AANP FNP Certification Exam Bank 2025: Practice Questions and Answers, Exams of Nursing

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Which of the following best describes psoriatic lesions in an elderly patient? A) Red, sharply defined plaques with silvery scales B) Yellow, scaly patches with central depression C) Itchy, raised lesions with a crusty appearance D) Round, flat, hypopigmented areas CORRECT ANSWER: A) Red, sharply defined plaques with silvery scales Rationale: Psoriatic lesions are characterized by sharply defined, red plaques covered with silvery scales. This is the classic presentation in both elderly and younger patients. A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. 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 symptom would be most indicative of hypoglycemia in this patient? A) Sweating B) Dry mouth C) Weight loss D) Dehydration CORRECT ANSWER: A) Sweating

Rationale: Beta blockers can mask adrenergic symptoms of hypoglycemia, such as tachycardia and tremors. However, sweating remains a common sign of hypoglycemia even when on beta blockers. An 88-year-old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has 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 nurse practitioner choose? A) Folstein Mini-Mental State Examination B) Montreal Cognitive Assessment C) Digit Span Test D) Neuropsychological testing CORRECT ANSWER: A) Folstein Mini-Mental State Examination Rationale: The Folstein Mini-Mental State Examination (MMSE) is a commonly used tool to assess cognitive function, including memory. It is widely used in clinical settings for quick screening of dementia. Which of the following is the leading cause of cancer-related deaths in the majority of women? A) Breast cancer B) Ovarian cancer C) Lung cancer D) Uterine cancer CORRECT ANSWER: C) Lung cancer

Rationale: Lung cancer is the leading cause of cancer-related deaths in women, surpassing breast cancer. Smoking is the primary risk factor for lung cancer, and the disease often goes undetected until it is advanced. Which of the following findings is typically a sign of acute appendicitis? A) Rebound tenderness at McBurney's point B) Palpable mass in the left lower quadrant C) Pain in the right lower quadrant with guarding D) Tenderness in the upper right quadrant CORRECT ANSWER: A) Rebound tenderness at McBurney's point Rationale: Rebound tenderness at McBurney's point is a classic finding in acute appendicitis. McBurney's point is located in the right lower quadrant, and rebound tenderness occurs when pain increases when pressure is released after palpation. A patient with macular degeneration has difficulty seeing objects: A) In the center of the visual field B) On the periphery of the visual field C) Under low-light conditions D) Only in one eye CORRECT ANSWER: A) In the center of the visual field Rationale: Macular degeneration primarily affects the central vision, leading to difficulty seeing objects directly in front of the patient. Peripheral vision is typically preserved. To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient:

A) The meaning of a common proverb B) To describe a recent event in their life C) To list their favorite books or movies D) To perform simple arithmetic CORRECT ANSWER: A) The meaning of a common proverb Rationale: Asking a patient to interpret a common proverb helps assess their ability to think abstractly. This type of questioning requires the patient to understand metaphorical or symbolic meaning. During an employment physical examination 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: A) Sexual history B) Use of medications or supplements C) Recent trauma or injury D) Socioeconomic status CORRECT ANSWER: D) Socioeconomic status Rationale: While sexual history, use of medications, and recent trauma are relevant for assessing unexplained bruising, socioeconomic status is not directly related to the clinical findings of bruising around the areolae. The best laboratory test to distinguish iron deficiency anemia from other anemias is: A) Hemoglobin electrophoresis

B) Serum ferritin level C) Total iron-binding capacity (TIBC) D) Reticulocyte count CORRECT ANSWER: B) Serum ferritin level Rationale: Serum ferritin is the most specific test for iron deficiency anemia. A low ferritin level indicates depleted iron stores, distinguishing it from other types of anemia that may have normal or elevated ferritin levels. A 17-year-old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the most appropriate diagnostic tests to order would be: A) Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid- stimulating hormone (TSH) B) Serum progesterone and cortisol levels C) Estrogen levels and pelvic ultrasound D) Thyroid-stimulating hormone (TSH) and prolactin CORRECT ANSWER: A) Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH) Rationale: Polycystic ovary syndrome (PCOS) is often diagnosed based on hormonal imbalances. FSH, LH, prolactin, and TSH help assess endocrine function in diagnosing PCOS. Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: A) The degree of airway obstruction B) A patient’s lung capacity is above average C) Whether a patient has reversible airway obstruction

D) The oxygenation status of the patient CORRECT ANSWER: C) Whether a patient has reversible airway obstruction Rationale: Spirometry with albuterol treatment tests for reversible airway obstruction, which is a hallmark of asthma. Improvement in airflow post-bronchodilator confirms asthma. An 88-year-old patient 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? A) Left-sided stroke B) Acute myocardial infarction C) Aortic aneurysm D) Lumbar disk herniation CORRECT ANSWER: A) Left-sided stroke Rationale: The patient's right-sided weakness and aphasia suggest a left-sided stroke, which can occur when there is a disruption in blood flow to the left hemisphere of the brain. Noncompliance with hypertension medication increases the risk of stroke. 29 - year-old male with noncomplicated Chlamydia infection may exhibit: A) Severe abdominal pain and fever B) No remarkable clinical symptoms C) Rectal bleeding and pain D) Persistent cough and dyspnea CORRECT ANSWER: B) No remarkable clinical symptoms

Rationale: Many individuals with Chlamydia infections, especially men, are asymptomatic or have mild symptoms. This is why screening is recommended for sexually active individuals. Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection? A) Hemoglobin A1C and C-Reactive Protein B) CD4 count and viral load C) Complete blood count and liver function tests D) Electrolyte panel and glucose levels CORRECT ANSWER: B) CD4 count and viral load Rationale: CD4 count assesses the immune system's strength by measuring the number of CD cells, which are targeted by HIV. Viral load measures the amount of HIV in the blood, indicating how actively the virus is replicating. Both are critical in monitoring HIV progression and guiding treatment decisions. 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. Which of the following is the most appropriate intervention to aid in the diagnosis of this case? A) Vaginal culture B) Ultrasound C) Pelvic examination D) MRI of the uterus CORRECT ANSWER: B) Ultrasound

Rationale: Ultrasound is the most appropriate initial intervention to assess the cause of vaginal bleeding during pregnancy. It can evaluate placental position, fetal development, and detect potential issues such as placenta previa or placental abruption. 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. Which of the following diagnostic tests would be most appropriate for the patient? A) Chest X-ray B) Sputum culture C) CBC with differential D) Tuberculosis skin test CORRECT ANSWER: B) Sputum culture Rationale: A sputum culture is essential for identifying the specific respiratory pathogen, especially in a setting where tuberculosis is a concern due to the presence of symptoms in multiple family members. It helps guide appropriate antibiotic therapy. To assess spinal function at the S1 level, which deep tendon reflex should be tested? A) Biceps B) Triceps C) Patellar D) Achilles CORRECT ANSWER: D) Achilles Rationale: The Achilles reflex is associated with the S1 spinal level. Testing this reflex helps assess the integrity of the S1 nerve root and spinal cord.

An 18-year-old college student presents for an athletic physical. When asked about current medications, 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? A) Echinacea B) Feverfew C) Ginkgo biloba D) St. John's Wort CORRECT ANSWER: B) Feverfew Rationale: Feverfew is commonly used for the prevention of migraines and is also sometimes used to alleviate menstrual cramps. An 88-year-old patient has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: A) Lateralize to the left B) Lateralize to the right C) Show no lateralization D) Have no response CORRECT ANSWER: A) Lateralize to the left Rationale: In conductive hearing loss caused by cerumen impaction, the Weber test lateralizes to the affected ear (in this case, the left ear). This is due to the obstruction of sound conduction in the ear.

Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? A) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white blood cells B) Large numbers of budding yeast cells with hyphal formation C) Clue cells with numerous small, motile, and flagellated organisms D) Gram-positive cocci in clusters CORRECT ANSWER: A) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white blood cells Rationale: Wet mount findings in bacterial vaginosis include the presence of clue cells (squamous epithelial cells with stippled appearance), absence of normal lactobacillus flora, and increased white blood cells, which indicate inflammation. Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? A) Urinalysis and urine culture B) Pelvic ultrasound C) Digital rectal examination (DRE) D) Prostate-specific antigen (PSA) test CORRECT ANSWER: A) Urinalysis and urine culture Rationale: Urinalysis and urine culture are essential first steps in diagnosing acute prostatitis. They help identify the causative organism and guide appropriate antibiotic therapy. 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 hours 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? A) Palpate structures around the shoulder B) Obtain an X-ray of the shoulder C) Perform an MRI of the shoulder D) Refer to physical therapy CORRECT ANSWER: A) Palpate structures around the shoulder Rationale: Palpation helps identify specific areas of tenderness or injury, which can provide insight into whether the issue is related to soft tissue inflammation, rotator cuff issues, or other conditions such as bursitis. Assessment findings that would support a diagnosis of mitral regurgitation include: A) Loud, high-pitched pansystolic murmur B) Harsh, crescendo-decrescendo systolic murmur C) Diastolic rumble with an opening snap D) Continuous murmur throughout systole and diastole CORRECT ANSWER: A) Loud, high-pitched pansystolic murmur Rationale: Mitral regurgitation is characterized by a loud, high-pitched pansystolic murmur best heard at the apex of the heart, often radiating to the axilla. Which of the following gastrointestinal changes is associated with normal aging? A) Decreased production of gastric acid

B) Increased bile production C) Increased small bowel motility D) Decreased risk of gastroesophageal reflux disease (GERD) CORRECT ANSWER: A) Decreased production of gastric acid Rationale: As individuals age, gastric acid production tends to decrease, which can affect digestion and nutrient absorption. Other changes, such as increased risk of GERD, may actually occur with aging. Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? A) Pain worse in supine position; focal neurological signs B) Pulsating headache that improves with movement C) Headache relieved by over-the-counter analgesics D) Headache that worsens with physical activity CORRECT ANSWER: A) Pain worse in supine position; focal neurological signs Rationale: Headaches caused by intracranial tumors often worsen in the supine position due to increased intracranial pressure and may be accompanied by focal neurological signs depending on the tumor's location. Which of the following is NOT an indication of preeclampsia? A) Proteinuria B) Hypertension C) Glucosuria D) Edema

CORRECT ANSWER: C) Glucosuria Rationale: While proteinuria, hypertension, and edema are key signs of preeclampsia, glucosuria is not a diagnostic criterion for this condition. Glucosuria is more associated with gestational diabetes. Which of the following laboratory tests should a nurse practitioner order when the suspected diagnosis is temporal arteritis? A) Erythrocyte sedimentation rate (ESR) B) Complete blood count (CBC) C) Thyroid-stimulating hormone (TSH) D) C-reactive protein (CRP) CORRECT ANSWER: A) Erythrocyte sedimentation rate (ESR) Rationale: ESR is typically elevated in cases of temporal arteritis, and it is used to aid in the diagnosis of this condition, which causes inflammation of the temporal arteries. According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a value equal to or greater than: A) 100 mg/dL B) 110 mg/dL C) 120 mg/dL D) 126 mg/dL CORRECT ANSWER: D) 126 mg/dL

Rationale: A fasting plasma glucose level of 126 mg/dL or higher is considered a key criterion for diagnosing diabetes according to the American Diabetes Association. An 85-year-old patient relates that on the way to an annual physical examination, 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: A) Retinal detachment B) Acute angle-closure glaucoma C) Macular degeneration D) Diabetic retinopathy CORRECT ANSWER: A) Retinal detachment Rationale: Retinal detachment is often characterized by flashes of light and a "curtain" coming down over the visual field. It requires immediate medical attention to prevent permanent vision loss. 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? A) Osteoarthritis B) Rheumatoid arthritis C) Gout D) Lupus erythematosus CORRECT ANSWER: B) Rheumatoid arthritis

Rationale: The presence of symmetrical joint swelling, prolonged morning stiffness, and involvement of multiple joints is characteristic of rheumatoid arthritis, an autoimmune inflammatory condition. A 38-year-old male 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. Examination reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: A) Inguinal hernia B) Testicular torsion C) Epididymitis D) Hydrocele CORRECT ANSWER: B) Testicular torsion Rationale: Sudden onset of acute testicular pain with swelling and a negative cremasteric reflex strongly suggests testicular torsion, a surgical emergency requiring prompt intervention to save the testicle. A 65-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical examination, there is pain on ROM, with no weakness noted. Laboratory studies show a low hemoglobin and an elevated sedimentation rate. Which of the following is the most likely diagnosis? A) Osteoporosis B) Polymyalgia rheumatica C) Rheumatoid arthritis D) Osteoarthritis CORRECT ANSWER: B) Polymyalgia rheumatica

Rationale: Polymyalgia rheumatica presents with pain and stiffness in the shoulder and pelvic girdles, elevated ESR, and systemic symptoms like weight loss. It is commonly seen in older adults. 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? A) Testicular torsion B) Epididymitis C) Testicular cancer D) Hydrocele CORRECT ANSWER: C) Testicular cancer Rationale:** A painless lump or bump in the testicle, especially in sexually active males, raises suspicion for testicular cancer. Prompt evaluation is necessary for early detection and treatment. A 10-month-old presents with a rash, runny nose, and cough. Examination reveals a cluster of tiny white papules with an erythematous base on the buccal mucosa. What does this suggest? A) Measles B) Chickenpox C) Hand-foot-and-mouth disease D) Scarlet fever CORRECT ANSWER: A) Measles Rationale:** Koplik spots, which are tiny white papules on an erythematous base inside the mouth, are pathognomonic for measles and aid in its diagnosis.

A nurse practitioner is evaluating a 40-year-old patient suspected of having a pulmonary embolus. The patient complains of anxiety and cough. A stat chest X-ray is normal. Which of the following tests should the nurse practitioner perform next? A) Ventilation-perfusion (V/Q) scan B) D-dimer test C) Helical CT pulmonary angiography D) Ultrasound of the legs CORRECT ANSWER: C) Helical CT pulmonary angiography Rationale:** Helical CT pulmonary angiography is the diagnostic test of choice for confirming a pulmonary embolus when the chest X-ray is normal, providing detailed images of the pulmonary arteries. A 72-year-old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3:00 A.M., is reluctant to go out although she has family members living nearby, and feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include: A) Depression, unresolved grief, and hypothyroidism B) Dementia, anxiety disorder, and bipolar disorder C) Generalized anxiety disorder, depression, and insomnia D) Schizophrenia, bipolar disorder, and depression CORRECT ANSWER: A) Depression, unresolved grief, and hypothyroidism Rationale:** The patient's symptoms of disrupted sleep, reluctance to go out, and intense emotional reactions to her husband's death suggest depression and unresolved grief.

Hypothyroidism should also be considered due to its overlapping symptoms like fatigue and mood changes. Trigeminal neuralgia manifests itself primarily with: A) Persistent dull ache in the face B) Electric-shock-like unilateral facial pain C) Tingling and numbness in the facial area D) Swelling and redness of the face CORRECT ANSWER: B) Electric-shock-like unilateral facial pain Rationale:** Trigeminal neuralgia is characterized by sudden, severe, electric-shock-like pain on one side of the face, often triggered by activities such as eating or speaking. 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 hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical examination, the patient is tachycardic, positive for jugular venous distention, and positive for S3, with a systolic murmur. Chest X-ray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: A) Chronic obstructive pulmonary disease B) Heart failure C) Pulmonary hypertension D) Acute myocardial infarction CORRECT ANSWER: B) Heart failure

Rationale:** The combination of symptoms (fatigue, dyspnea, ankle edema), physical findings (jugular venous distention, S3, systolic murmur), and chest X-ray findings (cardiomegaly, vascular redistribution) strongly suggest heart failure. Which of the following criteria differentiates a TIA from a stroke? A) Duration of symptoms B) Absence of residual symptoms C) Presence of motor deficits D) Location of the lesion CORRECT ANSWER: B) Absence of residual symptoms Rationale:** A transient ischemic attack (TIA) is characterized by temporary neurological symptoms without permanent deficits, whereas a stroke results in lasting neurological impairment. 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 × 4. The patient should be evaluated for: A) HIV infection B) Oral candidiasis C) Herpes simplex virus D) Leukoplakia CORRECT ANSWER: A) HIV infection Rationale:** Persistent oral white patches that do not rub off (leukoplakia) alongside otitis media with effusion can be indicative of immunosuppression, such as HIV infection. Early evaluation is essential for appropriate management.

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: A) Supracondylar fracture B) Radial head fracture C) Nursemaid's elbow D) Olecranon fracture CORRECT ANSWER: B) Radial head fracture Rationale:** A positive fat pad sign and inability to extend the elbow without clear bony fractures suggest a radial head fracture, commonly seen in children after falls on an outstretched hand. A 2-month-old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (non-beet-red) 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: A) Contact dermatitis B) Candidiasis C) Bacterial infection D) Psoriasis CORRECT ANSWER: A) Contact dermatitis Rationale:** The description of an erythematous, non-beet-red macular rash sparing the inguinal folds and absence of satellite lesions is consistent with contact dermatitis, often due to prolonged contact with urine or stool in the diaper area.

A 17-year-old female has never had her menses. She is at Tanner stage III of sexual development. Her physical examination is completely normal, and her weight is appropriate for her age and height. What is the most likely diagnosis? A) Primary amenorrhea B) Secondary amenorrhea C) Premature ovarian insufficiency D) Hypothyroidism CORRECT ANSWER: A) Primary amenorrhea Rationale:** Primary amenorrhea refers to the absence of menarche by age 15 in girls with normal growth and secondary sexual characteristics (Tanner stage III). Since her physical examination is normal and she has appropriate weight, primary amenorrhea is the most likely diagnosis. A 70-year-old male presents with paresthesia of the lower extremities. On examination, the patient appears pale and shows a decreased vibratory sense. Laboratory tests reveal elevated indirect bilirubin; Hct = 30%; mean corpuscular volume (MCV) = 120 μm³ [normal = 87- 103 μm³]. The most likely diagnosis is: A) Iron deficiency anemia B) Sickle cell anemia C) Pernicious anemia D) Thalassemia minor CORRECT ANSWER: C) Pernicious anemia Rationale:** The combination of macrocytic anemia (MCV = 120), elevated indirect bilirubin, and neurological symptoms like paresthesia and decreased vibratory sense strongly suggests pernicious anemia, a type of vitamin B12 deficiency.

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 diagnoses would include: A) Gastritis and peptic ulcer disease B) Gastroesophageal reflux disease (GERD) and pancreatitis C) Cholecystitis and hepatitis D) Irritable bowel syndrome (IBS) and diverticulitis CORRECT ANSWER: A) Gastritis and peptic ulcer disease Rationale:** Upper abdominal discomfort with nausea and burning after eating is most commonly associated with gastritis and peptic ulcer disease. These conditions involve irritation and ulceration of the stomach lining or the first part of the small intestine. A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T = 100°F (37.8°C). The patient does not appear toxic and can tolerate fluids. An appropriate plan should include: A) Clear liquids and oral antibiotics B) Immediate surgical consultation C) High-fiber diet and observation D) Intravenous antibiotics and hospitalization CORRECT ANSWER: A) Clear liquids and oral antibiotics Rationale:** In uncomplicated diverticulitis (diverticulosis with inflammation), the appropriate initial management includes a clear liquid diet and oral antibiotics. Hospitalization is not necessary unless the patient appears toxic or has severe symptoms.

Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? A) Fluorescein drops B) Erythromycin ointment C) Gentamicin ophthalmic (Genoptic) D) Timolol drops CORRECT ANSWER: C) Gentamicin ophthalmic (Genoptic) Rationale:** Gentamicin ophthalmic drops are an appropriate antibiotic treatment to prevent infection in corneal abrasions. They help in reducing the risk of bacterial colonization on the injured cornea. The most common bacteria responsible for pneumonia in older adults residing in the community is: A) Haemophilus influenzae B) Mycoplasma pneumoniae C) Streptococcus pneumoniae D) Staphylococcus aureus CORRECT ANSWER: C) Streptococcus pneumoniae Rationale:** Streptococcus pneumoniae is the most common cause of community-acquired pneumonia in older adults. It is responsible for a significant proportion of pneumonia cases and is associated with high morbidity and mortality in this population. 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?

A) Reassure the patient that this is normal B) Discontinue the oral contraceptive C) Schedule an immediate pelvic ultrasound D) Prescribe progesterone supplements CORRECT ANSWER: A) Reassure the patient that this is normal Rationale:** Midcycle spotting can occur during the initial months of starting oral contraceptives as the body adjusts to hormonal changes. Providing reassurance is appropriate unless other concerning symptoms are present. 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 nurse practitioner should advise the parent that the development of fever may: A) Lower the seizure threshold B) Indicate a worsening seizure disorder C) Require immediate hospitalization D) Be unrelated to the seizure activity CORRECT ANSWER: A) Lower the seizure threshold Rationale:** Fever can lower the seizure threshold, increasing the risk of febrile seizures, especially in children with a history of seizures. It's important to monitor the child closely and manage the fever appropriately. A common rule to follow when prescribing many medications for the elderly is to: A) Start at a higher dose to ensure efficacy

B) Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly C) Avoid all medications that require renal clearance D) Prescribe medications only once daily CORRECT ANSWER: B) Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly Rationale:** Elderly patients often have altered pharmacokinetics and pharmacodynamics, making them more susceptible to adverse drug reactions. Starting at a lower dose and titrating slowly helps minimize the risk of side effects. Which class of antihypertensive agents has been associated with acute renal failure and is contraindicated in patients with bilateral renal artery stenosis? A) Angiotensin-converting enzyme (ACE) inhibitors B) Beta blockers C) Diuretics D) Calcium channel blockers CORRECT ANSWER: A) Angiotensin-converting enzyme (ACE) inhibitors Rationale:** ACE inhibitors can cause acute renal failure in patients with bilateral renal artery stenosis by reducing glomerular perfusion pressure. They are contraindicated in these patients to prevent kidney injury. 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 headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: A) Amoxicillin