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Neurological and Psychiatric Disorders: Symptoms, Diagnosis, and Treatment, Exams of Health Physics

A wide range of neurological and psychiatric disorders, including parkinson's disease, generalized anxiety disorder, lewy body dementia, primary hyperparathyroidism, and more. It provides information on the symptoms, diagnostic tests, and recommended treatments for these conditions. Likely intended for medical students, healthcare professionals, or individuals interested in understanding the complexities of neurological and mental health disorders. It covers topics such as the role of the primary care provider in cancer management, the importance of neuropsychological testing for older adults with suspected dementia, and the management of various endocrine and hematological disorders. The level of detail and medical terminology suggest this document could be useful as study notes, lecture notes, or a summary for university-level courses in fields like neurology, psychiatry, or internal medicine.

Typology: Exams

2023/2024

Available from 09/12/2024

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FNP Final Exam Questions & Verified Answers.

A patient has recurrent cluster headaches and asks about abortive therapy. Which therapy is effective for a majority of patients with cluster headaches? a. Lithium b. NSAIDs c. Oxygen D. Verapamil - ANS C. Oxygen A patient reports recurrent headaches occurring 1 or 2 times per month that generally occur with weather changes or when sleep patterns are disrupted and describes them as severe, with throbbing on one side of the head and sometimes accompanied by nausea. What is the recommended treatment for this type of headache? a. Gabapentin b. Propranolol c. Rizatriptan d. Topiramate - ANS c. Rizatriptan Which medication is NOT useful in treating tension-type headaches? a. Antiemetics b. Lithium c. Muscle relaxants d. NSAIDse. Oxygen - ANS b. Lithium A patient reports two episodes of visual disturbances and eye pain that lasted 1 to 2 days each about 2 months apart. Which diagnostic testing will the provider order initially? a. Lumbar puncture b. Magnetic resonance imaging c. Optical Coherence Tomography d. Visual evoked potential - ANS b. Magnetic resonance imaging A patient with Parkinson's disease (PD) has been taking carbidopa-levodopa (Sinemet) with good results but develops increased dyskinesia. Which drug will be added to this patient's regimen to help control this symptom? a. Amantadine b. Benztropine c. Ropinirole d. Tolcapone - ANS a. Amantadine All of the following are common symptoms seen in patients with Parkinson's disease except: a. Bradykinesia b. Festination c. Hyperphonia d. Rigidity

e. Symmetric tremor - ANS c. Hyperphonia Which drug is used to treat patients with focal epilepsy and complex partial seizures? a. Carbamazepine b. Ethosuximide c. Lamotrigine d. Topiramate - ANS a. Carbamazepine A patient develops a gait disorder and the patient's spouse reports noticing recent personality changes. The provider suspects a brain lesion. Which evaluation is especially important in the initial physical examination? a. Assessment of peripheral reflexes b. Evaluation of speech c. Examination of the optic fundi d. Testing for memory loss - ANS c. Examination of the optic fundi A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do? A. Advise the parent that the child is exhibiting early symptoms of ADHD. B. Engage the parent in positive parenting strategies to facilitate appropriate child coping. C. Recommend evaluating the child for conduct or oppositional defiant disorder. D. Suggest putting the child in another day care center to ameliorate the problems - ANS B. Engage the parent in positive parenting strategies to facilitate appropriate child coping. A 14yearold female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect? A. Anorexia nervosa B. Bulimia nervosa C. Depression D. Substance abuse - ANS A. Anorexia nervosa During a well child examination on a 4monthold infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent infant relationship? a. "I can sense a difference in my baby's cries." b. "I let my baby cry a while to learn to be patient." c. "My baby prefers to nurse in a darkened room." d. "My baby seems very sensitive to loud noises." - ANS b. "I let my baby cry a while to learn to be patient."

The primary care pediatric nurse practitioner attempts to learn more about the emotional health of an 18monthold child through which assessment strategy? a. Asking the child to tell a story using dolls and other props b. Asking the child to draw a picture of him or herself and other family members c. Interviewing the child separately from caretakers and parents d. Observation of the child with caretakers in structured and unstructured situations - ANS d. Observation of the child with caretakers in structured and unstructured situations The parent of a 4 year old child reports that the child seems to be having trouble adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do? a. Ask the parent if the child is slow to warm up to other new situations. b. Reassure the parent that parallel play is common among preschool age children. c. Recommend that the parent spend time encouraging the child to play with others. d. Suggest that the day care center may be neglecting the child. - ANS a. Ask the parent if the child is slow to warm up to other new situations. The parent of a school age child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child? a. Generalized anxiety disorder (GAD) b. obsessive-compulsive disorder (OCD) c. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) d. Separation anxiety disorder (SAD) - ANS a. Generalized anxiety disorder (GAD) A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates and often spends time sitting quietly. What will the nurse practitioner do initially? a. Ask the mother about the child's relationship with the father. b. Consult with a child psychiatrist to prescribe medications. c. Recommend cognitive behavioral or psychodynamic therapy. d. Refer the family to a child behavioral specialist for counseling. - ANS a. Ask the mother about the child's relationship with the father. An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk?

a. Addition of risperidone therapy b. Cognitive behavioral therapy c. Family therapy d. Hospitalization - ANS b. Cognitive behavioral therapy A 13 year old child has exhibited symptoms of mild depression for several weeks. The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do? A. Administer an ADHD diagnostic scale and consider an ADHD medication. B. Consult with a child psychiatrist to prescribe an antidepressant medication. C. Reassure the parent that this behavior is common after mild depressive symptoms D. Refer the child to a child psychiatrist for evaluation of bipolar disorder. - ANS D. Refer the child to a child psychiatrist for evaluation of bipolar disorder. A 35-year-old patient reports suddenly experiencing an asymmetric smile along with drooping and tearing in one eye. The patient has a history of a recent viral illness but is otherwise healthy. During the exam, the provider notes that there is unilateral full-face paralysis on the right side. What is the initial intervention for this patient? a. Perform confirmatory diagnostic tests b. Prescribe oral prednisolone c. Recommend wearing an eye patch d. Refer the patient to a neurologist - ANS b. Prescribe oral prednisolone A patient reports symptoms of restlessness, fatigue, and difficulty concentrating. The provider determines that these symptoms occur in relation to many events and concerns. What other things will the provider question this patient about? a. Ability to manage social situations b. Body image and eating habits c. Headaches and bowel habits d. Occupational performance - ANS c. Headaches and bowel habits The spouse of a patient newly diagnosed with amyotrophic lateral sclerosis (ALS) asks about long-term care. What will the provider include when teaching the family about this disease? a. Bowel and bladder function will eventually be lost b. Positive-pressure ventilation can prolong life. c. Preventing malnutrition is a key element in care. d. The nerves affecting sensation will die initially. - ANS c. Preventing malnutrition is a key element in care. What is recommended to prevent ophthalmic complications in patients with Bell's palsy?

a. Acupuncture b. Lubricating eye drops c. Patching of the eye d. Sunglasses - ANS b. Lubricating eye drops A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient's symptoms? a. Alzheimer's disease b. Lewy body dementia c. Pseudodementia d. Vascular neurocognitive disorder - ANS b. Lewy body dementia A patient with Alzheimer's disease (AD) is taking donepezil to treat cognitive symptoms. The patient's son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms? a. Encourage activity and exercise b. Prescribe a selective serotonin reuptake inhibitor c. Recommend risperidone d. Referral to a neurologist for evaluation - ANS a. Encourage activity and exercise What is an important purpose of conducting an interview prior to beginning neuropsychological testing on an older adult suspected of having dementia? a. To assess the patient's ability to cooperate with the testing b. To determine the patient's degree of dementia c. To evaluate the patient's feelings about family members' concerns d. To find out whether a referral to a specialist is needed - ANS a. To assess the patient's ability to cooperate with the testing An elderly patient has symptoms of depression and the patient's daughter asks about possible Alzheimer's disease since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient? a. Order brain imaging studies such as CT or MRI b. Perform genetic testing to identify true risk c. Prescribe a trial of an antidepressant medication d. Recommend a trial of a cholinesterase inhibitor drug - ANS c. Prescribe a trial of an antidepressant medication A patient being treated with for caner has had chemotherapy within the past two weeks and comes to the primary care clinic with a fever of 38.5. What is the initial action? a. Order blood and urine cultures

b. Obtain a STAT CBC with diff c. Prescribe empiric antibiotics d. Order a chest radiograph - ANS b. Obtain a STAT CBC with diff Which of the following is NOT considered an oncologic emergency in a patient with cancer requiring urgent referral to an oncologist? a. SIADH b. Superior vena cava syndrome c. Bone marrow suppression d. Tumor lysis syndrome - ANS c. Bone marrow suppression Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism? a. Appropriately high PTH along with hypocalcemia b. Inappropriate secretion of PTH along with hypercalcemia c. Appropriately increased PTH and low or normal serum calcium d. Prolonged inappropriate secretion of PTH with subsequent hypercalcemia - ANS b. Inappropriate secretion of PTH along with hypercalcemia A patient is diagnosed with osteoporosis. What is the recommended treatment once the diagnosis is made? a. Estrogen replacement b. Calcium and vitamin D c. Yoga and weight bearing exercises d. Bisphosphonate therapy - ANS d. Bisphosphonate therapy The primary care provider is assessing a 45-year-old postmenopausal woman who has a family history of osteoporosis. Which test will be most useful to screen for this disease? a. Bone specific alkaline phosphate b. Bone densitometry of the hip and posteroanterior lumbar spine c. Plain radiographs of the hips and lumbar and thoracic spine d. Serum calcium and serum 25-hydroxyvitamin D - ANS b. Bone densitometry of the hip and posteroanterior lumbar spine A patient with normal renal function has a potassium level of 6.0 mEq/L. Which underlying cause is possible in this patient? a. Adrenocortical deficiency b. Malabsorption syndrome c. Alcoholism d. Hypertension - ANS a. Adrenocortical deficiency

A patient with cancer is expected to require long-term pain medication to manage cancer pain. Which agent will be best for this patient? a. Naloxone b. Ibuprofen c. Meperidine d. Morphine - ANS d. Morphine A woman has stopped having menstrual periods has vasomotor symptoms but does not want to use HRT. What measure will the provider recommend? a. Increase caffeine intake b. Keeping the house cold c. Trying herbal remedies d. Keeping the house cool, use of personal fans e. Having a glass of wine or two each evening - ANS d. Keeping the house cool, use of personal fans A woman who is taking oral contraceptives to prevent pregnancy calls the provider to report forgetting to take the pills for 4 days. She has not had sex. What will the provider recommend? a. Use a morning after pill today and resume the OCP's b. Resume the pills and use a back up method the remainder of the cycle c. Stop the OCP and use alternative method and resume OCP at the next cycle d. Take 2 pills daily for 4 days and use an alternate method for 4 days - ANS b. Resume the pills and use a back up method the remainder of the cycle An adolescent female reports moderate dysmenorrhea with periods and tells the provider that 400mg of ibuprofen Q6-8 hours does not control her pain. What will the provider recommend? a. Using extended-release naproxen 500 mg Q b. Increasing the ibuprofen does to 600 to 800 mg Q 6-8 hours c. Taking extra strength Tylenol 1000mg Q4-6 hours d. Taking naproxen 500 mg initially and then 250 mg Q6-8 hours - ANS d. Taking naproxen 500 mg initially and then 250 mg Q6-8 hours An obsess adolescent female patient reports irregular periods and excessive acne. The provider notes an increased amount of hair on her upper back, shoulders, and upper abdomen. What will the provider do? a. Counsel her about diet, exercise, and weight loss b. Consider treatment with oral contraceptives c. Refer to endocrinologist for evaluation

d. Recommend cosmetic laser hair removal - ANS c. Refer to endocrinologist for evaluation A 45-year-old woman has gone 120 days without a menstrual period. A pregnancy test is negative. What will the provider do based on this symptom? a. Tell her she has developed early menopause b. Evaluate for various causes of amenorrhea c. Reassure her that this can be normal d. Tell her that this is likely perimenopause - ANS b. Evaluate for various causes of amenorrhea A patient has rapid weight gain, amenorrhea without pregnancy, and mild hypertension. Once confirmatory tests are performed, what is the possible treatment for this patient? a. Mineralocorticoid replacement b. Antihypertensive therapy c. Pituitary tumor resection d. Oral hydrocortisone - ANS c. Pituitary tumor resection What is the purpose of radiation treatment prior to surgical resection of a tumor? a. To minimize local recurrence b. To debulk the tumor mass c. To reduce pain and bleeding To prevent metastases - ANS b. To debulk the tumor mass A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above the normal without signs of nephrolithiasis. What is the recommended treatment for this patient? a. Annual monitoring of calcium, creatinine, and bone density b. Avoidance of weight bearing exercises c. Decreasing calcium and vitamin D intake until values are normal Parathyroidectomy - ANS a. Annual monitoring of calcium, creatinine, and bone density A patient has new-onset hypertension with a systolic BP of 180 mm Hg. Which test will the provider order to diagnose this patient? a. ACTH suppression testing b. Cortisol excretion studies c. Fractionated metanephrine levels Adrenal antibody tests - ANS c. Fractionated metanephrine levels A woman has history of migraines with aura and request oral contraception to prevent pregnancy. Which type of contraceptive will the provider recommend?

a. Transdermal combination patch b. Combination oral contraceptive c. Progestin-only contraception d. Contraceptive implant - ANS c. Progestin-only contraception A patient has unexplained weight loss and the provider notes increased skin pigmentation on light exposed skin folds along with darkened palmar creases. Which laboratory test will the provider NOT order? a. Serum cortisol b. TB skin testing c. Serum electrolytes d. Serum ACTH - ANS a. Serum cortisol A patient has carpal spasm when a blood pressure cuff is inflated. Which diagnostic testing will the provider consider evaluating the cause of this finding? A. Magnesium and vitamin D B. Calcitriol level C. C-reactive protein Protein electrophoresis - ANS A. Magnesium and vitamin D A patient has a low serum calcium associated with low albumin. What is the recommended treatment for this patient? a. Thiazide diuretics and sodium restriction b. Correction of other serum electrolytes c. Calcium supplementation only d. Vitamin D and calcium supplementation - ANS b. Correction of other serum electrolytes What is the most important role of the primary care provider in cancer management? a. Performing regular screenings to detect cancer b. Referring patients for genetic testing to identify those at risk c. Counseling about healthy practices to reduce risk factors d. Teaching patients about cancer management once diagnosed - ANS c. Counseling about healthy practices to reduce risk factors A patient with breast cancer has been symptom free for 6 months and reports a new onset of lower back pain rated an 8/10. What is most important when evaluating this patients pain? a. Prescribing a trial or oral opioid medication b. Evaluating the possibility of drug seeking behavior

c. Obtaining an MRI of the spinal cord d. Referring the patient to the oncologist - ANS c. Obtaining an MRI of the spinal cord When should palliative care be initiated by a PCP? a. When an interdisciplinary team is formed to manage a disease b. After an ill patient asks for hospice c. As part of routine health maintenance d. When a patient is diagnosed with a serious disease - ANS c. As part of routine health maintenance A patient has bone pain and laboratory testing reveals an elevated alkaline phosphatase (SAP). Which test can help distinguish Paget's rom malignant bone disease? a. Bone marrow biopsy b. Bone density c. Bone scan d. Bone radiograph - ANS d. Bone radiograph The PCP is evaluating a 10-year-old child who is describing shooting pain in both legs associated with aching, tingling, and burning. The child id unable to pinpoint specific locations for the pain. Which type of pain does the provider suspect? a. Neuropathic pain b. Chronic pain c. Somatic pain d. Visceral pain - ANS a. Neuropathic pain Which underlying causes are related to chronic pelvic pain in women? a. Age under 25 years b. Recurrent pneumonia c. Interstitial cystitis d. Hepatitis e. Menopause - ANS c. Interstitial cystitis What is a possible cause of decreased arousal, libido, and orgasm in postmenopausal women? a. Low estrogen levels b. Diminished testosterone c. Uterine prolapse d. Endometriosis - ANS b. Diminished testosterone

A female patient is identified as having the BRCA mutation and she asks which intervention will reduce the risk of breast cancer the most? What will the provider tell her? a. Prophylactic mastectomy and oophorectomy b. Early childbearing and breastfeeding c. Clinical breast examination every 6 months Breast MRI - ANS a. Prophylactic mastectomy and oophorectomy A 17-year-old patient has undergone surgical incision and drainage of a Bartholin's gland cyst with insertion of a drain. What is an important aspect of care for this patient? a. Education about long term dyspareunia b. Teaching about reproductive sequelae c. Weekly follow-up monitoring d. Administration of antibiotics - ANS c. Weekly follow-up monitoring An asymptomatic female learns that her boyfriend has gonorrhea and asks about antibiotics. What will the provider recommend? a. Amoxicillin-clavulanate for 10 days b. Cultures and treatment if symptoms appear c. Trimethoprim-sulfamethoxazole d. Empiric ceftriaxone and azithromycin - ANS d. Empiric ceftriaxone and azithromycin A 50-year-old man reports having erectile dysfunction. What is an important response by the provider when developing a plan of care for this patient? a. Considering testosterone hormone replacement therapy b. Prescribing an oral phosphodiesterase type 5 inhibitor c. Evaluating the patient for cardiovascular disease d. Referring the patient for psychotherapy and counseling - ANS c. Evaluating the patient for cardiovascular disease A previously healthy 22-year-old female reports pain in the rectovaginal area that occurs with sexual intercourse. What is the most likely cause of this patient's discomfort? a. Inadequate lubrication b. Atherosclerosis c. Psychologic issues d. Endometriosis - ANS d. Endometriosis During a well-baby exam on a 9-month-old infant, the parent reports that the baby always uses the left hand to pick up objects and asks if the baby will be left-handed. What will the primary care pediatric nurse practioner do?

a. Perform a careful assessment of fine and ross motor skills b. Tell the parent a hand preference usually develops between 6 and 12 months c. Teach the parent to encourage the infant to use both hands d. Explain that it is too soon to tell which hand the infant will prefer later - ANS a. Perform a careful assessment of fine and ross motor skills A 30-year-old male patient has a positive leukocyte esterase and nitrites on a random urine dipstick during a well patient exam. What type of urinary tract infection does this represent? a. Unresolved b. Uncomplicated c. Isolation d. Complicated - ANS d. Complicated What is true about hypoactive sexual desire in older men? a. Hypoactive sexual desire in older men is related to sexual partners b. Hypoactive sexual desire is a conscious choice to avoid sexual relations c. The most common type of sexual dysfunction is hypoactive sexual desire d. Men with hypoactive sexual desire may have normal excitement and orgasm - ANS d. Men with hypoactive sexual desire may have normal excitement and orgasm A patient diagnosed with MS and began disease modulating therapy drugs. As part of the counseling about this therapy, the provider will tell the patient that this regimen will? a. Decrease the need for other medications b. Reduce the exacerbation rate c. Induce long-term remission d. Stop progression of the disability - ANS b. Reduce the exacerbation rate A woman who has had routine pap tests all of her life has an abnormal pap with low- grade intraepithelial lesion. What will the provider tell her about this result? a. The result most likely indicates HPV infection b. Colposcopy with biopsy is necessary c. She most likely has early cervical cancer d. She may have vaginal cancer - ANS b. Colposcopy with biopsy is necessary An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care provider care nurse do? a. Increase the TCA dose and reevaluate in 2-3 weeks b. Change the TCA to a SSRI c. Refer the adolescent to a pain management specialist

d. Evaluate the adolescent for drug-seeking behavior - ANS c. Refer the adolescent to a pain management specialist A 16-year-old female has primary amenorrhea. A pregnancy test is negative. Further testing reveals a normal TSH and an elevated prolactin level. Which test will the provider order next? a. Progesterone challenge test b. MRI c. Serum dehydroepiandrosterone d. Clomiphene challenge test - ANS b. MRI A middle school age child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will the family practioner manage this situation? a. Prescribe short-term antidepressants for this situational problem b. Suggest that the child have close follow-up by a school counselor c. Refer the child to a mental health specialist for evaluation and treatment d. Schedule extended appointments for counseling and mental health intervention - ANS c. Refer the child to a mental health specialist for evaluation and treatment A 69-year-old patient with cancer is reluctant to take an opioid agonist medication because of the side effects. What will the primary care provider recommend? a. Using opioids on an as needed basis only b. Taking a stool softener with the opioid c. Adding an NSAID to the pain regimen d. Using diphenhydramine to prevent itching - ANS b. Taking a stool softener with the opioid What is the medical diagnostic term used to identify transgender patients? a. Gender expression disorder b. Gender identity disorder c. Gender dysphoria - ANS c. Gender dysphoria A woman who has stopped having menstrual periods has vasomotor symptoms but does not want to use HRT. What measures will the provider recommend? (Mark all that apply) a. Having a glass of wine each evening b. Trying herbal remedies c. Engaging in regular exercises d. Keeping the house cool e. Avoid caffeine - ANS c. Engaging in regular exercises

d. Keeping the house cool e. Avoid caffeine An adolescent female has amenorrhea. The provide notes short stature, neck webbing, and a pigeon chest deformity. Based on these symptoms, what is the underlying disorder causing this patient's amenorrhea? a. Androgen insensitivity b. Turner syndrome c. Polycystic ovarian disease d. Hypothyroidism - ANS b. Turner syndrome A 16-year-old patient with primary dysmenorrhea has taken NSAID's and COX- inhibitors without getting relief from symptoms. What will the provider suggest? a. A combined oral contraceptive b. Counsel the patient to apply warm compresses c. IUD d. Narcotic analgesics as needed - ANS a. A combined oral contraceptive A woman who has just weaned her infant form breastfeeding develops signs of mastitis and is treated with antibiotics. At a follow up visit, the provider notes marked breast edema and erythema of the affected breast. What will the provider do next? a. Prescribe antibiotics to treat MRSA infection b. Counsel the patient to apply warm compresses c. Refer the patient for immediate biopsy d. Consult with a surgeon for I/D of the breast - ANS c. Refer the patient for immediate biopsy What are risk factors for PID? a. Age over 25 b. Using barrier methods of contraception c. Vaginal douching d. Faulty posture e. Tubal sterilization - ANS c. Vaginal douching What is the benefit of using liquid-based medium when performing a pap test? a. It is predictive of the later development of cervical cancer b. It is not necessary to use endocervical cells to obtain results c. It allows HPV, gonorrhea, and chlamydia testing with the same specimen d. It is more accurate test than the slide method of pap testing - ANS c. It allows HPV, gonorrhea, and chlamydia testing with the same specimen

A 35-year-old woman without a previous history of dysmenorrhea reports lower pelvic pain and irregular bleeding between periods. What is the initial action in managing this patient? a. Ordering a CBC, erythrocyte sedimentation rate, and cultures b. Performing an abdominal, pelvic, and rectovaginal exam c. Obtaining a pelvic ultrasound with saline infusion d. Prescribing a trial of NSAID's - ANS b. Performing an abdominal, pelvic, and rectovaginal exam A young female has a pap test which reveals ASCUS. What will the next step be in managing this patient? a. Repeat cytology in 12 months b. Repeat cytology in 3 months c. Colposcopy with biopsy d. Endometrial sampling - ANS a. Repeat cytology in 12 months A primary care provider suspects Parkinson's disease in a 70-year-old patient. Which test may be performed to diagnose this disorder? a. Serum creatinine phosphokinase levels b. Neuromuscular studies to identify reflex function c. Prescence of 2 cardinal signs which improves with Levodopa d. Neuroimaging to identify specific midbrain lesion - ANS c. Prescence of 2 cardinal signs which improves with Levodopa What is true about HPV infection in women? a. Most HPV lesions will resolve without causing cancer b. HPV subtypes causing genital warts indicate the likelihood of cancer c. A single, isolated HPV infection will lead to cervical cancer d. Most women with HPV infection will develop cervical cancer - ANS a. Most HPV lesions will resolve without causing cancer A postmenopausal woman reports unilateral breast pain that she describes as sharp and burning and localized to one area. A breast exam reveals no dimpling, discharge, or masses. Which diagnostic test will the provider order? a. Bilateral mammogram b. Hormone levels c. Focused ultrasound d. Needle biopsy - ANS a. Bilateral mammogram

A 67-year-old female patient reports vulvar pruritis and dyspareunia. The provider notes white papules on the vulva with thinning of the epithelium. What condition does the provider suspect? a. Vulvar psoriasis b. STD c. Bartholin duct cyst d. Lichen sclerosis - ANS d. Lichen sclerosis An 18-year-old sexually active young female reports vaginal discharge and moderate vulvovaginal irritation. The exam reveals a white, non-inflammatory discharge adhering to the vaginal walls, clue cells on microscopic exam and a positive KOH whiff test. What will the provider do next? a. Prescribe metronidazole 500mg for 7 days b. Order a gynecological referral for evaluation and treatment c. Obtain cultures of the vaginal discharge d. Screen the patient for gonorrhea and chlamydia - ANS a. Prescribe metronidazole 500mg for 7 days A 16-year-old sexually active female has symptoms of PID with fever. Cultures are pending. For outpatient treatment, what will the provider order? a. Clindamycin and gentamycin b. Cefotetan and doxycycline c. Ampicillin and doxycycline d. Rocephin, doxycycline, and metronidazole - ANS d. Rocephin, doxycycline, and metronidazole A couple who has been trying to conceive for over 9 months ask the provider about artificial reproductive therap. When discussing risks and benefits associated with these methods, what will the provider include? a. Lower rates of pregnancy induced HTN b. Increased premature births c. Likelihood of increased infant birth weight d. Less frequent multiple gestations - ANS b. Increased premature births A school aged child comes to the clinic for evaluation of excessive bruising. The NP notes a history of a URI 2 weeks prior. The physical exam is negative for hepatosplenomegaly and lymphadenopathy. Blood work reveals a platelet count of 60,000/mm3 with normal PT/PTT. How will the NP manage this condition? a. Refer to a pediatric hematologist b. Admit to the hospital for IVIG therapy c. Teach to avoid NSAIDs and contact sports

Begin a short course of corticosteroids - ANS c. Teach to avoid NSAIDs and contact sports The family NP reviews a patient's CBC with diff WBC's values and recognizes a left shift because of a? a. Decreased eosinophil count b. An elevated neutrophil count c. Decreased lymphocyte count d. Elevated monocyte count - ANS b. An elevated neutrophil count An infant who has begun nursing develops hyperbilirubinemia. What will the NP tell the mother? a. Switch to a formula until the bilirubin level drops b. To use a breast pump to increase her milk supply c. To decrease the frequency of breastfeeding - ANS b. To use a breast pump to increase her milk supply A woman who is currently pregnant reports that she has had three previous pregnancies: twins delivered at 35 weeks gestation (both living), one at 38 weeks gestation (living), and one miscarriage at 16 weeks gestation. How will this be recorded as her G/TPAL in her chart? a. G4P: b. G5P: c. G5P: d. G4P:1213 - ANS a. G4P: The NP is examining a 5-year-old child who has had recurrent fevers, bone pain, and a recent loss of weight. The exam reveals scattered petechiae, lymphadenopathy, and bruising. A CBC shows thrombocytopenia, anemia, and an elevated WBC. The NP will refer this child to a specialist for what? a. Immunoglobin testing b. Corticosteroids and IVIG c. Hemoglobin electrophoresis d. Bone marrow biopsy - ANS d. Bone marrow biopsy A patient has type 1 Von Willebrand. What treatment is generally effective to prevent and treat bleeding episodes in this patient? a. Vitamin K b. Coagulation factor c. Heparin d. Desmopressin - ANS d. Desmopressin

A CBC on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5. the infant has mild pallor with no hepatosplenomegaly. The NP suspects what? a. Sickle cell anemia b. Lead intoxication c. Iron deficiency anemia d. Hereditary spherocytosis - ANS c. Iron deficiency anemia What types of lymphomas typically have an aggressive presentation? a. Burkitt lymphoma b. Follicular lymphoma c. Splenic marginal zone lymphoma d. Diffuse large B-cell lymphoma e. Hodgkin lymphoma - ANS d. Diffuse large B-cell lymphoma The NP performs a well-baby exam on a 4-month-old who is exclusively breastfed and whose mom plans to introduce only small amounts of fruits and veggies in addition to breastfeeding. To ensure that the infant gets adequate amounts of iron what will the NP recommend? a. Elemental iron supplementation of 1mg/kg/day until cereals are added b. Offering iron fortified formula to ensure adequate iron intake c. Elemental iron supplementation of 3mg/kg/day for the duration of breastfeeding d. Monitoring the infants H/H at every check-up - ANS a. Elemental iron supplementation of 1mg/kg/day until cereals are added The NP provides care for a 30-month-old who has sickle cell anemia who has had one dose of 23-valent pneumococcal vaccine. Which is an appropriate action for health maintenance in this child? a. Give second dose of 23-valent vaccine b. Administer an initial meningococcal vaccine c. Begin folic acid supplementation d. Decrease the dose of penicillin V prophylaxis - ANS b. Administer an initial meningococcal vaccine A NP is caring for a couple who are trying to conceive. To evaluate ovulation and luteal surge most accurately in the woman, what test will the provider recommend? a. Urinary luteal hormone home kit b. Maintaining a menstrual calendar c. Plasma midluteal progesterone concentration level d. Basal body temperature - ANS a. Urinary luteal hormone home kit

A patient reports a neck mass that has been present off and on for 5-6 weeks which vaies in size. The NP palpates a lymph node measuring 1.25cm. Which test will provide proper histologic diagnosis for this patient? a. Bone marrow aspirate b. Positron emission tomography scan c. CT scan with IV contrast d. Lymph node biopsy - ANS d. Lymph node biopsy A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the NP asks about family history of bleeding disorders. The patient reports no female relatives who have had bleeding episodes but states that a maternal uncle and his maternal grandfather both had post-surgical complications related to bleeding. Based on this history, which diagnosis is possible? a. Thrombocytopenia b. Von Willebrand disease c. Thrombophilia d. Hemophilia - ANS d. Hemophilia The mother of a 3-day old newborn reports that her infant nurses every 4 hours during the day and sleeps 6 hours at night. What will the NP recommend? a. Awakening the baby every 3 hours to nurse b. Continuing this schedule until the infant is 6 months old c. Ensuring that her infant nurses for 15-10 minutes each time d. Pumping her breasts to maintain her milk supply - ANS a. Awakening the baby every 3 hours to nurse A patient with myelodysplastic syndrome (MDS) has severe neutropenia and anemia is given erythropoietin with improvement in hemoglobin. Which intervention has been shown to prevent infection in patients with MDS who have severe neutropenia? a. Antithymocyte globulin and cyclosporine b. Granulocyte-macrophage colony-stimulating factor (GM-CSF) c. IV immunoglobin infusions d. Prophylactic treatment with floroquinolones - ANS d. Prophylactic treatment with floroquinolones A pregnant woman reports not having any vaccinations as a child but requests vaccines during her pregnancy. Which vaccines may be given? (Select all that apply) a. Inactivated influenza b. MMR c. HPV

d. Tdap - ANS a. Inactivated influenza c. HPV d. Tdap A female patient has lower abdominal pain, nausea, and vomiting and reports missing her period 3 weeks prior. The patient reports using an IUD for contraception. A serum B-hCG is 1500. What will the NP do based on these findings? a. Recheck the B-hCG level in 4-6 weeks b. Perform a transvaginal ultrasound c. Tell the patient that a viable pregnancy is likely d. Refer for a diagnostic laparoscopy - ANS b. Perform a transvaginal ultrasound A patient is noted to have prolonged bleeding after donating blood. A subsequent lab test reveals a prolonged aPTT time with a normal PT. based on this result, the provider may suspect alteration in function of which factor? a. Factor VIII b. Factor V c. Factor X d. Factor VII - ANS a. Factor VIII The NP sees a 12-month-old infant who is being fed goats milk and a vegetarian diet. The child is pale and has a beefy red, sore tongue and oral mucous membranes. Which tests will the NP order to evaluate this child's condition? a. RBC, folate, iron, and B12 levels b. Reticulocyte levels c. Serum lead levels d. Hemoglobin electrophoresis - ANS a. RBC, folate, iron, and B12 levels A mother who has been breastfeeding her infant for several weeks develops a fever, breast warmth, and breast tenderness. What will the NP recommend? a. Ice packs and increased frequency of nursing b. Ice packs and decreased frequency of nursing c. Warm packs and increased frequency of nursing d. Warm packs and decreased frequency of nursing - ANS c. Warm packs and increased frequency of nursing A pregnant woman, in first trimester, who is overweight has no previous history of HTN or DM. her initial screening exam reveals a BP of 140/90 and a fasting glucose of 128. What will the NP do? a. Prescribe an antihypertensive medication b. Monitor BP and fasting glucose closely

c. Refer the patient to a high-risk pregnancy specialist d. Initiate insulin therapy - ANS b. Monitor BP and fasting glucose closely A patient reports recent mild fatigue and palpitations. A CBC reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present? a. Paresthesia, koilonychia, and pica b. Decreased MCV, MCH, and MCHC c. Decreased hematocrit d. Elevated total iron-binding capacity - ANS c. Decreased hematocrit A 60-year-old female patient has recently lost weight and an exam reveals a beefy-red, sore tongue, with no neurological findings. Based on these clinical findings, what will the provider anticipate in the lab data? a. Normal methylmalonic acid level b. Leukopenia and thrombocytopenia c. Decreased homocysteine levels d. Low hemoglobin and elevated MCV - ANS d. Low hemoglobin and elevated MCV The NP reviews hematology reports on a child with beta-thalassemia minor and notes an hemoglobin of 8. What will the NP do? a. Prescribe supplemental iron b. Order Hgb electrophoresis c. Evaluate serum ferritin d. Refer for RBC transfusions - ANS c. Evaluate serum ferritin Which patient with documented HIV infection may be classified as having AIDS? a. A patient with a CD4 count of 250 b. A patient with a CD4 count of 400 c. A patient with TB d. A patient with contact a partner that has AIDS e. A patient with a CD4 count of 150 - ANS e. A patient with a CD4 count of 150 C is also correct A child has a fever and arthralgia. The primary care pediatric nurse practitioner learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order? a. ASO titer b. Rapid strep test c. Throat culture d. AntiDNase B test - ANS a. ASO titer

The primary care pediatric nurse practitioner is performing a well-baby checkup on a 6nmonth old infant and notes a candida diaper rash and oral thrush. The infant has had two ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do? a. Refer the infant to an otolaryngologist to evaluate recurrent OM b. Order a CBC with diff and platelets and quantitative immunoglobins c. Refer the infant to an immunologist for evaluation of immunodeficiency Order candida and pneumococcal skin test and lymphocyte surface markers - ANS b. Order a CBC with diff and platelets and quantitative immunoglobins Which is a distinctive finding in patients who have Churg-Strauss syndrome (CSS)? a. Elevated ESR and CRP b. Increased eosinophils c. HBV surface antigen d. Positive antinuclear antibodies - ANS b. Increased eosinophils A patient has a palpable purpural rash. This finding is most consistent with a. Small vessel vasculitis b. Medium vessel vasculitis c. Large vessel vasculitis d. Central vessel vasculitis - ANS a. Small vessel vasculitis A homeless patient who has HIV infection has been on ART for 18 months and has had a normal CD4 counts and viral loads for the past year. What will the provider recommend? a. Allow for periods of time off from ART medications b. Begin monitoring viral load and CD4 counts every 6-12 months c. Consider beginning highly active HAART d. Continue monitoring viral load and CD4 counts every 3-4 months - ANS d. Continue monitoring viral load and CD4 counts every 3-4 months A 12-year-old is brought to the clinic with joint pain, a 3-week history of low-grade fever, and a facial rash. The NP palpates an enlarged liver 2cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive. Which test may be ordered to confirm a diagnosis of SLE? a. Anti-La antibodies b. Anti-RO antibodies c. Anti-Sm antibodies d. Anti-double strand DNA antibodies - ANS d. Anti-double strand DNA antibodies

A patient with systemic lupus erythematosus (SLE) has frequent symptoms and has been taking prednisone for each episode. The provider plans to start hydroxychloroquine and the patient asks why this medication is necessary. What will the provider tell this patient about this medication? a. It is given in conjunction with steroids to improve outcomes b. It lowers BP and decreases the risk for renal disease c. It is effective in reducing disease flares and for tapering steroids d. It prevents the need for bisphosphonate therapy - ANS c. It is effective in reducing disease flares and for tapering steroids A patient with systemic lupus erythematosus (SLE) develops end-stage renal disease. Because of the underlying SLE, what treatment is recommended for this patient? a. Dialysis only b. Immunosuppressant therapy c. Kidney transplantation d. Palliative care - ANS c. Kidney transplantation A child presenting with a high fever, bilateral conjunctivitis, and a desquamating rash is presumed to have a vasculitis disease. What is the likely treatment for this child? a. Antibiotic therapy for 10 to 14 days b. Aspirin (ASA) and intravenous immunoglobulin (IVIG) c. High-dose prednisolone therapy d. Immunosuppressant medications - ANS b. Aspirin (ASA) and intravenous immunoglobulin (IVIG) Which are symptoms of RA that distinguish it from OA? a. Joint stiffness later in the day b. Symmetric tender, swollen joints c. Extra-articular inflammatory signs d. Unilateral joint involvement e. History of injury to affected joints - ANS b. Symmetric tender, swollen joints C is also correct A 60-year-old patient reports a new onset of bilateral shoulder pain with morning stiffness lasting approximately 1 hour. Which will NOT be included in initial diagnostic testing for this patient? a. Antinuclear antibodies b. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) c. Liver function tests (LFTs) d. Protein electrophoresis e. Serum calcitonin - ANS a. Antinuclear antibodies

E is also correct The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg child with JIA who has oligoarthitis. If the child takes 4 doses per day, what is the maximum amount the child will receive per dose? a. 200 mg b. 250 mg c. 400 mg d. 450 mg - ANS b. 250 mg The primary care pediatric nurse practitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child? a. Cardiology b. Ophthalmology c. Orthopedics d. Pain management - ANS b. Ophthalmology A patient is treated for a urinary tract infection and, 3 weeks later, presents with pain and swelling of one knee and in one hand, along with inflammation in both eyes. What will the provider suspect as the cause of these symptoms? a. Ankylosing spondylitis b. Infectious arthritis c. Psoriatic arthritis d. Reactive arthritis - ANS d. Reactive arthritis Which laboratory tests may help distinguish systemic lupus erythematosus (SLE) from other systemic rheumatologic disorders? a. Antinuclear antibody titer b. C-reactive protein c. Rheumatoid factor d. Serum complement levels - ANS d. Serum complement levels The primary care pediatric nurse practitioner examines a child who has had stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for? a. enthesitisrelated JIA. b. oligoarticular JIA. c. polyarticular JIA. d. systemic JIA. - ANS b. oligoarticular JIA. The primary care pediatric nurse practitioner is reviewing the rheumatology plan of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes?

a. Have the child rest between activities. b. Obtain regular ophthalmology exams. c. Participate in low impact exercises. d. Use UVA and UVB sunscreen daily. - ANS d. Use UVA and UVB sunscreen daily. A pregnant patient tests positive for HIV infection. What will the NP recommend? a. Consideration of termination of the pregnancy b. No treatment and c-section for delivery c. Treatment with highly active antiretroviral therapy d. Treatment with standard antiretroviral therapy - ANS c. Treatment with highly active antiretroviral therapy A patient is diagnosed with ankylosing spondylitis and begins taking a COX-2 inhibitor with minimal pain and inflammation relief. What will the provider order initially to manage this patient's symptoms? a. A trial of sulfasalazine and methotrexate b. Biologic anti-tumor necrosis factor agents c. Changing to a COX-1 inhibitor medication d. Corticosteroid injections every 3 months - ANS c. Changing to a COX-1 inhibitor medication An adolescent female reports poor sleep, fatigue, muscle and joint paint, and anxiety lasting for several months. The primary care pediatric nurse practitioner notes point tenderness at several sites. What will the nurse practitioner do next? a. Evaluate the adolescent's pain using a numeric pain scale. b. Obtain ANA, CBC, liver function, and muscle enzymes tests. c. Reassure the adolescent that this condition is not life-threatening. d. Refer the adolescent to a rheumatologist for further evaluation. - ANS d. Refer the adolescent to a rheumatologist for further evaluation. An 8-year-old child is diagnosed with systemic lupus erythematosus (SLE), and the child's parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell the parent? a. Complete remission occurs in some children at the age of puberty. b. Periods of remission may occur but there is no permanent cure. c. SLE can be cured with effective medication and treatment. d. The disease is always progressive with no cure and no remissions. - ANS b. Periods of remission may occur but there is no permanent cure. The parent of a school age child who is diagnosed with oligoarticular JIA asks the primary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend?