlamydial infection at 20 weeks of gestation. What is the most accurate method for confirming this diagnosis? - ANSWER>>Nucleic acid amplification test (NAAT) of urine

An adult male presents with intermittent retrosternal burning. He has gained 30 lb in the past year. PE results are unremarkable and the EKG is normal. The most likely diagnosis is? - ANSWER>>GERD

A geriatric male patient is being followed for type 2 DM and HTN. He also has a diagnosis of polycythemia vera and has regular phlebotomies to control this. What statement about this patient is true? - ANSWER>>He should avoid dietary iron supplements.

An adult patient reports increasingly frequent migraines, especially upon rising in the morning. The headaches have been successfully managed in the past with APAP and Midrin prn, a neurological etiology has been ruled out. Of the following drugs, which would be recommended for prophylactic migraine management in this case? - ANSWER>>Propranolol HCL (Inderal) 40 mg BID

Long-term management of a patient with stable COPD includes: - ANSWER>>Annual influenza vaccine

For a late adolescent with acquired hypothyroidism who has been stable, a follow-up eval should be performed every? - ANSWER>>6-12 months

An adult male with a BMI of 19 and continued GERD presents for follow-up visit after using OTH Pepcid for 6 weeks. What is the best next treatment option for this patient? - ANSWER>>PPI

A confused elderly female presents for the first time accompanied by her daughter. The patient is taking glipizide-metformin, lisinopril, glargine, ASA, and a multivitamin. What is the most likely cause of the patient's symptoms? - ANSWER>>Hypoglycemia

An adult male presents with general malaise and concerns about delayed ejaculation. His medication regimen consists of quinapril, paroxetine, loratadine, HCTZ. The delayed ejaculation is most likely caused by? - ANSWER>>Paroxetine (Paxi)

An NP is assessing a 4-day-old newborn. The parents brought the patient into the clinic the day before for concerns regarding breastfeeding. The newborn was assessed as jaundiced with a bilirubin level of 12 (elevated). The parents were instructed to increase breastfeeding and to return to clinic today. Today's assessment shows the newborn continues with jaundice and the bilirubin level is now 15.2. The NP should? - ANSWER>>Prescribe phototherapy for the infant

An elderly patient is diagnosed with acute gastritis. The patient stops taking Naproxen and is started on Pepcid. Three weeks later, the patient complains that the anorexia, nausea, and epigastric pain and tenderness have not been relieved. What diagnostic study should be ordered? - ANSWER>>Testing for H. pylori

A geriatric female was diagnosed with hypothyroidism and started on levothyroxine, 25 ug 1 week ago. She feels tired and wishes to have her medicine increased. What is the best response? - ANSWER>>Your blood levels should be checked every 6 weeks, as it takes the body several weeks to adjust to the medication

An elderly patient with type 2 DM has been well-controlled on glipizide and recently developed stage 1 HTN. After 3 months of lifestyle therapy, the patient is still not at goal BP. What drug class would be the best choice? - ANSWER>>ACE inhibitor

Smoking MJ leads to what? - ANSWER>>Increased HR

A geriatric male presents late in the day. The NP suspects bacterial PNA, prescribes abx, and sends the patient home. The next day, the patient returns, but has not improved. What finding would be an indication for hospitalization? - ANSWER>>Confused mental status

In a mass casualty situation with presumed anthrax exposure, the drug of choice for prophylaxis is? - ANSWER>>Doxycycline

A child with refractory retentive encopresis has been treated with a laxative protocol. What is the next step in this patient's treatment plan? - ANSWER>>Referral to GI

An early adolescent male presents with a history of low-grade fever, headache, and facial rash. Upon exam, the NP finds red papular, vesicular lesions along the right side of the nose. Priority care for this patient should include? - ANSWER>>Referral to an ophthalmologist today

The preferred treatment for early syphilis is? - ANSWER>>Benzathine penicillin G 2.4 million units IM once

A 12-year-old child diagnosed with mild persistent asthma has a peak expiratory flow (PEF) of less than 80% of predicted. The most appropriate action would be to? - ANSWER>>Add a long- acting beta agonist to the inhaled corticosteroid

For treatment of otitis media in a child who is allergic to penicillin, the abx of choice is? - ANSWER>>Cefdinir (Omnicef)

What medication is prescribed for the treatment of pinworm? - ANSWER>>Albendazole (Albenza)

An adult patient presents with a burning feeling in the eyes and crusty, inflamed eyelids. He is diagnosed with dry eye syndrome. The best treatment for this condition would include initiating? - ANSWER>>Eyelid hygiene with baby shampoo and warm water

A geriatric male is diagnosed with stage II PD. What should be a first-line medication? - ANSWER>>Levodopa-carbidopa (Sinemet)

At a 6-month well-child visit, an infant weighs 12 lb, compared to a birthweight of 6 lb. The mother states breastfeeding is going well, but the infant frequently spits up afterward. The best management for the NP is to? - ANSWER>>Reassure the mom that the baby's weight gain in normal

A late adolescent male goes to a clinic with a puncture wound after being bitten by a neighbor's cat. After irrigating the wound, the NP should? - ANSWER>>Prescribe Augmentin

A healthy early adolescent female presents for a clinic visit because of concern about her menses not having started yet. Exam reveals Tanner stage III-IV development and scant pubic hair. What is the most appropriate intervention? - ANSWER>>Reassure, explaining that she will probably begin menses within the year; reassess in 6 months.

What diagnoses in a late adolescent male necessitates an immediate referral for eval by a specialist? - ANSWER>>Testicular torsion

A late adolescent who has been taking loratadine for seasonal allergies is diagnosed with acute bacterial sinusitis. The patient is allergic to penicillin's and sulfa drugs. What abx should be prescribed? - ANSWER>>Cefdinir (Omnicef)

An adult female presents at 7 weeks of gestation with bleeding and lower abdominal cramping. The NP suspects imminent spontaneous abortion. The patient is Rh negative. When should RhoGAM be administered? - ANSWER>>Within 72 hours

Solid foods can be introduced into an infant's diet at what age? - ANSWER>>6 months

A mother brings her 8-week-old to the clinic who has been inconsolably crying for the last 3 days. After completing a thorough physical exam with normal findings, what diagnostic tests should the NP order next? - ANSWER>>Urine culture

What microorganism is most frequently associated with acute bacterial rhino-sinusitis? - ANSWER>>Streptococcus pneumoniae and H. influenza

A patient on warfarin therapy for DVT is about to have lumbar spinal fusion surgery. The patient's warfarin is put on hold starting 5 days prior to the surgery and SQ Lovenox has been ordered for DVT prophylaxis until the resumption of the warfarin. The NP knows that the patient's postoperative warfarin dose should be restarted based on the? - ANSWER>>Baseline PT and INR values

In pulmonary function testing, forced vital capacity represents the? - ANSWER>>Maximum volume of air that can be forcefully exhaled after maximum inspiration

On physically assessing a newborn's head, you note an enlarged, fluid-filled area that is subperiosteal and does not cross suture lines. This finding indicates the presence of? - ANSWER>>Cephalohematoma

The clinical presentation of placenta previa that develops during the third trimester includes? - ANSWER>>Sudden onset of painless and profuse bleeding

An adult female who recently returned from a business trip to Japan presents for a recheck appointment. The only remarkable lab result is for TSH, at 0.3 (0.4-6 = normal). The patient reports that her neck hurts; exam reveals thyroid tenderness. What lab tests should the NP order now? - ANSWER>>T3 and free T

In most cases, the first manifestation of AD is? - ANSWER>>Decrease in short-term memory

A mother presents her 12-month-old child with concern because the child does not yet say "mama" or "dada." The mother reports that in the first months of life, the child loved listening to music and being talked to. The past medical history is negative for ear infections. The NP should? - ANSWER>>Evaluate for hearing loss

An otherwise healthy adult female presents complaining of vaginal burning and itching during urination. She has a social history of two sexual partners. She denies fever or vaginal discharge, but has noted a lesion on one labium. The NP should not order? - ANSWER>>Dark-field microscopy of fluid from the lesion

The most important diagnostic factor in evaluating angina pectoris is the patient's? - ANSWER>>History

Anticholinergic agents such as ipratropium (Atrovent) and tiotropium (Spiriva) are used in COPD primarily to? - ANSWER>>Induce bronchodilation

The symptoms of benign prostatic hypertrophy are often overlooked because the older male? - ANSWER>>Considers urinary problems to be a normal part of aging

T-wave inversion with a normal ST segment on a 12-lead EKG may represent? - ANSWER>>Acute coronary ischemia

A 13-year-old is concerned because she has not yet begun to menstruate. PE indicates that the patient is at Tanner stage IV and is of average height and weight. What is the most appropriate response? - ANSWER>>Your development is exactly as expected for you age; you'll probably begin to have periods within a year

A frail elderly patient presents with constipation. What normal physiologic changes seen with aging is the most likely cause? - ANSWER>>Decreased bowel muscle tone

The most common bacterial cause of cellulitis in patients with DM is? - ANSWER>>Staphylococcus aureus

An adult female who is homeless presents for an initial obstetric visit at 34 weeks of pregnancy. She is diagnosed with Chlamydia trachomatis infection. What complication will her newborn be most at risk? - ANSWER>>Conjunctivitis

The most common sign of cervical cancer is? - ANSWER>>Postcoital bleeding

An 86-year-old patient presents with pinguecula, a yellow triangular degenerative tissue thickening of the bulbar conjunctiva. This condition is? - ANSWER>>Solar-induced lesion.

A late adolescent patient presents with complaints of acute-onset unilateral right eye pain, visual changes, seeing halos around lights, abdominal pain, and intermittent nausea. Physical findings include an erythematous right eye without discharge, a cloudy cornea, and a moderately dilated right pupil that is nonreactive to light. The NP should immediately? - ANSWER>>Refer to ED

A 16-year-old female adolescent is brought to the NP's office by her mother, who is concerned about her daughter's recent weight loss. History reveals that the daughter was consistently in

the 50th percentile for weight, but is now in the 10th percentile. The mother states that she is concerned that the daughter is purging. In addition to a CBC with diff, what lab tests will be most helpful for further assessment? - ANSWER>>Electrolytes, BUN/creatinine, UA

A pediatric male is present with his mother, who states that he is extremely restless at night and constantly scratches his anal area. What diagnostic procedure would confirm a diagnosis of pinworm infestation? - ANSWER>>Exam of transparent tape sample from perianal skin

An 86-year-old is experiencing radiculopathy-associated lower back pain that has not improved over the past 4 weeks. The medial history includes a lumbar discectomy. The best type of imaging study for evaluating this patient would be a? - ANSWER>>MRI

There are three reasons for latex allergies. What is not a reason? - ANSWER>>Cytotoxic hypersensitivity

Risk factors for genital herpes include? - ANSWER>>Multiple sexual partners and years of sexual activity

A geriatric female presents for her annual exam. She has been on antihypertensive meds for over 20 years, with good control. Lab values are within normal ranges. The NP is concerned about the patient's cardiac health risks, due to her weight and her waist circumference. According to AHA guidelines, what goal is expected for this patient? - ANSWER>>Physical activity for 30 minutes daily, for a minimum of 5 days a week

An 87-year-old patient presents with round, pruritic plaques and small vesicles on the lower legs. The most likely diagnosis is? - ANSWER>>Nummular eczema

A 30-month-old with a history of frequent ear infections was seen in September after a symptom-free summer. Exam revealed bilateral bulging eardrums. After two separate courses of abx, fluid is noted in both ears. The parent reports speech difficulties. The most likely diagnosis is? - ANSWER>>Otitis media with effusion

During the past 24 hours, a 62-year-old has experienced abdominal pain that radiates to the back. The patient also reports several episodes of nausea and vomiting, a low-grade temperature, and a history of excessive drinking. PE reveals a distended abdomen. Lab serum values indicate elevated alkaline phosphatase, amylase, and serum lipase. The most likely diagnosis is? - ANSWER>>Acute pancreatitis

A patient reports to your office, having been struck on the right cheek with a baseball bat. On exam, you notice tenderness and swelling over the cheek. The patient is unable to gaze laterally with his left eye, and he complains of double vision when he attempts to do so. This is most likely associated with? - ANSWER>>Orbital rim fracture

Unilateral spontaneous serous or serosanguineous discharge from a single duct of a breast is most often caused by? - ANSWER>>Intraductal papilloma

A young athletic adult presents with shoulder pain and inability to raise the arm above the shoulder. The most likely diagnosis is? - ANSWER>>Rotator cuff tear

What is a hallmark of lumbar spinal stenosis? - ANSWER>>Leg, buttock or back pain precipitated by walking.

Anorexia nervosa occurs most commonly in who? - ANSWER>>High-level athletes

What is typically observed in the GI system upon stimulation of the PNS? - ANSWER>>Increased peristalsis

A 26-year-old female presents with abdominal distention, bloating, and intermittent crampy abdominal pain relieved with defecation. She has four to six loose stools a day when stressed. Between bouts of diarrhea, she often has constipation. PE results are normal. The CBC was normal. The most likely diagnosis is? - ANSWER>>IBS

A frail elderly widow presents with a 3 to 4 day history of confusion that became worse the evening before but currently seems a little better, although her speech is rambling and difficult to follow. During the exam, the patient is anxious and agitated. She is on cardiac medications, an antidepressant, and insulin. The most likely diagnosis is? - ANSWER>>Polypharmacy

A 54-year-old male who is 30 lbs overweight states that he awakens at night with heartburn and the taste of hot acid in his mouth. Stress makes his condition worse, yet baking soda seems to provide some relief. Findings on exam are normal and the stool for occult blood is negative. The preliminary diagnosis should be? - ANSWER>>GERD

An NP is evaluating an infant for possible colic. What could indicate the need for a more extensive eval? - ANSWER>>3-oz weight gain over the past 2 weeks

Type 2 DM is characterized by what? - ANSWER>>Decreased reabsorption of sodium-glucose transporters

The 16-year-old mother of a 2-month-old presents the infant, reporting that the child is very irritable and does not feed well. During PE, the child's head drops ack and the child exhibits sudden flexing of the extremities. As the flexing stops, the child cries uncontrollably. Funduscopic exam reveals retinal hemorrhages. What diagnostic test should be ordered? - ANSWER>>CT scan

A 27-year-old male patient, who works as a janitor, presents with a 6-month history of an intermittent rash on his hands. History reveals irregularly-distributed scaly maculopapular erythematous patches extending from the dorsum of the hand several inches up the forearms, and dry palms with no nail involvement. The most likely diagnosis is? - ANSWER>>Contact dermatitis

A pregnant woman with known HIV infection can reduce the risk of perinatal transmission through zidovudine (Retrovir) therapy. Based on current research, optimal therapy is to start daily dosing? - ANSWER>>After 14 weeks of gestation

In treating a pregnant female with migraine headaches, what drug is in Category X? - ANSWER>>Ergotamine tartrate (Ergomar)

A 46-year-old female presents with a complaint of amenorrhea for 3 months. The first-line diagnostic workup is? - ANSWER>>Urine pregnancy test

A 70-year-old patient presents to the clinic complaining of dyspnea, palpitations, and fatigue. The patient reports a 2-week history of blackened stools. Assessment reveals BP = 110/60, P = 100, R = 24, Hgb = 4.5, Hct = 16%. What is the most appropriate intervention? - ANSWER>>Send to ER

During a well-child exam of an 18-month-old, premature tooth decay and inflamed gums, particularly of the maxillary incisors, are noted. The approach to this problem includes? - ANSWER>>Referring the child to a dentist, assessing for bottle feeding and fluoride in local water.

A 3-year-old female has been diagnosed with bacterial meningitis. She attends preschool daily at a local church day care program. The day before her diagnosis, she ate lunch with her mother

at a local restaurant. For which contact would chemoprophylaxis with rifampin be recommended? - ANSWER>>Preschool contacts in the past 7 days

A 19-year-old patient who has used OCPs for 3 years plans to discontinue the pill at the end of her current cycle to become pregnant. What daily supplement would receive the highest priority? - ANSWER>>Folic acid

The most commonly prescribed medication for mild systemic lupus erythematosus is? - ANSWER>>Ibuprofen

A child is being treated with Ritalin for ADD. What is not a side effect of Ritalin? - ANSWER>>Slight increase in growth velocity

A mother has just noticed that her 15-month-old, 15 kg child has just recently ingested an unknown quantity of iron tablets. The mother has ipecac syrup and activated charcoal on hand. The mother should be advised to? - ANSWER>>Take the child to the ER

What is not used for therapy of an acute attack of gout? - ANSWER>>Allopurinol

In a 6-year-old, what is the preferred drug for stage 1 Lyme disease? - ANSWER>>Cefuroxime (Ceftin)

The optimal treatment for latent TB is? - ANSWER>>Isoniazid (Nydrazid) for 9 months

A 46-year-old female found a lump in her breast this morning. History includes: no prior breast disease; G2P2; maternal aunt diagnosed with breast cancer at age 72; LMP 2.5 weeks ago. On exam, an NP palpates a 2-cm round, soft, mobile, tender lesion in the upper outer quadrant of the right breast. Mammogram is negative. What action is most appropriate? - ANSWER>>Schedule a right-breast US

The medication of choice for initial treatment of juvenile RA is? - ANSWER>>Ibuprofen

A 3-year-old presents with a 2-day history of acute diarrhea with a total of 8 watery stools without blood or mucus, and 2 episodes of vomiting in the past 48 hours. Assessment reveals no current abx therapy, dehydration <5%, soft abdomen with hyperactive bowel sounds, no masses or organomegaly; other physical findings are normal. What is the appropriate management plan? - ANSWER>>No lab workup; instruct parents on signs and symptoms of dehydration; diet of clear liquids, advancing to bananas, rice cereal, Jell-O, and soup

An NP places a 76-year-old patient on nifedipine (Procardia) 10 mg TID for angina. The patient is unable to remember to take the medication at the scheduled times. The practitioner should? - ANSWER>>Change the dose to extended release 30 mg daily

The most common side effect of the oral ribavirin used in the treatment of hep C is? - ANSWER>>Hemolytic anemia

A 2-year-old male presents for reevaluation. Two days ago, he had four episodes of vomiting and six diarrheal stools. On PE today, his vital signs reveal P = 120 and capillary refill 3 seconds. The patient's eyes are sunken and his extremities are mottled and cool to touch. The treatment plan would include? - ANSWER>>Hospitalization for IV fluid replacement

A young child with asthma presents for follow-up eval. After numerous changes in medications and doses, the parents report that the child continues to have difficulty with coughing, especially during the night. What condition would be the most likely cause of the continued asthma symptoms? - ANSWER>>GERD

The NP prescribes amitriptyline (Elavil) for a patient with neuropathic pain secondary to DM. On follow-up, the patient complains of urine retention and dry mouth. The practitioner would? - ANSWER>>Discontinue amitriptyline and begin Gabapentin

The management of COPD in the elderly is best guided by? - ANSWER>>Symptomatology

A 65-year-old woman presents for a follow-up exam after a new patient visit. She has not seen a healthcare provider for several years. She is a smoker and her HTN is now adequately controlled with medication. Her mother died at age 40 from a hear attack. The fasting lipid profile shows cholesterol = 240, HDL = 30, and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the NP should start the patient on? - ANSWER>>A statin drug

A 12-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up exam after a recent hospitalization. It is most important to continue monitoring growth, development, and? - ANSWER>>Hemoglobin levels

A 28-year-old patient presents with profuse yellow vaginal discharge, odor, and local irritation. She reports completing a 7-day course of oral metronidazole 4 weeks ago. She has had multiple recurrences over the last 18 months. Microscopic exam reveals presence of clue cells. What is

the appropriate treatment intervention? - ANSWER>>Treat both patient and partner with oral metronidazole 500 mg BID x 7 days

A 7-year-old child presents with group A streptococcal infection confirmed by throat culture. Past history includes treatment for positive streptococcal infection with erythromycin 3 weeks ago. What is the appropriate next intervention? - ANSWER>>Treat with amoxicillin for 10 days

Upon admission to a nursing home, an 85-year-old patient receives a negative result on the PPD test. To determine TB status in the frail elderly, a second PPD should be performed in? - ANSWER>>1 week

A 65-year-old patient being treated with digoxin for CHF presents with complaints of palpitations. Three days ago, the patient was placed on clarithromycin by another provider for community-acquired PNA. The appropriate course of action at this point would be to? - ANSWER>>Obtain a digoxin level and change the abx to azithromycin

A 17-year-old male with RA is being treated wit an NSAID and omeprazole. The patient complains of HA, abdominal pain, and gas. These symptoms are most likely: - ANSWER>>Associated with the omeprazole

What lab tests are most widely accepted as indicators of the progression of HIV infection? - ANSWER>>CD4 count and viral load

An 88-year-old male presents with concerns about memory loss. e feels good, takes an ASA daily, and as no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the NP choose? - ANSWER>>Folstein Mini-Mental State Exam

Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: - ANSWER>>Whether a patient has reversible airway obstruction

A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 ours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? - ANSWER>>Palpate structures around the shoulder

Which of the following wet-mount results confirms a preliminary diagnosis of BV? - ANSWER>>Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many WBCs

An 88-year-old patient has had a gradual onset of hearing loss in the left ear. Exam shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the NP would expect the Weber test to? - ANSWER>>Lateralize to the left

A patient with macular degeneration has difficulty seeing objects: - ANSWER>>In the center of the visual field

A 29-year-old male with non-complicated Chlamydia infection may exhibit: - ANSWER>>No remarkable clinical symptoms

A 17-year-old female is suspected of having PCOS. In addition to testosterone, the most appropriate diagnostic tests to order would be? - ANSWER>>FSH, LH, prolactin, TSH

A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. What is the most appropriate intervention to aid in the diagnosis of the case? - ANSWER>>US

A patient is referred with a diagnosis of DM, HTN, and CAD. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptoms would be most indicative of hypoglycemia in this patient? - ANSWER>>Sweating

A 3-year-old patient 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. What diagnostic test would be most appropriate for the patient? - ANSWER>>Sputum culture

To assess a patient's ability to think abstractly, an NP could ask the patient? - ANSWER>>The meaning of a common proverb

Which of the following signs/symptoms are often associated with HAs due to an intracranial tumor? - ANSWER>>Pain worse in supine position; focal neurological signs

Which of the following is NOT an indication of preclampsia? - ANSWER>>Glucosuria

Which of the following best describes psoriatic lesions in an elderly patient? - ANSWER>>Red, sharply defined plaques with silvery scales

An 18-year-old college student presents for an athletic physical. When asked about current medication, she mentions that she takes "some herb" she bought at a health food store for migraines and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? - ANSWER>>Feverfew

Which of the following findings is typically a sign of acute appendicitis? - ANSWER>>Rebound tenderness at McBurney's point

Which of the following lab tests should an NP order when the suspected diagnosis is temporal arteritis? - ANSWER>>Erythrocyte sedimentation rate (ESR)

An 88-year-old presents with right-sided weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with a hypertension medication regimen. What is the most likely diagnosis? - ANSWER>>Left-sided stroke

What would be the most appropriate to perform in the initial eval of a patient with symptoms of acute prostatitis? - ANSWER>>Urinalysis and urine culture

Assessment findings that would support a diagnosis of mitral regurgitation include - ANSWER>>Loud, high-pitched pansystolic murmur

The best lab test to distinguish iron deficiency anemia from other anemia is? - ANSWER>>Serum ferritin level

Which of the following GI changes is associated with normal aging? - ANSWER>>Decreased production of gastric acid

What is the leading cause of cancer-related deaths in the majority of women? - ANSWER>>Lung cancer

During an employment PE of a 21-year-old female, bruising around the areolae on the breasts is noted. An appropriate health history for these findings should include all of the following EXCEPT: - ANSWER>>Socioeconomic status

To assess spinal function at the S1 level, which deep tendon reflex should be tested? - ANSWER>>Achilles

A 70-year-old male presents with paresthesia of the lower extremities. On exam, the patient appears pale and shows a decreased vibratory sense. Lab tests reveal elevated indirect bilirubin; Hct = 30%; MCV = 120 (normal = 87-103). The most likely diagnosis is? - ANSWER>>Pernicious anemia

A 65-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On PE, there is pain on ROM, with no weakness noted. Labs show a low hemoglobin and an elevated ESR. What is the most likely diagnosis? - ANSWER>>Polymyalgia rheumatica

Which of the following criteria differentiates a TIA from a stroke? - ANSWER>>Absence of residual symptoms

A 2-month-old infant is presented for exam and immunizations. History includes an uncomplicated full-term delivery and hep B virus immunization shortly after birth. Exam is unremarkable except for a diffusely erythematous macular rash in the diaper area, sparing the inguinal folds. No satellite lesions are noted. The infant's diaper rash is most likely caused by? - ANSWER>>Contact dermatitis

Trigeminal neuralgia manifests itself primarily with? - ANSWER>>Electric-shock-like unilateral facial pain

According the the American Diabetes Association, the newest standard for determining the presence of DM on fasting plasma sugar level is a value equal to or greater than? - ANSWER>>126 mg/dL

A 47-year-old patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. The patient does not currently take any medications. The most likely differential diagnosis would include: - ANSWER>>Gastritis and peptic ulcer disease

A 10-month-old presents with a rash, runny nose, and cough. Exam reveals a cluster of tiny white papules with an erythematous base on the buccal mucosa. What does this suggest? - ANSWER>>Measles

A 17-year-old female has never had her menses. She is at Tanner stage III of sexual development. Her PE is completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? - ANSWER>>Primary amenorrhea

An 85-year-old patient relates that on the way to an annual PE, the patient suffered a sudden loss of vision in the right eye characterized by "a bunch of lights" and a feeling that "a curtain came down." The most likely diagnosis is? - ANSWER>>Retinal detachment

A 66-year-old patient presents with bilateral otitis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 x 4. The patient should be evaluated for? - ANSWER>>HIV infection

A 20-year-old male presents with a 1-month history of a "bump on my testicle." He reports being sexually active, with frequent episodes of unprotected intercourse with multiple partners. Which condition should be suspected? - ANSWER>>Cancer of the testicles

A 14-year-old patient who fell on an outstretched hand complains of proximal forearm pain. X- ray reveals a positive fat pad sign, and the patient is unable to fully extend the elbow. No definitive bony changes are seen on X-ray. The most likely working diagnosis is? - ANSWER>>Radial head fracture

An NP is evaluating a 40-year-old patient suspected of having a pulmonary embolus. The patient complains of anxiety and cough. A stat CXR is normal. What tests should the NP perform next? - ANSWER>>Helical CT pulmonary angiography

A 38-year-old experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Exam reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is? - ANSWER>>Testicular torsion

A 32-year-old patient reports a 6-month history of intermittent symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? - ANSWER>>RA

A 65-year-old male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild HTN. On PE, the patient is tachycardic, positive for JVD, and positive for S3, with a systolic murmur. CXR reveals cardiomegaly with vascular redistribution. The NP's diagnosis should be? - ANSWER>>HF

An 18-year-old patient presents with c/o maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? - ANSWER>>Augmentin

A patient with a diagnosis of diverticulosis presents with localized LLQ discomfort, a palpable mass, mild leukocytosis, and T = 100F. The patient does not appear toxic and can tolerate fluids. An appropriate plan should include? - ANSWER>>Clear liquids and oral antibiotics

The management of choice for polymyalgia rheumatica includes - ANSWER>>Prednisone

The most common bacteria responsible for PNA in older adults residing in the community is: - ANSWER>>Streptococcus pneumoniae

What would be an appropriate alternative to erythromycin therapy in an 18-year-old patient with Mycoplasma pneumoniae infection? - ANSWER>>Azithromycin (Zithromax)

The parent of a 13-year-old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The NP should advise the parent that the development of fever may? - ANSWER>>Lower the seizure threshold

A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate? - ANSWER>>Providing reassurance

A 40-year-old male presents with a 2-week history of rectal pain and itching. He reports a past history of constipation and finding spots of bright red blood on toilet paper several times a week. Rectal exam reveals a tender, swollen, bluish, ovoid mass. The stool guaiac test is negative. What action should the NP take? - ANSWER>>Prescribe bulk-forming agents and hydrocortisone suppositories

After a 3-week camping trip, an 11-year-old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe HA, malaise, fatigue, and generalized MSK pain for several days. Pharmacologic management of this condition is? - ANSWER>>Doxycycline

Research findings have shown that, in order to improve the longevity of a patient with COPD, the treatment of choice is? - ANSWER>>Oxygen

What would the most important med to administer to a patient who has a corneal abrasion? - ANSWER>>Gentamycin ophthalmic (Genoptic)

Which class of antihypertensive agents ahs been associated with acute renal failure and is contraindicated in patients with bilateral renal artery stenosis? - ANSWER>>ACE inhibitors

An 18-month-old child presents with a bulging, immobile tympanic membrane; T = 103F/ Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is to: - ANSWER>>Reevaluate the patient in 10 days

Initial therapy for a 3-week-old infant with uncomplicated symptoms of GERD includes what position and diet changes? - ANSWER>>Smaller, more frequent feedings while holding the infant

An NP is suturing a simple laceration on an 11-year-old patient. The use of lidocaine with EPI is contraindicated in all areas except: - ANSWER>>Scalp

A common rule to follow when prescribing many medications for the elderly is to: - ANSWER>>Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly

A lab assessment of a 12-year-old patient with a family history of thalassemia and anemia reveals Tanner stage II presentation and Hct = 35%. In addition to a CBC, the NP should order which of the following? - ANSWER>>Hemoglobin electrophoresis

What is the most serious outcome of Barrett's esophagus? - ANSWER>>Esophageal adenocarcinoma

A 14-year-old male with bronchitis is being treated with fluids and expectorants. He returns to the clinic with a fever of 103F, right pleuritic chest pain, and green sputum. What exam results would be expected? - ANSWER>>Right lower lobe crackles

What medication can cause delayed ejaculation? - ANSWER>>Paroxetine (Paxil)

An NP orders pulmonary rehab for a 75-year-old with COPD. Expected outcomes of this program include all of the following EXCEPT: - ANSWER>>Increased lung capacity

A patient with bronchitis, fever of 101.2F, and a productive cough, with thick, yellow-green, foul-smelling sputum. The NP should prescribe: - ANSWER>>A macrolide antibiotic

A patient with type 1 DM who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of? - ANSWER>>The Somogyi effect

During development of a treatment plan for an 84-year-old patient with hypothyroidism, the NP must keep in mind the possibility of the worsening o? - ANSWER>>Osteoporosis

A 15-year-old patient returns for contraceptive services 2 weeks after a diagnosis of trichomonas and treatment with metronidazole. She reports discharge and itching are gone, but still has dysuria and frequency. She has not resumed sexual activity and has had her period since her last visit. Exam reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. GC are negative. Which test should be performed immediately? - ANSWER>>Microscopic exam of urine

A 68-year-old female presents with a new onset of left-sided throbbing HA. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. ESR is elevated, but all other lab values are within normal limits. The HA is most likely due to: - ANSWER>>Temporal arteritis

The follow up exam of a 12-month-old treated 2 weeks ago for bilateral otitis media reveals a normal left tympanic membrane and a right tympanic membrane with visible serous fluid levels and decreased mobility. An appropriate plan should include a: - ANSWER>>Follow up eval of the ears in 2 months

A 67-year-old with DM2, CHF, and mild CAD is currently taking digoxin, 0.25 mg daily; HCTZ, 25 mg daily; metformin, 500 mg daily; glipizide, 10 mg daily; and atorvastatin, 20 mg h.s. What is true of this medication regimen? - ANSWER>>The HCTZ will predispose the patient to digoxin toxicity