FNP PPRACTICE EXAM REVISION QUESTIONS WITH ANSWERS 2024 UPDATES, Exams of Nursing

Download FNP PPRACTICE EXAM REVISION QUESTIONS WITH ANSWERS 2024 UPDATES and more Exams Nursing in PDF only on Docsity! FNP PPRACTICE EXAM REVISION QUESTIONS WITH ANSWERS 2024 UPDATES 1. 1. Question A 65 year old female patient presents today to the clinic with worsening back pain over the last week. She appears to be sweating and states that she is profusely dizzy. Which of the following findings on her urinalysis would indicate the most immediate need for referral to the emergency department ? o Red blood cell (RBC) casts, as they are indicative of possible cytomegalovirus o White blood cell (WBC) casts, as they are indicative of pyelonephritis o Hyaline casts, as they are indicative of dehydration after exercise o Glucose, as it confirms a new diagnosis of Diabetes Correct With the patient’s presenting symptoms, it appears that the likely diagnosis is pyelonephritis. WBC casts in conjunction with the presenting symptoms would warrant an immediate referral as it can be life threatening. Dehydration does not always warrant an immediate referral, and glucose in the urine does not confirm a diagnosis of Diabetes. RBC casts are not indicative of possible Cytomegalovirus (CMV). 2. 2. Question A middle aged patient recently started taking Benadryl (diphenhydramine) for issues with allergic rhinitis symptoms. Which of the following signs or symptoms would be least likely for the patient to report after regularly taking this medication? o Blurred vision o Dry mouth o Diarrhea o Urinary hesitancy Correct Benadryl (Diphenhydramine) is a second line treatment for allergic rhinitis. This drug belongs to the antihistamine drug class which is notorious for anticholinergic side effects. The typical anticholinergic side effects that can occur are constipation, vision complaints, dry mouth, and urinary hesitancy. 3. 3. Question A patient presented with suspected gallstones, and the ultrasound results indicate there are no gallstones present. However, the patient continues to have symptoms of acute cholecystitis. Which of the following would be the most appropriate next action for this patient? 6. 6. Question A middle aged patient presents to the clinic requesting hormone replacement therapy for her menopausal symptoms. Which of the following in the patient’s history is not a contraindication to starting hormone replacement therapy? o 2 pack per day smoker o Deep vein thrombosis o New vaginal spotting that began two weeks ago o Endometrio sis Incorrect The American Academy of Family Physicians notes that undiagnosed vaginal bleeding is an absolute contraindication to hormone replacement therapy (HRT). Endometriosis and previous history of thromboembolism are relative contraindications. At this time, smoking is ill advised while taking HRT but is not considered a contraindication. 7. 7. Question A 68-year-old male presents with complaints of swelling and redness in his right lower leg. He explains that he has always had veins that “stuck out” but now his skin itches and looks “leathery”. During the exam, the nurse practitioner notes a reddish-brown discoloration of the legs with mild edema present. There are also several varicose veins on the right lower leg, sparing the foot. What is the most likely diagnosis? o Deep Vein Thrombosis (DVT) o Cellulitis o Lymphedema o Chronic Venous Insufficiency (CVI) Correct Chronic venous insufficiency (CVI) is characterized by lower extremity edema, varicose veins, pruritus of the skin, discoloration of the skin, and possible ulcerations or abrasions to the skin. It is due to inadequate venous circulation caused by a partial vein blockage or leakage of a venous valve that increases pressure. Although DVTs can be caused by CVI – it is important to remember that this can happen from other things as well such as sitting or standing too long, smoking, obesity, or trauma to the leg. 8. 8. Question An 82 year old patient presents to the office today with complaints of severe pain, redness, warmth, and swelling of the distal interphalangeal joint on her right hand. Which of the following diagnoses may be responsible for her acute symptoms? Select all that apply by choosing two of the following answer choices. o Carpal tunnel syndrome o Rheumatoid arthritis o Gout o Cellulitis o Ganglion cyst Incorrect Based on the pain, redness, warmth, and swelling this patient is experiencing in her finger, both gout and cellulitis should be considered. Gout, although more common in the great toes and knees, can occur in the fingers. Herberden’s nodes are traditionally associated with osteoarthritis rather than rheumatoid arthritis. Finally, a ganglion cyst may present with pain and swelling, but will likely not present with redness and warmth. 9. 9. Question A 63 year old patient diagnosed with COPD has a CAT (COPD Assessment Test) score of 6 and has not had any severe exacerbations in the last year, placing them in treatment Group A. Which medications might this patient be on? Select all that apply by choosing two of the following answer choices. o Levoalbuterol (Xopenex) o ipatropium bromide and albuterol (Combivent) o Budesonide (Pulmicort) o Theophylline (Theochron) o Cromolyn sodium (Gastrocom) o Fomoterol (Perforomist) Correct Patients in COPD group A should be prescribed a bronchodilator – either a short acting or a long acting bronchodilator depending on the patient’s response. Therefore, this patient could be prescribed levoalbuterol (a SABA) or fomoterol (a LABA) from the list above. 10. 10. Question A 46 year old African American patient with a history of GERD presents to the clinic today with a blood pressure of 134/89 mmHg. Three months ago his blood pressure was 137/85 and he was educated on lifestyle modifications like smoking cessation, low sodium diet, and exercise. According to the JNC 8 hypertension guidelines, what treatment should the nurse practitioner initiate for this patient? o Amlodipine (Norvasc) o Hydrochlorothiazide (HCTZ) o Captopril (Capoten) o Continue lifestyle modifications Correct According to the JNC 8 hypertension guidelines, patients less than 60 years old do not need treatment with antihypertensives until the blood pressure reaches >140/90. Since this patient’s systolic and diastolic blood pressure are still under that threshold, we can continue encouraging lifestyle modifications. In patients 60 years old or greater, we do not need to initiate antihypertensive treatment until their blood pressure is >150/90 according to the JNC 8 guidelines. There are variations in these cutoffs if the patient has either diabetes or chronic kidney disease. 11. 11. Question An 89 year old patient presents to the office accompanied by his daughter. He has not been into the office in over three years but to your knowledge, has no significant past medical history. He appears agitated and overall withdrawn at the visit today, and his daughter reports that he has stopped paying bills and is repeatedly checking to ensure the doors are locked at home. She states he will wander around the house for hours and accuse family members of stealing his personal belongings. Based on this information, which of the following would be the most appropriate medication for this patient? o Dicycloverine (Bentyl) o Quetiapine (Seroquel) o Donepezil (Aricept) o Olanzapine (Zyprexa) Correct This patient has stereotypical symptoms of Alzheimer’s disease. Donepezil (Aricept), a cholinesterase inhibitor, has been shown to help patients with Alzheimer’s disease by improving cognitive function and their ability to complete activities of daily living, as well as improve some psychiatric symptoms. Other examples of cholinesterase inhibitors include Rivastigmine (Exelon) and Galantamine (Razadyne). Quetiapine (Seroquel) and Olanzapine (Zyprexa) are not routinely recommended and should only be used to treat the symptoms of hallucinations, delusions, or paranoia when alternative options have proven unsuccessful. Dicycloverine (Bentyl), commonly used to treat irritable bowel syndrome, would not be appropriate for this patient’s o A glomerular filtration rate will decrease as a patient ages, but the creatinine will increase o A serum creatinine is a more accurate indicator of kidney function than the glomerular filtration rate o African American patients have a slightly lower glomerular filtration rate than other ethnicities o A low creatinine level may indicate the start of kidney disease Correct The glomerular filtration rate (GFR) decreases as patients age as well as in kidney disease or failure. The GFR and creatinine usually have an inverse relationship. Therefore, as a patient develops kidney disease, their creatinine will rise. African Americans have a slightly higher GFR than other ethnicities and this is taken into account when measuring a patient’s GFR levels. A normal glomerular filtration rate (GFR) is typically >90 mL/min. 15. 15. Question After initial testing, a 42-year-old female patient is diagnosed with a trichomoniasis infection. What is the treatment for this infection? o Metronidazole (Flagyl) PO for both the patient and her partner o Metronidazole (Flagyl) PO for the patient o Ceftriaxone (Rocephin) IM for the patient o Azithromycin (Zithromax) PO for both the patient and her partner Correct A trichomoniasis infection can be treated with an oral course of metronidazole (Flagyl). Trichomoniasis is a sexually transmitted infection (STI) so the patient’s sexual partner should be treated as well. Ceftriaxone (Rocephin) is used to treat gonorrhea, and azithromycin (Zithromax) is used to treat chlamydia. 16. 16. Question An elderly female patient reports to the clinic today for a follow up on her recent bone density scan. Her T-score was -2.9, which indicates that the patient has osteoporosis. Which of the following statements would be most inappropriate to teach the patient about the use of Risedronate (Actonel)? o “It is common to experience gastrointestinal side effects with this medication class.” o “Please take this medication at least 30 minutes before your first meal or beverage of the day.” o “You will need to remain upright for at least an hour after taking this medication.” o “We will re-evaluate your bone density scan results in a couple of years to evaluate if you need to continue the medication.” Correct The patient only needs to remain in an upright position for thirty minutes instead of a full hour. The reason that the patient needs to do this after taking a bisphosphonate is due to the fact that it may cause esophageal irritation and erosion. 17. 17. Question After explaining the mechanism of action of Alzheimer’s disease to a patient’s daughter, she wants to know if there is any medication that can help. Which of the following medications can be prescribed to help slow the progression of Alzheimer’s disease? o Donepezil (Aricept) o Benztropine (Cogentin) o Propranolol (Inderal) o Carbidopa-levodopa (Cinemet) Correct Cholinesterase inhibitors are used for mild to moderate dementia because they prevent the breakdown of acetylcholine which is a major neurotransmitter of the parasympathetic nervous system. Examples include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). N-methyl- D-aspartate receptor antagonists (NMDA) are prescribed for more advanced dementia and work by inhibiting the action of glutamate, also known as the “excitatory” cell. Selective serotonin reuptake inhibitors (SSRIs) can be used to treat associated depression. 18. 18. Question If a patient who is eligible for Medicare opts into Part B coverage, which of the following is not covered within this program? o A patient who needs an emergent ambulance ride to the closest emergency department due to onset of a myocardial infarction o A patient who needs a second opinion on a recent breast cancer diagnosis o A patient who needs a wheelchair due to recently diagnosed adult onset muscular dystrophy o A patient who needs new glasses due to onset of presbyopia Correct The Medicare Part B program covers emergent ambulance services, durable medical equipment, second opinions, outpatient visits, and certain health prevention measures. The Medicare Part C program would cover additional coverages for hearing, vision, etc. 19. 19. Question A tuning fork is placed on the patient’s mastoid process and then in front of the ear. The nurse practitioner times each area. What test is being performed? o Audiometry o Tympanometry o Weber test o Rinne test Correct The rinne test is performed to detect conductive hearing loss. A normal finding in this test would be air conduction is two times longer than bone conduction. Causes of conductive hearing loss include fluid in the ear, cerumen, tympanic membrane perforation, foreign object in the ear, ear mass, or ear malformation. 20. 20. Question A 68 year old female was recently started on olanzapine (Zyprexa) for her bipolar disorder. Which of the following is the least likely side effect of this medication? o Hyperglycemia o Hyperlipidemia o Weight loss o Galactorrhea Correct Zyprexa (olanzapine) belongs to the atypical antipsychotics drug class. This drug class is known to lead to issues with galactorrhea (typically when the medication is first initiated) in addition, this class may lead to increases in glucose, LDL, total cholesterol and triglycerides. Due to these side effects, weight gain is typically seen when a patient is utilizing this particular drug class. 21. 21. Question A 70-year-old patient presents to the clinic complaining of feeling like when people talk to him, their voices are muffled in his right ear. The nurse practitioner conducts a Rinne test, which is normal. A weber test is then performed, which lateralizes to his left ear. Which of the following is the correct interpretation of these results? o Order a complete blood count, comprehensive metabolic panel, and a lipid panel o Educate the patient that this is a benign finding that will likely resolve on its own spontaneously Correct This exam finding is descriptive of arcus senilis which is caused by lipid deposits in the patient’s cornea. Routine lab work, specifically a lipid panel, will aid in the diagnosis of possible hyperlipidemia. Hyperlipidemia is the root cause of this condition. 26. 26. Question A patient is following up over the results of their recent eye exam. On exam, there were new formations of small blood vessels noted along with tiny red dots present throughout the retina. Which of the following would be important to check in this patient? o Neurological Status o Hemoglobin A1C o Medication reconciliation o Blood pressure o Visual acuity Correct This question is describing neovascularization and microaneurysms that are seen in patients with diabetic retinopathy. Cotton wool spots are another common finding in these patients. If we see signs of diabetic retinopathy on the physical exam, it is important to assess the patient’s current diabetes status and management. 27. 27. Question The nurse practitioner is reviewing the results of a urinalysis. The sample is positive for red blood cells, as well as red blood cell casts. Which of the following would be the biggest concern with this patient based on these results? o Glomerulonephritis o Pyelonephritis o Nephrolithiasis o Amyloidosis Incorrect Casts, either white blood cell or red blood cell, are both concerning when seen on a urinalysis result. White blood cell casts can indicate pyelonephritis, while red blood cells can indicate glomerulonephritis. Both of these results would warrant a referral and further investigation. 28. 28. Question Triple therapy for treatment of H. pylori may include which of the following drugs? Select all that apply by choosing four of the following answer choices. o Omeprazole (Prilosec) o Pepcid (Famotidine) o Clarithromycin (Biaxin) o Metronidazole (Flagyl) o Amoxicillin (Amoxil) Correct Traditional triple therapy for H. pylori consists of a proton pump inhibitor, Amoxicillin and Clarithromycin. Metronidazole can be utilized instead of Amoxicillin if patient allergies are present.Triple therapy is a 14 day treatment of antibiotics followed by 2-4 continuing weeks of the PPI. 29. 29. Question Which of the following religious groups participate in Sabbath? Select all that apply by choosing two of the following answer choices. o Islamics o Seventh Day Adventists o Orthodox Jewish o Jehovah’s Witnesses o Buddhists Incorrect Sabbath is a day of religious observance, sometimes from sundown Friday to sundown Sunday, where certain religions do not go to work or use any technology like phones and computers. They instead use this time for worship and rest. This is most commonly observed by Orthodox Jewish and some Seventh Day Adventists. 30. 30. Question While assessing a patient’s cranial nerves, the nurse practitioner taps over the facial nerve and elicits a twitching response. Which electrolyte imbalance should the nurse practitioner suspect? o Hypercalcemia o Hyponatremia o Hypocalcemia o Hypernatremia Correct The nurse practitioner has elicited a positive Chvostek’s sign by tapping the face near the ear where the facial nerve runs. A positive sign is when the patient elicits facial twitching and is indicative of hypocalcemia. 31. 31. Question The nurse practitioner is testing a patient’s cranial nerves and wants to assess their eyes. Which of the following nerves should the provider assess? Select all that apply by choosing four of the following answer choices. o CN VI o CN IV o CN V o CN II o CN III o CN I Correct Cranial nerves II, III, IV and VI all are related to the eyes. Cranial nerve II is the optic nerve which is responsible for visual acuity and can be tested with the Snellen chart. The oculomotor (CN III), trochlear (IV) and abducens (VI) nerves are all motor nerves that are responsible for various forms of eye movement. 32. 32. Question The nurse practitioner is discussing the importance of glycemic control with a patient who recently had an glycosylated hemoglobin (HgbA1c) result of 9.2%. Which of the following are potential microvascular complications that may occur as a result of uncontrolled diabetes? Select all that apply by choosing three of the following answer choices. o Kidney damage o Changes to their vision o Heart disease o Loss of sensation in their hands and feet o Skin infections Correct The three microvascular complications that can be caused by uncontrolled diabetic control are neuropathy, nephropathy, and 137/91, HR 110, RR 20, and SpO2 97% on room air. She has lost a significant amount of weight since your last visit, but tells the nurse practitioner it is probably because she’s been having diarrhea recently. What should the nurse practitioner do next? o Recheck the patient's thyroid profile o Decrease the patient’s dose of levothyroxine (Synthroid) o Teach the patient about common side effects of levothyroxine (Synthroid) o Ask the patient how the patient is taking her levothyroxine (Synthroid) Correct This patient is newly diagnosed with hypothyroidism, but is showing signs of hyperthyroidism at today’s visit. These signs include high blood pressure, tachycardia, weight loss and diarrhea. The next thing the nurse practitioner should do is assess how the patient has been taking her levothyroxine (Synthroid) as she could be taking too much. The nurse practitioner should also recheck a patient’s thyroid stimulating hormone (TSH) at this visit after completing her assessment and educate the patient or adjust the dose as needed. 38. 38. Question A 30-year-old male comes into the office complaining of neck pain that has now progressed down his spine. The pain is keeping him awake at night. He has extremely limited range of motion and has a hunched back appearance forming. He has no history of injury or significant past medical history. Which of the following is the best diagnostic test for this patient? o CT Scan o Spinal x-ray o MRI o No imaging is indicated at this time Incorrect This is a classic case of ankylosing spondylitis. The pain typically starts in the neck, and extends down the spine, causing intense pain and limited range of motion. An x-ray is the best diagnostic test for this, and it will show a telltale “bamboo spine”. Treatment consists of a rheumatology referral, NSAIDs, and sometimes stronger agents like TNF inhibitors. 39. 39. Question All of the following are associated with Crohn’s disease except: o Fistulas o Skip lesions o Affects only the colon o Affects any part of the GI tract from mouth to anus Correct Ulcerative colitis is an inflammatory bowel disease that affects only the colon. Patients will present with bloody diarrhea, often with mucus. Abdominal pain, weight loss, and fatigue are all common symptoms of Crohn’s disease as well. 40. 40. Question A 31-year-old male presents for a follow up after recently being treated with Omeprazole (Prilosec) for 8 weeks. He reports that he hasn’t noticed much improvement and still has acid reflux almost every day. He also reports recently having some difficulty swallowing. What should the provider do next? o Refer the patient for an esophagogastroduodenoscopy (EGD) o Refer the patient for a colonoscopy o Prescribe Famotidine (Pepcid) and discontinue the Omeprazole (Prilosec) o Continue the Omeprazole (Prilosec) for 4 more weeks Correct GERD should be treated for 4-8 weeks with a proton pump inhibitor. If symptoms persist past this point, the provider should refer the patient to gastroenterology for an EGD to rule such conditions as peptic ulcer disease (often caused by H Pylori or long term use of NSAIDs.) 41. 41. Question Which of the following items is a potential consequence of long term use of levothyroxine (Synthroid)? o Decreased bone density o Ischemic stroke o Increased incidence of breast cancer o Severe kyphosis Correct It is imperative that patients being treated for hypothyroidism have routine TSH screenings performed. If the Synthroid dosing is too high, the patient will begin to exhibit issues with signs and symptoms of hyperthyroidism instead. Hyperthyroidism and too much Synthroid can both accelerate bone loss, therefore leading to osteoporosis. 42. 42. Question A 28-week pregnant mother brings her 2-year-old child in for a follow- up visit. The child recently had Varicella and has recovered. The mother had labs drawn to assess immunity to Varicella, but they came back non-immune. When would be the best time to give this pregnant mother her Varicella vaccine to protect both her, her child at home, and her fetus? o At today’s visit due to Varicella exposure o After the baby is born o It would not be appropriate as she has aged out of the Varicella series o After 32 weeks gestation Correct Varicella is a live vaccine typically given to children at their 12 month and 4-6 year annual visits. Live vaccines are not safe to administer to pregnant women, so waiting until the baby has been born is the safest course of action. Pregnant women should always be reminded to screen any potential contacts for communicable diseases as they are at a higher risk of complications due to pregnancy. 43. 43. Question A 23 year old female calls the clinic over her recent pap smear. Her results note AS-CUS (atypical squamous cells of undetermined significance) and the patient is wondering if this means she needs to be tested for HPV. What should the nurse practitioner tell her? o If she is not experiencing any other symptoms, she can repeat her pap smear in 3 years o We can have her follow up with a repeat pap smear in 1 year and test for HPV at that time o Since ASCUS is noted, we can order HPV testing now. o Since she received the Gardasil vaccine when she was 11, no further testing is needed Correct ASCUS stands for atypical squamous cells of undetermined significance. This can result on a pap smear for many reasons ranging ensure the doors are locked at home. She states he will wander around the house for hours and accuse family members of stealing his personal belongings. Based on this information, what is the most likely diagnosis? o Depression o Schizophrenia o Obsessive compulsive disorder o Alzheimer’s disease Correct Signs and symptoms of Alzheimer’s disease vary based on progression of the disease and its severity, but commonly includes the “Three A’s”: aphasia, apraxia, and agnosia. Other signs may include losing important objects, poor judgement, wandering, difficulty paying bills, loss of the ability to read and write, and personality or behavior changes. Individuals with obsessive compulsive disorder may experience repetitive behaviors such as this patient, but would likely not exhibit the other symptoms he presents with. Those with depression do not present with repetitive behaviors and those with schizophrenia may present with more disorganized thinking, delusions, or hallucinations. 47. 47. Question A middle aged patient presents with fatigue and shortness of breath. On exam the nurse practitioner notes lower extremity edema, jugular vein distention, and bilateral crackles in the lungs. To help support the nurse practitioner’s suspicions, which of the following tests could be ordered? Select all that apply by choosing three of the following answer choices. o FEV1/FVC Ratio o Echocardiogram o Chest x-ray o Thyroid stimulating hormone level o Brain Natriuretic Peptide (BNP) level o FEV1 Correct This patient is presenting with signs of heart failure. There are many tools the nurse practitioner can use to help confirm their suspicions. An echocardiogram could be performed to check the patient’s ejection fraction. An increased BNP level, or brain natriuretic peptide, is also commonly seen in heart failure. Upon a chest x-ray, the heart should be no more than half the width of the chest. However, in a heart failure patient cardiomegaly may be seen. Other tests that can be used for heart failure include an electrocardiogram (EKG), checking other labs such as a complete blood count (CBC) and comprehensive metabolic panel (CMP), and possibly even a stress test or magnetic resonance imaging (MRI). 48. 48. Question A 75-year-old patient presents to the office for an annual physical. He is up to date on all vaccinations, and has no new medical history. He was last seen for new cataracts 3 months ago, for which he was referred to ophthalmology. What diagnostic tests would be appropriate to order today due to this patient’s age? Select all that apply by choosing two of the following answer choices. o Prostate-specific antigen level (PSA) o Intraocular pressure o Gastric pH level o Serum creatinine clearance o Glomerular filtration rate (GFR) Correct All of these measures may be appropriate to order for various reasons, but the most appropriate ones to order today would be related to the kidneys. As patients age, their glomerular filtration rate and serum creatinine clearance rates decrease, which can be a sign of chronic kidney disease. Since chronic kidney disease can have a slow onset, renal function monitoring is recommended at least every 2 years, (ideally every year) in patients over 70 years old. 49. 49. Question A woman comes in for her 35-week prenatal visit. Her urine dipstick is negative for glucose and protein, and she asks if any other testing will be done at today’s visit. Which of the following is the most appropriate response? o “No, if your first trimester testing was normal and blood pressure is normal, there are no additional tests to do for today's visit.” o “You will have a vaginal introitus and rectum swab done today for Group B Streptococcus.” o “Yes, you will have your second RhoGam vaccine today since your blood type is A-.” o “Yes, you will have your 2-hour oral glucose tolerance testing done at today’s visit to assess for gestational diabetes.” Correct Group B Streptococcus is tested for between 35 and 37 weeks gestation. Group B Streptococcus naturally inhabits the vaginal canal of many women, but can be dangerous to fetuses when delivered vaginally which is why testing and treating are important. The 2-hour glucose tolerance test is done between 24 and 28 weeks gestation, while RhoGam is given at 28 weeks and then again at 72 hours post delivery. 50. 50. Question A middle aged patient was recently diagnosed with a parathyroid adenoma, and subsequently had a parathyroidectomy performed. Due to this recent surgery, the nurse practitioner knows that this patient should now be taking which of the following supplements? o Phosphorus o Potassium o Calcium o Levothyroxine (Synthroid) Correct The parathyroid gland is responsible for regulating calcium levels in the body and when a patient undergoes a parathyroidectomy, they will need to take a calcium supplement to keep their calcium levels within a safe range. 51. 51. Question The nurse practitioner is seeing a 76 year old male in the office for his annual physical. Which statement made by this patient would prompt further investigation for potential cataracts? o “I feel like the center of my vision is gone.” o “I am having increased difficulty seeing things at a distance” o “I am having increased difficulty seeing things nearby” o “It feels like my right eye is worsening, but my left eye is not changing.” Incorrect Adults presenting with cataracts will usually complain of bilateral vision changes. These changes may include difficulty seeing things at a distance when compared to things close by due to the myopic shift that occurs with cataracts. A classic problem that patients present with is the increased difficulty with night driving. They may also have foggy has immunity from Hepatitis B. Immunity from Hepatitis B occurs either from past infection or from the immunization. This patient has a positive IgG, meaning they had an infection that is now gone. Since their HBsAb is positive, they are now immune to hepatitis B due to the previously resolved infection. 56. 56. Question A nurse practitioner is talking to her patient who is worried about the results of her recent skin biopsy. The provider tells the patient that she will call her with the results as soon as she sees them. The following week, the provider calls the patient and informs her that her skin biopsy was benign. Which ethical principle is the nurse practitioner upholding in this scenario? o Beneficence o Justice o Fidelity o Veracity Correct In this scenario, the nurse practitioner is upholding the principle of fidelity. Fidelity revolves around maintaining trust with patients and keeping your promises. The nurse practitioner stated she would call when her patient’s results came in. By following through and calling the patient with the results when she got them, the nurse practitioner is keeping their promise with the patient. Justice is related to treating patients fairly. Veracity is about truth telling. Beneficence means to do good or to benefit the patient. 57. 57. Question Which type of hearing loss would be present in a patient who presents with otosclerosis? o Conductive o There would be no hearing loss with the benign condition o Complete, irreversible hearing loss o Sensorineural Correct Otosclerosis happens when the bones of the inner ear stop vibrating, thus stopping the transmission of sound. The stapes bone slowly molds to be fixed to the oval window, causing inability to vibrate and transmit sound. On an otoscopic exam, we would see less movement of the stapes bone. This is a type of conductive hearing loss. 58. 58. Question A young woman presents to the clinic today with her elderly father. The woman is visibly upset as she describes that her father is becoming increasingly confused and recently ran several red lights because he stated they were green. She is requesting that the nurse practitioner revoke his license for his safety. Which of the following should be the nurse practitioner’s initial action? o Obtain a Montreal Cognitive Assessment test (MoCa) o Initiate the process to revoke the client’s license, and educate the patient that this is an expected part of the aging process o Administer an ishihara test to determine if that is the root of the patient’s problem while driving. o Educate the patient’s daughter that her father needs an immediate referral to a neurologist Correct The most appropriate initial action is to assess the patient’s reported cognitive decline by administering a MoCa test. Decisions about patient care should not be based solely on findings reported by family members in this situation. In addition, it would be uncommon for color blindness to occur later in life, so an ishihara test is likely irrelevant in this patient. 59. 59. Question The nurse practitioner is aware that pleuritic chest pain may occur with a large variety of different conditions. Which of the following is the least likely diagnosis for a patient to present with pleuritic chest pain? o Pulmonary embolism o Bornholm disease o Empyema o Left ventricular hypertrophy Correct Pleuritic chest pain is a severe pain that occurs upon inspiration and expiration. One of the most serious reasons for chest pain to occur is due to a pulmonary embolism, which would require immediate intervention. Bornholm disease, also known as pleurodynia, also leads to severe and recurrent episodes of pleuritic chest pain. An empyema is a collection of pus in the pleural space which can lead to this as well. Left ventricular hypertrophy itself is not known to typically lead to pleuritic chest pain occurring. o Macrobid (Nitrofurantoin) o Keflex (Cephalexin) o Augmentin (Amoxicillin/Clavulanic acid) o Bactrim (Trimethoprim/Sulfamethoxazole) Correct Sulfamethoxazole is a competitive inhibitor of the CYP2C9 enzyme which is responsible for metabolizing warfarin. Therefore, in those taking warfarin, we want to avoid bactrim as it can cause delayed metabolism of the warfarin, increasing the risk of bleeding in the patient. If the only drug of choice is bactrim, we would decrease the dosage of warfarin – or in some instances, completely hold, during the course of the antibiotic. 65. 65. Question A patient presents today with complaints of insomnia due to severe perianal itching which worsens significantly at night and began four days ago. He denies all other symptoms. What diagnostic test would be most helpful for this patient? o Colonoscopy o Anoscopy o Scotch tape test o Sleep study o Stool sample Correct Perianal itching that worsens at night is a key symptom of pinworms (also known as enterobiasis). This patient should be instructed to apply a piece of tape to the area first thing in the morning with the intent of catching the pinworms or the eggs, which will be viewed under a microscope to confirm diagnosis. Sometimes this test needs to be completed for a few consecutive mornings to get a good sample. 66. 66. Question An elderly female patient reports she has recently started taking the herbal supplement Valerian root. Which of the following is the likely reason that she started this supplement? o Insomnia o Night sweats o Increasing anxiety and stress o Memory loss Incorrect Valerian root has traditionally been taken for bouts of insomnia. Gingko is usually used for memory and cognitive function. Menopausal women often use black cohosh for night sweats. In addition, Kava kava is often used for anxiety. 67. 67. Question When educating a middle-aged patient about how to stay healthy, what suggestions could the nurse practitioner give to help reduce the patient’s overall risk of kidney disease? Select all that apply by choosing two of the following answer choices. o Discuss dietary supplements to increase his hemoglobin that was 11.7 mg/dL today o Initiate measures to lower their blood pressure that was 155/93 today o Promote at least 150 minutes of physical activity per week o Discuss smoking cessation due to the fact that he smokes 1 pack per day o Implement ways to lower his glycosylated hemoglobin (HgbA1c) from 8.4% today Correct In the United States, the two leading causes of chronic kidney disease (CKD) are high blood pressure and diabetes. A sedentary lifestyle can lead to obesity that can contribute to CKD, but is not a leading cause of the disease. Smoking can cause heart disease, which may impact the kidneys, but is not a leading cause. CKD can cause anemia, but anemia does not increase the risk of developing CKD. 68. 68. Question A 26-year-old patient comes into the office complaining of molar pain and nasal congestion for the last 10 days. She states she was just getting over a bad cold when these symptoms developed. Which of the following could be appropriate potential differentials in this patient? Select all that apply by choosing three of the following answer choices. o Allergic rhinitis o Molar abscess o Nasal polyp o Acute bacterial rhinosinusitis o Bullous myringitis Incorrect This patient is exhibiting signs and symptoms most consistent with acute bacterial rhinosinusitis, a nasal polyp (or polyps) and potentially a molar abscess. Bullous myringitis is an acute otitis media infection, and allergic rhinitis presents with rhinorrhea, and itchy/watery eyes, not the facial and molar pain this patient has. 69. 69. Question When the CD4 count decreases below 200 cells/mm3, AIDs patients are at a serious increased risk of opportunistic infections. When the CD4 is at this point, which antibiotic is the preferred first line agent as prophylaxis for pneumocystis jirovecii pneumonia (PJP)? o Atovaquone (Mepron) o Pentamidine (Pentam) o Dapsone (Aczone) o Bactrim (Trimethoprim/Sulfamethoxazole) Incorrect Each of these medications are possible prophylaxis options for PJP. However, Bactrim is the preferred first line agent due to cost and ease of use in comparison to other options. It also has significant efficacy against PJP. 70. 70. Question Voiding cystourethrogram (VCUG) results are being reviewed with the father of a 3 year old patient. The results indicate that the reflux fills the ureter and collecting system, but does not cause dilation. What is the nurse practitioner going to inform the patient’s father regarding the results and treatment plan? o These results indicate Grade I vesicoureteral reflux (VUR). We will start him on prophylactic antibiotics to prevent recurrent urinary tract infections. o These results indicate Grade II vesicoureteral reflux (VUR). We will continue to monitor, but this will likely resolve spontaneously by age five o These results indicate Grade IV vesicoureteral reflux (VUR). We will refer him to urology for further evaluation and treatment. o These results indicate Grade III vesicoureteral reflux (VUR). We will repeat the voiding cystourethrogram (VCUG) in six months to reevaluate. Correct When reviewing voiding cystourethrogram (VCUG) results, grade I reflux fills the ureter, grade II fills both the ureter and collecting system but does not dilate, and grade III is when mild o Recommend she take a standard prenatal vitamin o Recommend she take 400 mcg of folic acid daily o Recommend she eat a diet high in folate o Recommend she take 4,000 mcg of folic acid daily Correct In women of childbearing age, the standard dose of folic acid is 400mcg daily which is typically included within a standard prenatal vitamin. However, if the patient has a history of a child having a neural tube defect such as spina bifida, it is recommended that they take at least 4,000 mcg daily. 74. 74. Question A 17 year old male presents with an erythematous and pruritic patch on the inside of his thigh with central clearing. Which of the following is the appropriate term for this lesion? o Tinea cruris o Tinea corporis o Tinea unguium o Tinea capitis Incorrect A pruritic patch with central clearing is most likely a tinea infection. Tinea corporis is the term for ringworm. Tinea cruris is a tinea fungal infection in the groin or inner thighs referred to as “jock itch.” Tinea capitis is an infection of the scalp. Tinea unguium is a fungal infection of the nail. These are treated with antifungals like topical or oral fluconazole (Diflucan). 75. 75. Question A 30 year old male patient presents to the clinic with concerns over his chest size in the last several weeks. He states that he feels like he has new masses extending from his nipples. Which of the following medications is this patient likely taking? o Furosemide (Lasix) o Indapamide (Lozol) o Spironolactone (Aldactone) o Enalapril (Vasotec) Correct Approximately 10% of male patients who are taking spironolactone will develop gynecomastia. This is due to the displacement of androgen that occurs when taking the medication. 76. 76. Question A 68 year old female with a history of atrial fibrillation, major depressive disorder, and a cerebrovascular accident provides the nurse practitioner with a list of her medications. Aside from her prescribed medications and a multivitamin, you notice that she is also taking St. John’s wort and ginkgo daily. Which patient statement demonstrates the need for further education? o “I am aware that I may have to stop taking St. John’s wort since I was recently prescribed medication for depression.” o “One of my friends who also takes warfarin (Coumadin) told me that it interacts with many medications and recommended that I talk to my primary healthcare provider about the supplements I have been taking” o “I researched both supplements and it seems like the benefits of taking St.John’s wort and ginkgo outweigh the risks.” o “I recently read that gingko can cause an increase in bleeding, so I stopped taking it 2 days ago.” Correct Patients are often unaware of the potential dangers of herbal supplements primarily because they can be bought over the counter. Many patients with depression take St. John’s wort to improve their mood. This patient was most likely prescribed a Selective Serotonin Reuptake Inhibitor (SSRI) because they are used first line in depression. This would warrant discontinuation of St. John’s wort, because the combination of serotonin in both medications can lead to serotonin syndrome. Patient presentations of serotonin syndrome are agitation, tachycardia, shivering, tremors, seizures, and potential death. Gingko is primarily used for memory and cognition. Gingko is contraindicated in patients taking anticoagulants or antiplatelets because this supplement interacts with platelet conjugation, leading to an increased risk of bleeding. 77. 77. Question A 45 year old patient was recently diagnosed with Meniere’s Disease and would like more education on her treatment plan. Which of the following teaching statements is the most appropriate? o “We will prescribe you medication to take long term that will prevent this disease from progressing to permanent hearing loss.” o “There is no definitive treatment or therapy that will help alleviate your symptoms.” o “We will start you on antibiotics and prescribe them again during flare ups.” o “There is no definitive treatment but we can prescribe you medications that might help your symptoms.” Incorrect Meniere’s Disease is caused by buildup of fluid in the part of the inner ear called the labyrinth. The labyrinth plays a part in both hearing and balance – the fluid, endolymph, helps stimulate receptors in the brain. However, when there is a build up of this fluid it can cause an interference between the receptors which thus causes the symptoms of Meniere’s Disease. There is no curative treatment for this condition, however there are medications, dietary changes, and therapy that can help diminish the symptoms. 78. 78. Question An elderly female patient is diagnosed with lentigines on her hands and is concerned that these lesions will turn into skin cancer. What education are you going to provide this patient regarding her diagnosis and treatment plan? o “We can treat these with hydroquinone, a depigmenting agent.” o “I would like to refer you to dermatology for biopsy.” o “I am going to send a prescription for fluorouracil (Efudex) to your pharmacy.” o “These are considered precursors to seborrheic keratosis and I will refer you to dermatology for laser treatments.” Incorrect Although these lentigines are benign and do not require treatment, they will persist if left untreated and may result in seborrheic keratosis. Laser therapy and cryotherapy have both been proven beneficial in the treatment of lentigines while hydroquinone has not shown success in resolution of the lesions. Fluorouracil (Efudex) is a treatment option for actinic keratosis, not lentigines. 79. 79. Question 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? o Lupus nephritis o Myasthenia gravis o Sjorgren's syndrome o Hemolytic anemia o Herniated disc o Sciatica o Spinal stenosis Incorrect Low back pain that is relieved by sitting is a sign of spinal stenosis. Weakness or “foot drop,” burning in the buttocks and thigh, and abnormal reflexes can all be signs of spinal stenosis as well. Spinal stenosis is most common in patients older than 50 years old and is many times due to osteoarthritis. The pain is often described as dull or aching. 85. 85. Question A middle aged patient presents with complaints of numbness and tingling in her buttocks and the inner aspects of her thighs. She also states that in the last several days, she has been having new bouts of incontinence which she has never had before. Which of the following is the most likely differential diagnosis? o Sciatica o Functional incontinence o Reflex incontinence o Cauda equina syndrome Correct Cauda equina syndrome presents with several early signs and symptoms such as “saddle anesthesia,” incontinence and bilateral lower extremity weakness. Saddle anesthesia is when there is numbness, tingling, and/or loss of sensation in the areas of the body that would normally touch a saddle when riding a horse. Various types of incontinence would not present with symptoms such as numbness, tingling or loss of sensation. New concerns with incontinence would be unrelated to a sciatica diagnosis. 86. 86. Question A 24-year-old female patient comes in for her routine pap- smear. Her last pap smear was performed 3 years ago and was normal. Upon cervical exam, you notice an erythematous cervix with some purulent discharge around the cervical os. She states she has been having unprotected sex with “a few” males and was last tested for STIs a couple of years ago. Based on this information and these clinical findings, what would be the priority test to order today? o Venereal disease research laboratory (VDRL) o Rapid plasma reagin (RPR) o HIV-1/HIV-2 antibody antigen assay test o Nucleic acid amplification test (NAAT) Correct Chlamydial infection commonly presents with no symptoms, which is why cervical exams are so valuable. Female patients may experience post-coital bleeding, and vaginal discharge, but the majority experience no symptoms related to infection. Male patients sometimes experience urethritis, but can also transmit infection with no symptoms. The test of choice for both chlamydia and gonorrhea is a Nucleic acid amplification test (NAAT). 87. 87. Question A 7 year old child is brought to the clinic by his father with concerns over his recent “daydreaming.” The father states that the child will often be unresponsive for several minutes at a time despite the fact that his eyes are open. The nurse practitioner is aware that this is most likely which of the following diagnoses? o Attention deficit hyperactivity disorder (ADHD) o Narcolepsy o Absence seizures o Abdominal migraines Correct This patient has a classic description of an absence seizure. When absence seizures occur, there is a brief and momentary lapse in attention. It is common for children to outgrow this condition as they age, but if not, it can be managed with anti seizure medications. 88. 88. Question A 18-year-old male patient presents to the clinic after sustaining a knee injury. He reports that while he was playing soccer, he went to kick the ball and felt a pop in his right knee. Since then, he has been experiencing sharp pain and is unable to fully extend his leg. During the physical exam, the provider notes a palpable ‘click’ when extending and flexing his affected knee. Mild edema is also present, but there are no obvious deformities. Which of the following is the most likely differential diagnosis in this patient? o Medial Meniscus Tear o Patellar Tendon Tear o Posterior Cruciate Ligament Tear o Anterior Cruciate Ligament Tear Correct Medial Meniscus tears are common knee injuries that occur during sports and result from twisting, cutting, pivoting, or A 19 year old female presents to the clinic with complaints of nausea, fatigue, and amenorrhea for 2 weeks. She states that she cannot be pregnant as she has been on birth control and only occasionally forgets to take it. The nurse practitioner decides to run a urine hCG pregnancy test which is positive. The provider understands that this is a o Potential sign of pregnancy o Likely a false positive due to her contraception use o Positive sign of pregnancy o Probable sign of pregnancy o Presumptive sign of pregnancy Correct Positive urine pregnancy tests as well as a positive serum hCG are examples of probable signs of pregnancy. Her complaints of nausea, fatigue, and amenorrhea would be subjective data and would fall under presumptive signs of pregnancy. Positive signs of pregnancy include objective findings from the provider such as fetal heart tones, palpation of the fetus or ultrasound. 92. 92. Question A 68 year old female patient presents to the clinic today for a follow- up. Her past medical history includes hypertension, atrial fibrillation, and type 2 diabetes mellitus. She has previously been on metformin (Glucophage), but her HgbA1C at today’s visit is 8.3%. The nurse practitioner decides to order an additional medication for this patient. Which of the following medications listed are considered to be cardioprotective given the patient’s cardiac history? Select all that apply by choosing two of the following answer choices. o Canagliflozin (Invokana) o Sitagliptin (Januvia) o Glipizide (Glucotrol) o Piaglitazone (Actos) o Dulaglutide (Trulicity) Incorrect Both GLP-1 agonists (Dulaglutide) as well as SGLT-2 inhibitors (Canagliflozin) have been found to reduce overall cardiovascular risk in those with diabetes mellitus. In addition, thiazolidinediones (Piaglitazone) should be avoided due to the increased risk of heart failure in these patients. 93. 93. Question A 32-year-old patient comes into the office for a follow-up about their ongoing allergic rhinitis. They state they have been trying to avoid triggers, but are still having symptoms. They are wondering if you can prescribe them any medications today. Which of the following is the most appropriate response? o “The best plan of action is for you to be referred to an allergy specialist for skin prick testing.” o “There are no true medications to help allergic rhinitis, but you can try some over-the-counter treatments like Allegra (Fexofenadine) or Zyrtec (Cetirizine).” o “We will start you on Benadryl (Diphenhydramine) as it is the first line medication for allergic rhinitis.” o “We will start you on an intranasal corticosteroid like Flonase (Fluticasone) to help alleviate your allergic rhinitis symptoms.” Correct The true first line treatment for allergic rhinitis is to have patients avoid triggers. If this is not possible, or this fails to relieve symptoms, then intranasal corticosteroids are the second line treatment. 94. 94. Question The Health Information Technology for Economic and Clinical Health (HITECH) Act was designed to protect patient electronic information and aid in patient care. Which of the following is not a part of the HITECH Act? o Putting abnormal lab values in red o Informing patients of potential data breaches o Alerting the provider to a heart rate entered as 123 in a patient’s chart o Alerting patients when information is accessed by their medical team Correct The HITECH Act was implemented in 2009 under the American Recovery and Reinvestment Act of 2009. It protects patient information and alerts patients to any potential out of care team breaches. Other aspects of the HITECH Act include alerts to abnormal labs and abnormal vitals. 95. 95. Question The nurse practitioner is evaluating a 40-year-old male patient who is complaining of hearing loss on the left side. Upon an otoscopic exam, the nurse practitioner notes an overgrowth of the footplate of the stapes bone. What would be the best treatment option for this patient? o Refer him to otolaryngology for potential surgery o Do nothing, this is a normal finding in the middle aged and he will always have mild hearing loss in that ear o Refer him emergently to ENT for depressurization of the inner ear o Fit him for a hearing aid while at today’s visit Incorrect Otosclerosis is a bony overgrowth of the footplate of the stapes bone. It is a form of conductive hearing loss and commonly diagnosed before 50 years old. It is not an emergency condition, but can be detrimental to a patient’s quality of life. Potential treatment includes hearing aids, but these will only help for a short amount of time as the bony growth covers more of the stapes. Ultimately, surgery is the best treatment for this condition. 96. 96. Question New parents bring their newborn daughter in for her first visit after birth. The mother is extremely concerned because she saw some pink- red blood in the infant’s diaper this morning. She states the baby has had about 7 wet diapers a day since she was born and one bowel movement. The baby is gaining weight appropriately and is well otherwise. Which of the following would be the most likely diagnosis? o Suspected child abuse and endangerment o False menses o Urinary tract infection due to diapering o Anal fissure due to pressure of defecation Correct Female infants may experience false menses due to the drop in maternal hormones. This presents as pink spots typically in the diaper. It generally resolves in about 3-4 days and is benign in nature. 97. 97. Question When the nurse practitioner is following up on recent labs, it is noted that a 26 year old pregnant patient has a positive rubella titer of more than 10 IU/ml. What would be the most appropriate next action for this patient? >140 mg/dL or fasting >95 g/dL, the patient must have a follow up test with 100-g OGTT performed and fasting for at least 8 hours must be done beforehand. A1C goal for a patient with GDM is 6%-6.5%. Group B strep testing is done between 35-37 weeks. Testing of alpha fetoprotein levels (AFP) is done between 16-20 weeks. High levels indicate possible neural tubal defects, e.g. spina bifida. If Rhogam is needed, it is given at 28 weeks and 72 hours after birth. 101. 101. Question Which of the following conditions may lead to conductive hearing loss? Select all that apply by choosing three of the following answer choices. o Cholesteatoma o Presbycusis o Tympanic membrane perforation o Otitis media o Meniere’s disease Correct Conductive hearing loss can be determined if in the Rinne test BC>AC, or the Webe test lateralizes to the affected ear. Conductive hearing loss is caused by things the examiner can physically see, like otitis media, a perforation, or a cholesteatoma. Meniere’s disease and presbycusis are examples of sensorineural hearing loss causes. 102. 102. Question While a patient is lying in the supine position, the nurse practitioner raises the patient’s leg to the point of pain or 90 degrees, whichever occurs first. Which of the following clinical tests is being performed? o Straight Leg Test o Fajersztajn’s Test o Braggard’s Test o Yeoman’s Test Correct The straight leg test is performed by having your patient lie supine and raising the patient’s left to the point of pain or 90 degrees. The test is indicative of lumbosacral root nerve irritation and the test has a high sensitivity to low lumbar disc herniation which could be the cause of their pain that radiates down one leg to the foot, also known as sciatica. 103. 103. Question The nurse practitioner sees a patient today who complains of painful eyelid swelling for the last 48 hours. She states it began shortly after using her friend’s eye makeup. Upon examination, erythema and swelling on the conjunctival side of the eyelid is noted. Which of the following is the most likely diagnosis? o Chalazion o Hordeolum o Xanthelasma o Benign nevi Correct A hordeolum (stye) presents as erythematous and painful eyelid swelling. They most commonly cause swelling on the underside of the eyelid. Individuals with a history of skin conditions affecting the face and eyelids are at an increased risk, similar to the patient in this scenario. This patient should be advised to apply moist, warm compresses to the area several times a day to facilitate drainage of the stye and refrain from using any eye makeup until this resolves. One way a chalazion differs is that they are typically painless. 104. 104. Question A young adult male was diagnosed three days ago with his first Bell’s palsy episode. Today, he presents to the clinic again complaining of a “gritty” feeling in the affected eye as well as some light sensitivity. Which of the following would be the most appropriate to perform next for this patient? o Fundoscopic exam o Tonometry o Fluorescein stain o Schirmer tear test Correct The symptoms that the patient described sound indicative of a possible corneal abrasion. To evaluate further for this condition, a fluorescein stain will need to be performed. 105. 105. Question The nurse practitioner is educating a group of athletes on common injuries when a soccer player begins to tell the group about his previous anterior cruciate ligament (ACL) injury. While playing soccer, you are aware that the patient must have made a specific motion before hearing a “pop” in his knee. Which of the following motions is most likely to cause an ACL injury? o A sudden twisting motion o Over extension of the lower extremity o Repetitive motions suchs as jumping o Running and making a sudden stop Correct Injury of the anterior cruciate ligament (ACL) is most commonly caused by a sudden twisting movement. Therefore it is frequently seen in athletes. Tear of the ligament causes instability and excess range of motion. 106. 106. Question You see a 73 year old patient in the office today with complaints of a fever, severe headache, stiff neck, and nausea. Based on her presentation, you are concerned about meningitis. You have the patient lay in a supine position and flex her hip to 90 degrees. When in this position, she is unable to fully extend her knees without significant pain. What sign are you testing? o Psoas sign o Brudzinski sign o Babinski sign o Kernig sign Correct Kernig sign is tested by having a patient lay supine and flex their hip at 90 degrees. In this position, if they are unable to extend the knees fully, it indicates a positive Kernig sign and is suggestive for meningitis. 107. 107. Question An 88 year old male with severe chronic obstructive pulmonary disorder (COPD) presents to the clinic for a routine follow-up. Which of the following lung percussion sounds would be expected in this particular patient? o Hyper-resonant o Wheezing o Dull o Crackles Correct It is characteristic in COPD patients for there to be hyper- resonance on percussion. Hyper-resonance occurs when the lungs are hyperinflated with air. This hyperinflation is known to occur in COPD patients as well as in asthmatic patients who are having an acute attack. An angle greater than 15 degrees on x-ray is indicative of hallux valgus. An angle of >45 degrees would be indicative of a severe hallux valgus. 112. 112. Question In order to diagnose a patient with a chronic obstructive pulmonary disease (COPD) exacerbation, all of the following are used for diagnosis except: o Orthopnea o Dyspnea o Increased sputum purulence o Increased sputum production Incorrect A chronic obstructive pulmonary disease (COPD) exacerbation is an acute event accompanied by worsening of the respiratory symptoms the patient experiences on a daily basis. Symptoms of dyspnea, increased sputum production, and/or increased sputum purulence must be present to diagnose a COPD exacerbation. 113. 113. Question A 69-year-old patient comes into the office complaining of cold sensitivity, weight loss, and constipation. She has a history of bipolar disorder and generalized anxiety disorder. After doing some lab work, the nurse practitioner notices that her TSH is extremely high and her T3 and T4 are low. Which of the following medications may have led to these lab results? o Lexapro (Escitalopram) o Elavil (Amitriptyline) o Buspar (Buspirone) o Lithium (Lithobid) Correct This patient’s lab values are consistent with hypothyroidism. Hypothyroidism can be caused by a variety of medications, including lithium. It is important to monitor patients on lithium and have them report any side effects. 114. 114. Question The nurse practitioner is reviewing the imaging and lab results of a patient with suspected rheumatoid arthritis. Her sedimentation rate is elevated and her rheumatoid factor is positive. What is the next step in her treatment? o Refer the patient to orthopedics for a steroid joint injection o Start the patient on a Disease-Modifying Antirheumatic Drug (DMARD) such as Methotrexate (Trexall) o Refer the patient to rheumatology o Start the patient on Naproxen (Aleve) 500mg every 12 hours Correct Early referral is important in the diagnosis of rheumatoid arthritis. The goal for these patients is to reduce the overall amount of joint damage by providing early, aggressive treatment. Primary care may prescribe patients medications to aid in pain relief, but it is imperative to refer for further treatment. 115. 115. Question A mother brings in her 3 day old infant into the office for a well child check. She is worried that her infant is not getting enough breastmilk. Which of the following findings in the baby would be concerning? o The infant consistently has 5 wet diapers a day o The newborn wants to breastfeed every two hours and multiple times overnight o The infant was 3500 grams at birth and weighs 3360 grams today o The mother started her newborn on vitamin D supplementation Correct We know that breastfeeding is effective if the child is having 6-8 wet diapers a day and is gaining weight appropriately. Only having 5 wet diapers a day would be concerning finding. Although this baby has lost a little weight since birth, we know it is normal for newborns to lose 7- 10% of their birth weight after delivery. This child is only down 4% and is not expected to be back to birth weight until 2 weeks old. 116. 116. Question The nurse practitioner is reviewing results of alpha-fetoprotein (AFP) levels from a woman who is 18 weeks pregnant with twins. The NP correctly understands that the AFP is typically made in: o The maternal ovaries o The maternal liver o The fetal liver o The placenta Correct Alpha-fetoprotein, also known as AFP, is produced by the fetal liver. This is why it is expected to have a slightly higher AFP level when a patient is pregnant with multiples. A lower level may indicate incorrect 121. 121. Question An adolescent female presents to the clinic with concerns about the skin on her upper arms and thighs. She states that the skin is incredibly rough, and she always feels like she has “goose bumps.” She has tried several different body soaps and lotions without improvement in symptoms. Which of the following is the most likely differential diagnosis? o Acne vulgaris o Keratosis pilaris o Eczema o Plaque psoriasis Correct Keratosis pilaris is a benign skin condition that is commonly referred to as “goosebump skin” or “chicken skin” due to its rough nature. This condition is quite common, and oftentimes resolves as the patient ages. In the meanwhile, patients can utilize emollients and moisturizers for symptom relief. Eczema, while also rough in nature, has other associated symptoms and tends to occur on flexor surfaces. Plaque psoriasis has thick, silvery scales as its distinguishing factor. Acne tends to be present in other areas of the body with more inflammatory symptoms. 122. 122. Question A 27-year-old male patient comes into the clinic for his annual physical. He has been feeling depressed and is wanting to start medication for his symptoms. The nurse practitioner and the patient decide to start him on Escitalopram (Lexapro). The patient then asks, “When can I see results in my mood after starting this drug?” How should the nurse practitioner respond? o “The medication can take up to 3-6 months to begin having an effect.” o “It can take up to 4-6 weeks to start feeling the effects of this medication.” o “The effects of the medication are immediate.” o “You will begin to feel better a week after starting the medication.” Correct SSRIs (selective serotonin reuptake inhibitors) can take up to 4-6 weeks to begin having an effect on a patient’s mood. Telling the patient that effects can take up to 3-6 months could be correct, but most patients may begin feeling better as early as 2 weeks of treatment with continued improvements for 4-6 weeks. 123. 123. Question An eight year old presents with a headache and vomiting over the last two days. The mother reports that symptoms began after the child had a difficult exam at school. The nurse practitioner suspects that a migraine may be occurring. Which of the following signs or symptoms is common to see in a pediatric migraine? o Abdominal pain o An aura o Photophobia o Phonophobia Correct Migraines in children often-times present differently than they do in adults. The child typically has nausea, vomiting, and abdominal pain. These vague symptoms can make it difficult to distinguish from other various ailments. Children with abdominal migraines often will grow into adults with true migraines. 124. 124. Question A 68 year old male patient who has smoked two packs per day for most of his life presents with concerns about lung cancer. He states that his friend was recently diagnosed, and he would like more information for signs and symptoms to watch for in the future. Which of the following is the most common presenting symptom of lung cancer? o Copious sputum production o Daily hemoptysis o Chronic cough o Dyspnea on exertion Incorrect A chronic cough is typically the presenting symptom of lung cancer. This is unfortunate as many patients who develop lung cancer are, or have previously been, smokers and therefore likely have a chronic cough at baseline. Hemoptysis and dyspnea on exertion may be seen with lung cancer, but are not the most common presenting symptoms. In addition, copious sputum production would be more likely to be seen with other conditions such as acute bronchitis. 125. 125. Question A 12 year old female presents to her annual physical and is concerned that she is much shorter than her classmates. During the physical exam, the nurse practitioner notices she is only 4 feet 6 inches, has no breast development, and has wide shoulders and neck. Which of the following differentials is the minutes. What medication, if reported as taking by this patient, may put him at a higher risk for this condition? o Cephalexin (Keflex) for a recent cellulitis infection o Propranolol (Inderal XL) for chronic migraine prophylaxis o Colchicine (Colcrys) for a gout flare o Acyclovir (Zovirax) as herpes simplex suppressive treatment Incorrect This patient is suffering from nephrolithiasis, or a renal calculi. This is most commonly caused by a buildup of calcium oxalate, and occurs most frequently in males. Most stones pass within 48 hours, but severe cases may need to be referred to the emergency room. This patient should hydrate well, can take NSAIDs for pain, and should strain his urine to try and catch the stone. If he does catch it, he should bring it to the office for evaluation. Medications like acyclovir, sulfadiazine, and indinavir can all increase risk for nephrolithiasis. 128. 128. Question Which of the following are common side effects associated with the Copper-T intrauterine device (IUD)? o Irregular menses and cramping o Breast tenderness and nipple discharge o Increase in depressive symptoms and mood disorders o Weight gain and acne Correct The Copper-T intrauterine device (IUD) is a non-hormonal birth control option, but with any IUD, there is an increased risk of irregular menstrual cycles and cramping. The Copper-T IUD has no effect on breast tissue, weight, acne, or mood disorders because it is a non- hormonal device. 129. 129. Question You are currently a nurse practitioner in Arkansas and do not have a collaborating physician agreement in place. You plan to move to Kansas and would like to know whether you need a collaborating physician to practice. Where would you find this information? o The National Council of State Boards of Nursing o Nursing Board Certification Body o American Nurses Association o State Nursing Practice Act Incorrect Your scope of practice as a nurse practitioner varies based on each state. This information can be found in the State Nurse Practice Act. This is enforced by the State Board of Nursing. 130. 130. Question A pregnant patient who is currently at 14 weeks gestation is following up in regards to concerns over her prenatal lab results. Which of the following would be inappropriate to tell the patient? Select all that apply by choosing three of the following answer choices. o “Because you are HIV positive, you cannot have a vaginal delivery.” o “Even though varicella titer was negative, you cannot receive a booster until after delivery.” o “Because your Rh was negative, you will definitely need a Rhogam shot around 28 weeks and after delivery.” o “Your hepatitis B status is immune, but it is recommended that your baby receive the hepatitis B vaccine on the first day of life.” o “Since your rubella titer was negative, you do not need any boosters.” Correct While mothers who are Rh negative will receive Rhogam around 28 weeks gestation, they only need the vaccination after delivery if the newborn is Rh positive. 131. 131. Question The nurse practitioner is preparing for a new patient visit of a 75 year old female by reading her former primary care provider’s office visit note. In the note, it is noted that this patient has a history of frequent falls, Barrett’s esophagus, impaired sleep patterns, hiatal hernia, osteoporosis, restrictive lung disease, and mid-back pain. Of the following diagnoses, which might you suspect to also see in the note? o Discitis o Sciatica o Spinal stenosis o Hyperkypho sis Correct All of the history listed above are common findings in a patient with hyperkyphosis, or excessive curvature of the thoracic spine. It is commonly called a “hunchback” or Dowager’s hypochromic in nature. Iron deficiency anemia is one of the most common hypochromic, microcytic anemias. 134. 134. Question A 65 year old female patient presents with a cough, wheezing and chest congestion for the last four days. She states that she feels as if she cannot stop coughing, and often coughs up yellow-green phlegm. After further evaluation, the nurse practitioner suspects a possible diagnosis of acute bronchitis. Which of the following items would be inappropriate for the nurse practitioner to include in this patient’s plan of care? o Educate the patient to use a humidifier as needed o Azithromycin (Z-pak) o Mucinex (Guaifenesin) o Albuterol sulfate (ProAir) inhaler Correct The majority of acute bronchitis cases are viral in nature, which means that the use of an antibiotic is often not needed as treatment. Due to the patient’s complaint of wheezing, both an Albuterol sulfate inhaler as well as a humidifier would be warranted. In addition, to make it easier for the patient to cough up sputum, Mucinex may be used in conjunction with adequate hydration. 135. 135. Question A 53-year-old patient presents with worsening symptoms of depression despite trying several different first line antidepressants. After discussing various options with the patient, you both come to the agreement that the best medication to begin at this time is amitriptyline (Elavil). What are some side effects that should be discussed with the patient prior to beginning this medication? Select all that apply by choosing three of the following answer choices. o Dry mouth o Insomnia o Diarrhea o Delirium o Weight gain Incorrect Tricyclic antidepressants, such as amitriptyline (Elavil), can cause anticholinergic-type side effects like dry mouth, constipation, and blurred vision, not diarrhea. These medications can also cause central nervous system (CNS) depression leading to increased drowsiness, not insomnia, and can cause weight gain. 136. 136. Question A 12-year-old patient comes in with their parent after experiencing a severe sore throat for the last 3 days, along with fever and malaise. He states it is painful to swallow and he feels extremely fatigued. On the exam the nurse practitioner notes 3+ tonsils bilaterally, which the patient reports developed over the last week or so. Which of the following would be the most likely diagnosis? o Infectious mononucleosis o Streptococcal infection o Tonsilloliths o Bacterial tonsillitis Incorrect Infectious mononucleosis can be identified based on symptoms of fever, fatigue, tonsillar exudate, and adenopathy. Further diagnostic workup includes a CBC, and an EBV profile. A point of care “mono spot” test can help expedite diagnosis. For a return to sports, a spleen ultrasound should be performed. 137. 137. Question A child with Down syndrome is interested in participating in sports later this year. He is undecided between soccer or swimming at this time. Which of the following would contraindicate this child’s ability to play sports safely? o Absence of cervical lordosis o Pseudosubluxation of C2 on C3 o Cervical instability o Incomplete ossification of posterior vertebral elements Correct : Individuals with Down syndrome are at an increased risk for cervical spine instability, also known as atlantoaxial instability. Because of this, a cervical spine x-ray is warranted for all patients with Down syndrome prior to participating in sports to ensure safety. If the x-ray results are positive for cervical instability, the patient cannot safely participate in sports. All other findings listed are normal anatomic variants in the c- spine of children. 138. 138. Question A 74 year old female presents for an annual physical exam accompanied by her daughter who voices concerns regarding her mother’s memory. The nurse practitioner is aware that she is demonstrating early signs of dementia. Which of the following best explains the underlying cause of Alzheimer’s disease? o Thiamine deficiency due to frequent binge drinking use can cause damage to the brain o Ischemic damage due to atherosclerotic plaques, bleeding, or blood clots o Loss of dopamine receptors in the basal ganglia of the substantia nigra o Deposits of beta amyloid protein and neurofibrillary tangles on the frontal and temporal lobes Correct Alzheimer’s disease is the number one cause of dementia and the most common form of dementia in the United States. Neurofibrillary tangles or plaques can develop overtime leading to permanent brain damage resulting in a decrease in acetylcholine production. Loss of dopamine is seen in Parkinson’s disease. Alcoholics who develop a thiamine deficiency likely have Wernicke-Korsakoff syndrome. Ischemic damage can cause vascular dementia. 139. 139. Question According to the COPD GOLD guidelines, which of the following medications should be prescribed to patients in Group B? o Budesonide (Entocort) o Formoterol (Perforomist) o Ipratropium (Atrovent) o Albuterol (ProAir) Incorrect It has been found that patients in Group B benefit from a long acting bronchodilator, with a long acting beta agonist or a long acting muscarin 140. 140. Question An elderly patient presents for followup regarding a pressure injury on the back of the left heel. Upon exam, a stable heel eschar is noted with no associated drainage or erythema. Which of the following is the most appropriate plan of care for this patient? o Irrigate the site with normal saline but leave the eschar in place o Remove the eschar and initiate a compression wrap over the foot crease may be present, it would likely be present across the nose and not the upper lip. 143. 143. Question The nurse practitioner is assessing a 6-month-old infant who was born at 26-weeks-gestation. She can not roll belly to back yet, but can roll back to belly. The baby’s mother asks when she should be expected to catch up with the other babies who were born at term. Which of the following is a correct teaching statement? o She should be referred for neurocognitive testing due to her inability to roll in both directions, which is expected at 6-months old regardless of gestational age at birth o Babies born near-term like this baby should not be behind with milestones o Because she was born before 30-weeks, it can take up to a year for her to catch up to expected milestones o Babies born prematurely can be expected to catch up to milestones at about 24 months old Correct Premature babies may lag in milestones for up to the first 24 months of life. Typically, the closer to being full term babies are born at, the quicker they catch up to normal expected milestones. It would not be expected that this baby, born at 26-weeks, would be able to roll in both directions at 6 months old. 144. 144. Question A mother comes back for a visit as her symptoms of mastitis have not improved. She states she does not have a fever any longer, but her breast is still extremely painful along with several other symptoms. Which of the following is the best course of action for this patient? o Extend her dicloxacillin (Dynapen) course for another week o Start her on cephalexin (Keflex) as the bacteria causing the mastitis was most likely penicillin resistant o Do nothing as her fever is gone and her breast symptoms should soon resolve o Refer her to a breast surgeon for a breast ultrasound and possible mammogram Incorrect Patients treated for mastitis who do not experience total resolution of their symptoms after treatment should be referred for follow up. This is because breast cancer can be misdiagnosed as mastitis, so this needs to be investigated further. 145. 145. Question Your 65 year old male patient was recently diagnosed with heart failure. When doing a medication reconciliation, which medication would be the most appropriate to discontinue at today’s visit? o Diclofenac (Voltaren) o Sertraline (Zoloft) o Enalapril (Vasotec) o Acetaminophen (Tylenol) Incorrect Diclofenac is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are typically avoided in those with heart failure due to their potential to exacerbate sodium retention. In addition, it has been found that NSAIDs may also decrease the effectiveness of antihypertensives. 146. 146. Question A patient comes in today with complaints of an abnormal growth on both of his eyes. He states that it is causing some discomfort and blurry vision more recently, prompting the visit. Upon examination, you note mild erythema bilaterally as well as bilateral 3.1 mm, flat, white growths encroaching onto the cornea. What is the most likely diagnosis? o Pinguecula o Subconjunctival hemorrhage o Pterygium o Conjunctival squamous cell carcinoma Correct This patient presentation is consistent with a pterygium. Pterygiums are benign overgrowths of the conjunctiva that frequently present as eye redness and irritation. One distinguishing feature is that it encroaches onto the cornea. Patient’s with these usually do not seek treatment until it causes discomfort or vision changes. 147. 147. Question A 14 year old female presents to the clinic today by herself stating that she isn’t sure what to do because she was just sexually assaulted by a family member. Which of the following actions would be the most appropriate for the nurse practitioner to perform next? o Tell the patient that since she is a minor, you need parental consent in order to treat her o Send the patient to the emergency room so a rape kit can be completed o Reassure the patient that she is safe and facilitate open dialogue with her o Report the sexual assault to local law enforcement Correct In patients who have been sexually assaulted, it is important to use therapeutic communication, remind the patient that they are safe, and interview the patient in a non-judgemental way. Parental consent is not required for minors who are seeking care after being sexually assaulted. While it is important to report the event since this patient is a minor, we want to reassure and talk with the patient first. Medical exams and rape kits can be collected in the office. 148. 148. Question A 25 year old female patient has been having recurrent bouts of hidradenitis suppurativa over the last several years. The patient is frustrated about the condition and is looking for guidance on how to prevent these from occurring as frequently. The nurse practitioner reports that which of the following are modifiable risk factors for hidradenitis suppurativa? Select all that apply by choosing two of the following answer choices. o Poor hygiene o Female gender o Obesity o Smoking o Family history Incorrect Smoking and obesity have both been linked to hidradenitis suppurativa, and are both considered to be modifiable risk factors. Family history and female gender are also both risk factors for this condition, but are non-modifiable. In addition, poor hygiene does not cause this condition to occur. It is often- times more so related to genetics than anything else. 149. 149. Question A patient presents for a diabetic follow up and has an HgbA1c of 8.7 at today’s visit. This is an increase from 7.9 three months ago. After educating him that he will likely need to start insulin soon, the patient decides to be more compliant with a healthy diet and wants to start an exercise routine. Which of the following is this an example of? having shortness of breath and facial swelling after taking Augmentin (amoxicillin/clavulanate) as a child. Which of the following antibiotics would be appropriate to prescribe for this condition? Select all that apply by choosing two of the following answer choices. o Augmentin (Amoxicillin/clavulanate) o Cephalexin (Keflex) o Erythromycin (EES) o Dicloxacillin (Dycill) o Clindamycin (Cleocin) Incorrect As this patient has previously had an anaphylactic reaction to penicillins, this contraindicates the use of both penicillins and cephalosporins. Erythromycin and Clindamycin are great alternative options to treat this patient’s acute mastitis. 154. 154. Question A patient presents with a cat bite on her left lower wrist. The patient states that the cat is fully vaccinated and mostly lives inside her house. The nurse practitioner irrigates the wound and it appears both clean and shallow. Which of the following antibiotics would be most appropriate to prescribe? o Antibiotics are not necessary o Oral cephalexin (Keflex) o Oral amoxicillin/clavulanate (Augmentin) o Topical mupirocin (Bactroban) o Oral amoxicillin (Amoxil) Correct Bite wounds, especially from cats, dogs, or humans, have a high risk of infection. After these injuries, it is most appropriate to clean the wound and prescribe an empiric antibiotic such as amoxicillin/clavulanate (Augmentin) for prophylaxis of infection. 155. 155. Question A mother presents with her 5 year old son with concerns over his vision. She states that he is having immense difficulty distinguishing between the colors red and green while at school. Which of the following would be the most appropriate for the nurse practitioner to do next? o Screen the child for attention deficit hyperactivity disorder (ADHD) o Perform the Ishihara test with the child o Educate the mother that he is not old enough for 20/20 vision, so this will improve in a few years o Refer the patient to ophthalmology for further evaluation Correct The mother’s description suggests that this child may be colorblind. To assess color blindness, an Ishihara test is performed. If the child is able to correctly identify 12 of the 14 charts presented, it is considered a passing score. 156. 156. Question A 10-year-old boy presents to the office today with his father. The father is concerned as he noticed after soccer practice that his son had swelling just below his left knee that has not gone down in size. There was no trauma or injury noted to the affected knee. The patient states that the “bump” does not hurt during activity and there is only mild tenderness on palpation during the exam. Which of the following is the most likely diagnosis? o Osgood-Schlatter Disease o Anterior Cruciate Ligament tear o Patellofemoral pain syndrome o Tibial fracture Correct Osgood-Schlatter is a common disease in young adolescents. It creates an area of inflammation where the patellar tendon attaches to the tibia. The inflammation is due to the repetitive pulling motion of the quadricep muscle on the patellar tendon, which then also pulls on the tibial tubercle. It occurs most often during growth spurts and treatment can include rest, ice, and non-steroidal antiinflammatory drugs. However, often-times children are asymptomatic and can return to playing sports immediately. 157. 157. Question A three year old presents to the clinic today as his mother is very concerned about his delayed development. She states that recently he has been much more uncoordinated than usual in addition to acting more aggressive. Which of the following signs and symptoms would not support a possible differential of Fragile X syndrome? o Macrognathia o Pectus Excavatum o Pterygium colli o Scoliosis Incorrect Pterygium colli is the medical term for “webbed neck” which is seen in Turner’s syndrome. Macrognathia indicates a large jaw is present, which is common in Fragile X syndrome. Scoliosis and pectus excavatum are also typically seen in those with this syndrome as well. 158. 158. Question A nurse practitioner student is reviewing causes of community acquired pneumonia with their preceptor. The preceptor notes that which of the following bacterias leads to the most overall deaths in patients with community acquired pneumonia? o Mycoplasma pneumoniae o Staphylococcus aureus o Streptococcus pneumoniae o Legionella Correct Streptococcus pneumoniae is the most common bacterial cause of community acquired pneumonia that leads to death. This particular bacteria can lead to necrotizing pneumonia and hemorrhages within the lungs. It also can be unresponsive to antibiotics, making it more difficult to treat. 159. 159. Question A middle aged patient presents to have a “beauty mark” assessed that has recently changed colors. After completing the ABCDE assessment, the nurse practitioner suspects a possible diagnosis of malignant melanoma. Which of the following is the most appropriate plan of care for this patient? o Tell the patient we will refer her to dermatology but it does not warrant immediate attention. o Tell the patient not to be concerned as this is benign so treatment is not needed. o Tell the patient we will continue to watch the lesion and if it grows any larger that we will refer her to dermatology. o Refer the patient immediately to dermatology for treatment Correct Malignant melanoma needs to be referred out immediately to dermatology. Although less common, it is an aggressive form of skin cancer that can spread easily to other organs if not treated in a timely 165. 165. Question A patient recently diagnosed with hypertension begins to exercise and also quits smoking. Which of the following levels of prevention for hypertension is this? o This does not represent a level of prevention o Primary prevention o Secondary prevention o Tertiary prevention Correct Tertiary prevention represents treatment and preventing complications from the disease. Since this patient has already been diagnosed with hypertension, this is an example of tertiary prevention, or helping treat and reduce the complications of hypertension. If the patient was exercising and quitting smoking to prevent a diagnosis of hypertension, that would be an example of primary prevention. Secondary prevention represents screening and early diagnosis/recognition. 166. 166. Question The nurse practitioner is seeing a 22 year old for a follow up after an accidental burn injury. Upon assessment of the scarring, an area is noted that is erythematous and raised above her normal skin level, but is confined to the original burn area. She reports moderate pain. What is this patient experiencing? o Pitted scar o Hypertrophic scar o Scar contracture o Keloi d Incorrect Hypertrophic scars present as raised areas similarly to keloids, but do not invade the surrounding healthy tissue. They typically go through rapid growth phases of about six months and then improve over the following 12 to 18 months. Hypertrophic scars usually occur at the following sites: lacerations, burns, surgical wounds, vaccination sites, or over acne. 167. 167. Question Acute otitis media often presents as an erythematous, bulging tympanic membrane when looked at on an otoscopic exam. Which of the following is not a typical cause of acute otitis media? o Streptococcus pneumoniae o Non-typeable Haemophilus influenzae o Staphylococcus aureus o Moraxella catarrhalis Incorrect Acute otitis media if often seen after viral infection, but can be bacterial in nature. Common causes include Streptococcus pneumoniae, Moraxella catarrhalis, and non-typeable Haemophilus influenzae. Amoxicillin (Amoxil), the first line antibiotic for acute otitis media, will treat all of these causes. If the patient has a penicillin allergy, macrolides like azithromycin (Zithromax) can be used. 168. 168. Question A patient with a history of mild persistent asthma has been using inhaled budesonide (Pulmicort) twice daily for over a year and rarely needs to use her rescue inhaler. Her pulmonary function tests show her FEV1 at 93%. She states her allergy symptoms have been much better since moving out of a house with a cat 6 months ago and she is interested in stepping down her treatment. What response is most appropriate by the nurse practitioner? o “You can stop taking your budesonide (Pulmicort) today and follow up for repeat pulmonary function tests in 3 months.” o “Since you have been diagnosed with mild persistent asthma, you should remain on budesonide (Pulmicort) to control the inflammation in your lungs.” o “As long as your symptoms have improved, you can discontinue your budesonide (Pulmicort) immediately and report any worsening symptoms.” o “You can taper down on the budesonide (Pulmicort) gradually and follow up for repeat pulmonary function tests.” Correct Step-down treatment of asthma is not based on symptoms or rescue inhaler use alone. If the patient’s pulmonary function tests have improved and triggers have lessened, the patient can gradually try and taper off the routine inhaled corticosteroid. The inhaled corticosteroid should still be used as a rescue option as needed. It is important to not abruptly discontinue and inhaled corticosteroids in order to prevent the patient from developing any exacerbations or withdrawal effects. 169. 169. Question A patient is requesting treatment for her erythematous facial rash. You note dryness, redness, and a few pimples on her nose and cheekbones, with a few lesions on her nasolabial creases. Which of the following is o Puberty begins o The penis grows more in width than length o The scrotum enlarges and has fine pubic hair o The penis elongates Correct In tanner stage II, males get a few, fine pubic hairs and enlargement of the scrotum. Tanner stage II marks the beginning of puberty. Tanner stage III is the stage in which the penis elongates the most. In tanner stage IV, it grows more in width and the scrotum/testes enlarge and darken. 175. 175. Question An 11 year old female patient presents to the clinic with a headache and sore throat that started two days ago. Upon exam, there are red, blotchy areas present on the roof of the mouth in addition to thick, white tonsillar exudates. The patient is diagnosed with a classic case of strep throat, and is treated with Amoxicillin (Amoxil). Which of the following is not a potential complication of untreated strep throat? o Glomerulonephritis o Rheumatic fever o Septal perforation o Tonsillar abscess Correct Septal perforation is usually due to some type of nasal trauma. This trauma could be from a piercing, inflammation, intranasal drug use, etc. Untreated strep throat can lead to rheumatic fever, tonsillar abscesses, and glomerulonephritis. 176. 176. Question Which of the following is not a component of the “female athlete triad”? o Irregular menstruation/amenorrhea o Decreased bone density o Compulsive exercise o Restrictive eating Correct The female athlete triad is a combination of three conditions – irregular menstruation/amenorrhea, osteoporosis, and restrictive eating habits. This triad is common in sports in which females are rewarded for their appearance. This needs to be addressed as soon as it is noticed due to the long term health effects this could have on the body.