TEST BANK FOR NR667 CEA FNP Latest Exam| Questions With Verified Answers|NR 667 (Latest Up, Exams of Nursing

Download TEST BANK FOR NR667 CEA FNP Latest Exam| Questions With Verified Answers|NR 667 (Latest Up and more Exams Nursing in PDF only on Docsity! 1. A patient currently undergoing concurrent chemothcrapy / radiation treatment for glottic squamous cell carcinoma is admitted to the rehab unit you oversee for management of intractable nausea, vomiting, and dehydration. Admission CBC showed WBC 1.3, Hgb 7.5, PLT 45, ANC 0.8. Which of the following conditions is this patient at risk for? A. Macrocytic anemia due to B12 deficiency B. Iron deficiency anemia duc to chronic blood loss C. Microcytic anemia due to chronic kidney disease D 2. Your patient presents to the urgent care clinic with a swollen exudative pharynx, profound fatigue, and a very tender left upper quadrant abdomen. What is the most likely diagnosis? A. Strep pharyngitis B. Tonsillitis C. Epstein Barr virus (EBV) D. Pancreatitis Cc 3. Which of the following best characterizes presbycusis in the older adult? A. Bilateral low-frequency sensorineural hearing loss C. Unilateral high-frequency sensorineural hearing loss D. Unilateral low-frequency sensorineural hearing loss B 4. A 35-year-old woman presents with allergic rhinitis, experiencing significant nasal congestion, sneezing, and itchy cyes. She has tried over-the-counter antihistamines with limited relief. What is the most appropriate next step in management? Cc A. Oral decongestants B. Nasal saline irrigation D. Referral to an allergist for immunotherapy 5. A patient currently undergoing concurrent in a 26 y.o. F at 34 weeks of pregnancy C. Ferrous sulfate 325 mg PO TID for a 25 y.o. F with menorrhagia D. Ferrous sulfate 325 mg PO BID for a 63 y.o. M with ulcerative colitis A 10. Which of the following is not a common mechanism of neutrophil expenditure and resultant neutropenia? A. Decreased neutrophil production in the bone marrow B. Redistribution of neutrophils to the spleen or vascular endothelium C. Loss of circulating neutrophils in acute blood loss D. Immune destruction c 11. Which of the following blood Icad levels (BLL) would likely require chelation therapy? A. < 80 mceg/dL B. 35 meg/dL Cc C. >100 meg/dL D. 75 mcg/dL 12. A geriatric patient with anemia, back pain, osteoporosis, and elevated crythrocyte scdimentation rate should be evaluated for: A. cauda cquina syndrome. B. renal dystrophy. C. Paget's disease. D. multiple myeloma. D 13. Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following? A. Thrombocytopenia B. Aplastic ancmia C. Myelodysplastic syndrome D. Disseminated intravascular coagulation D 14. A patient on warfarin (Coumadin) therapy for recurrent deep vein thrombosis (DVT) is about to have lumbar spinal fusion surgery. The patient's warfarin is put on hold starting 5 days prior to the surgery and subcutaneous enoxaparin (Lovenox) has been ordered for DVT prophylaxis until the resumption of the warfarin. The nurse practitioner knows that the patient's postoperative warfarin dose should be restarted based on the: A. Value of her morning Prothrombin time B. baseline PT and INR values C. target INR of 2.5 D. Loading dose of 20 mg, plus the previous warfarin dose B 15. Your patient presented yesterday to urgent care with symptoms of lower extremity weakness and then went home for observation with family. They have B returned to urgent care, and it now appears to be affecting the patient's abdomen in just the past few hours. What is your priority intervention? A. Order physical therapy evaluation and treatment B. Immediate transportation to the hospital and monitor for airway involvement C. Apply oxygen via nasal cannula D. Assess muscular strength in bilatcral lower extremities 16. Which of the following is a common symptom of B. Type UI C. Type II D. Type IV A 22. Your paticnt has been diagnosed with HIV and wants to know the goal of treatment with "all these medications". Which of the following represents the most reasonable goal in the treatment of HIV? A. Ability to reduce to one medication as therapy rather than multiple agents B. Reducing the CD4 count to an undetectable level C. Reducing viral load to an undetectable level D. Complete healing with no need for further medications Cc 23.A 6/119 Your patient arrives the urgent care complaining of a swollen throat and vocal changes. Which of the following statements made by the patient brings an index of suspicion of angiocdema? A. I have been taking my lisinopril for the past week as prescribed B. I do not take any ibuprofen since it gives me an upset stomach C. [have never had this happen before D. This seems to be getting better alrcady getting out of the cold 24. Which of the following treatments is not recommended for a patient with a new diagnosis of rheumatoid arthritis? A. Prednisone burst, then taper to a lower daily maintenance dose B. Methotrexate daily C. Oxycontin PRN for mild pain D. Adalimumab daily Cc 25. A 43-year-old male patient weighing 100kg was burned over 20 percent of their body with partial thickness burns after escaping a house fire. Using the Parkland formula, what is the most appropriate amount of IV fluid resuscitation to provide the patient in the first 8 hours? A. 8 Liters B. 2 Liters C. 3 Liters D. 4 Liters D 26. What is the etiology of verruca? A. Human Papilloma Virus infection in the skin B. Chronic UV-B exposure to the skin A C. Chronic UV-A exposure to the skin D. Group B Strep infection in the skin 27. Which of the following medications is prescribed for the treatment of pinworm? A. Metronidazole (Flagyl) B. Corticosteroids C. Lindane (Kwell) D. Albendazole(Albenza) D 28. A frail elderly male with a history of sun exposure and rough, scaly, brownish lesions on the face, ears, and hands presents with a firm crythematous, ulcerated nodule on the dorsal surface of the hand. The most likely diagnosis is: A. Seborrheic keratosis B. Melanoma C. Squamous cell carcinoma stop it abruptly without any side effects B. I will not use this anywhere other than where it is prescribed since it has a high risk of damaging my skin C. If I don't sce results from this, | can switch to a higher potency steroid than an ointment. D. I can add additional medications at the same site if they are put on top of the steroid B 34. Herpes zoster can be difficult to diagnose in the prodromal stage, but can later be identified by the A 9/118 presence of characteristic: A. Unilateral vesicular lesions B. Bilateral dermatomal lesions C. Herpetic whitlows of the fingers D. "herald spots" at the site of infection 35. The most spccific test for gout is: A. Synovial fluid with monosodium urate crystals B. Hyperuricemia greater than 7m¢g/dL C. Serum purine level D. Normalized uric acid level after a trial of allopurinol (Zyloprim) A 36. Which of the following are not items assessed for compartment syndrome? A. Guarding B. Pain C. Sensation D. Skin color A 37. Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis? A. Indomethacin (Indocin) B. Allopurinol (Zyloprim) C. Misoprostol (Arthotec) D. Salicylic acid (aspirin) B 38. Which of the following treatments is most successful for patients with chronic fatigue syndrome? A. Graded exercise program B. Antiviral therapy C. High carbohydrate dict D. CNS stimulants A 10/119 39. Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis? A. Allopurinol (Zyloprim) B. Salicylic acid (aspirin) C. Indomethacin (Indocin) D. Misoprostol (Arthotcc) A 40. Which of the following behaviors is likely to clicit rhabdomyolysis? A. Participating in a full ironman triathlon B. Working out for 30 minutes with plyometric exercises C. Starting on a low-intensity statin for lipid reduction D. Swimming for 10 minutes in a lap pool A 41. Patients who have been in a multi-car pileup should be evaluated for which of the following elements of the secondary survey? A. Evidence of adequate circulation feature consistent with which of the following diagnoses? A. urge-type incontinence B. overflow incontinence A C. functional incontinence D. stress incontinence 47. A 45-year-old man with a history of benign prostatic hyperplasia (BPH) presents with worsening urinary symptoms, including nocturia and weak stream. What is the most appropriate initial pharmacological treatment? A. Antibiotics B. Alpha-blockers C. 5-alpha-reductase inhibitors D. Anticholinergics B 48. A male adult patient presents to the clinic with sudden onset of painful hematuria. The most likely diagnosis is: A. Sexually transmitted infection B. Urinary tract infection C. Benign prostatic hypertrophy D. Bladder carcinoma D 49. A 24-year-old female reports urinary urgency with suprapubic tenderness relieved by bladder emptying. The patient has been evaluated by urology and urogynccology. Review of laboratory reports reveal negative urinalysis and cultures, negative results for sexually transmitted infections, and an unremarkable cystoscopy. Which of the following is an appropriate plan of care? A. Referral to psychiatry B. Nitrofurantoin (Macrodantin) 100 mg oral once daily C. Amitriptyline (Elavil) 25 mg oral once daily D. Propranolol (Inderal) 10 mg oral once daily Cc 50. Which of the following states represents an example of postrenal failure? A 13/146 A. Blood clot obstructing a foley catheter after a transurethral prostatectomy B. Hypotension after overdosing on lisinopril C. Contrast induced nephropathy after an angiogram D. Overuse of furosemide 51. An older adult patient with chronic renal disease has been experiencing a steady decrease in glomular filtration rate over the past 3 months. Which type(s) of antihypertensive medication would be most appropriate for the patient at this time? A. Beta-blocker, thiazide diuretic B. Aldosterone antagonist C. Angiotensin-converting enzyme (ACE) inhibitor, thiazide diuretic D. Angiotensin-converting enzyme (ACE) inhibitor, angiotensin-receptor blocker D 52. Paticnts presenting to the emergency department with hematuria and RBC casts in their urine should be considered for which diagnosis? A. Acute tubular necrosis B. Glomerulonephritis C. Nephrotic syndrome D. Pyelonephritis B 53. A 25-year-old woman presents with a urinary tract infection (UTI) confirmed by urinalysis. She has no and increased tanning of scars, areolas, and hand creases. The patient's husband states that she seems depressed and is eating a lot of salt. To determine the suspected cause of the patient's symptoms, the nurse practitioner would order a: A. Random glucose test B. Liver function test C. Complete blood count (CBC) D. Morning cortisol level 59. An adolescent male college freshman presents to the student health office with concerns about succeeding in school. He is in his second semester and is on academic probation because of poor grades. He states that he has always struggled in school but managed to graduate from high school with a 3.5 grade point average because his parents monitored and controlled his studying... A. explaining that his high school grades prove that he does not have a Icarning disorder, he just necds to work harder B. acknowledging that he might have an attention disorder or learning disability, and then refer him for an evaluation C. calling his parents after he leaves the office to report his school problems and recommending tutoring services D. informing him that he might have an attention disorder or learning disability, but is too old for any diagnosis or treatment B 60. A woman with vascular dementia presents with agitation. Your first action should be to do which of the following: A. prescribe an anxiolytic B. mini mental exam D 16/119 C. prescribe an antipsychotic D. assess for infection 61. A patient who presents to your clinic with an acute change in facial symmetry, inability to speak clearly and unilateral muscular weakness should be transported for evaluation immediately as treatment for embolic stroke with tPA within which timeframe? A. Less than 24 hrs. B. Less than 8 hrs. C. Less than 4.5 hrs. D. Less than 6 hrs. Cc 62. An adult patient presents with a history of hcadaches. Which new symptom should immediately cause the patient to be referred for further evaluation and possible neuroimaging? A. Frontal headache upon awakening B. Aura of visual flashing lights C. Unilateral motor weakness D. Unilateral pulsating head pain Cc 63. Medication overuse (analgesia rebound) headaches occur: A. In approximately half of all patients with chronic daily headaches. B. infrequently in patients who use analgesics regularly. C. occasionally during switching from one type of analgesic to another. D. in the majority of patients using analgesics. A 64. Paticnts who take chronic anti-scizure medication A. Fifth disease B. Chickenpox C. Measles D. Scarlet fever 70. A nconatc has purulent discharge of the cyes and erythema. History includes a vaginal birth at term delivered at home. What is the most likely cause of the presenting signs and symptoms? A. Chlamydia trachomatis infection B. Viral conjunctivitis C. E-coli infection D. Subconjunctival hemorrhage A 71. At what age should a child typically begin to show interest in playing with other children and engaging in cooperative play? A.5 years B. 2 years C.3 years D. 4 years Cc 72. A 7-year-old child presents with group A streptococcal infection confirmed by throat culture. Past history includes treatment for positive streptococcal infection with erythromycin (EryPed oral suspension) 3 wecks ago. What is the most appropriate next intervention? A. Obtain culture for all household members. B. Treat with azithromycin (Zithromax) for 10 days. Cc 19/116 C. Treat with amoxicillin for 10 days. D. Intramuscular Penicillin. 73. A late adolescent is brought to the nurse practitioncr's office by her mother, who is concerned about her daughter's recent weight loss and the potential of purging herself after meals. The daughter denies any self-induced vomiting, starvation or excessive activity. History reveals that the daughter was consistently in the 50th percentile for weight but is now in the 10th percentile. She does state that she jogs 5 miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment? A. Electrolytes, FSH, stool for occult blood B. Creatine phosphokinase, follicle-stimulating hormone (FSH) C. Electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis D. Electrolytes, fasting blood sugar Cc 74. A 5-year-old boy presents with a sore throat, fever, and a sandpaper-like rash. What is the most likely diagnosis? A. Measles B. Fifth disease C. Kawasaki disease D. Scarlet fever D 75. A 25-year-old woman presents with a 2-ycar history of fluctuating mood states, including periods of mild depression and hypomania. These symptoms have not been severe enough to meet the criteria for major depressive or manic episodes. What is the most likely diagnosis? A 20/119 A. Cyclothymic disorder symptoms? A. Atypical antipsychotics B. Monoamine oxidase inhibitors C. Selective serotonin reuptake inhibitors D. Tricyclic antidepressants Cc 82. Which of the following need to be assessed when determining if a patient is a risk of self-harm or harm to others? A. Physical examination B. Means to commit the harm to self or others C. Social history D. Medical history B 83. Which of the following represent precipitating factors for excited delirium? A. Lopressor use B. LSD use C. Cigar smoking D. Amitriptyline use B 84. A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate? B A. Double dosing for 2 days B. Providing reassurance C. Modifying use D. Changing to Ortho-Novum 1/35 85. A male presents with a painless penile lesion which has been present for 4 weeks. There is no urcthral discharge. He is sexually active with multiple partmers and docs not use a condom. The initial diagnosis is: A. Primary syphilis B. Herpes simplex type 2 C. Lichen planus D. Chancroid A 86. In treating a pregnant female with migraine headaches, which of the following drugs would be contraindicated? A. Amitriptyline (Elavil) B. Frovatriptan (Frova) C. Sumatriptan succinate (Imitrex) D. Ergotamine tartrate (Migergot) D 87. A patient is 28 weeks pregnant and presents with a single episode of vaginal blecding. Prenatal progress is normal, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate to determine a diagnosis? A. non-stress test B. Nitrazine test C. Ultrasound D. Bimanual cervical examination Cc 88. Which of the following tests is the most effective in differentiating between solid and cystic breast lesions? Cc 23/119 A. Screening mammography B. Fine necdle aspiration C. Ultrasonography D. Xcromammographic Cc 93. Risk factors for genital herpes include: A. genctic transmission. B. multiple sexual partners and frequent use of public spas. C. infection with other sexually transmitted diseases before the age of 12. D. multiple sexual partners and years of sexual activity. D 94. Which of the following is a typical symptom of asthma in adults? A. Weight loss B. Frequent sinus infections C. Persistent cough, especially at night D. High blood pressure Cc 95. he optimal treatment for latent tuberculosis is: A. Isoniazid (Nydrazid) for 9 months. B. cthambutol for 6 months. C. rifampin (Rifadin) for 5 months. D. pyrazinamide for 6 months. A 96. A 60-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with an acute exacerbation, including increased sputum production and dyspnea. He has no known drug allergies. What is the most appropriate initial antibiotic treatment? A. Azithromycin B. Amoxicillin-clavulanate C. Levofloxacin D. Doxycycline B 97. What does force vital capacity (FVC) represent in pulmonary function testing? A. The maximum volume of air that can be inhaled after a normal exhalation. B. Maximum volume of air that can be forcefully exhaled after maximum inspiration. C. Total volume of air exhaled during the first second of forced expiration. D. Volume of air remaining in the lungs after forced exhalation B 98. Recommendation for advanced COPD treatment: A. daily antibiotics B. short acting beta agonist C. oral bronchodilator D. long-acting beta agonist D 99. A 55-year-old man with a history of smoking presents with a persistent cough and hemoptysis. A chest X-ray reveals a solitary lung nodule. What is the most appropriate next step? A. CT scan of the chest B. Bronchoscopy A C. PET scan D. Sputum culture 100. The nurse practitioner caring for the hospitalized 14-year-old patient with multiple days of high concentration oxygen should evaluate the patient for which of the following exams? A. Vagus nerve exam B. 2D Echocardiography C. Facial nerve exam D. Visual acuity test C. CBC and metabolic panel D. increase whole grain and water intake B 107. A 56-year-old male with recurrent upper GI bleeds has had an upper endoscopy with no signs of blecding found. Which procedure/procedures could be done to further investigate his source of bleeding select all that apply? A. Pill video capsule B. Colonoscopy C. ERCP D. Deep small bowel enteroscopy D 108. C B/ 119 An adult female returns to the clinic with severe profuse watery diarrhea, abdominal pain, and cramping after treatment with Cipro x 10 days. WBC is 12.5, stool culture is positive for c diff. The NP would recommend: A. Acidophilus B. Cleocin 450 C. Metronidazole 500 tid for 10-14 d D. No further treatment 109. A 45-year-old woman presents with chronic diarrhea, weight loss, and abdominal pain. Endoscopy reveals villous atrophy of the small intestine. What is the most appropriate initial management? A. High-fiber diet B. Antibiotics C. Gluten-free diet D. Lactose-tree diet Cc 110. A 35-year-old man presents with sudden onset of severe flank pain radiating to the groin, nausea, and vomiting. He reports a history of similar episodes. What is the most likely diagnosis? A. Renal calculi B. Chronic kidney disease C. Pyclonephritis D. Acute cystitis A 111. The most common side effect of the oral ribavirin used in the treatment of hepatitis C is: A. weight gain. B. depression. C. hemolytic anemia. D. hypothyroidism c 112. Gastric ulceration 29/119 An adult female with rhcumatoid arthritis presents to the office for a follow up. She is currently taking methotrexate and over the counter Ibuprofen. Today she complains of severe stomach pain and intense abdominal cramping. After the nurse practitioner makes appropriate adjustments to the patient's medication regimen, the patient still complains of abdominal discomfort and reports dark stools. The practitioner suspects: 113. An older adult paticnt with new onsct GERD, cough, heartburn. Initial tx A. Antacid and lifestyle modification/weight loss B. Sucralfate C. H2 receptor antagonist D. PPI A 114. Which sphincter tends to be involved with the symptoms associated with patients who have GERD? A. Pyloric sphincter B. Internal anal sphincter C. Lower esophageal sphincter D. leocecal sphincter D. Delay in surgery can increase incidence of choroidal hemorrhage 120. An older adult female reports nasal congestion, clear nasal secretions, and a post-nasal drip since going through menopause. After a thorough examination reveals no significant abnormalities, the nurse practitioner diagnoses the paticnt with: A. Allergic rhinitis B. Vasomotor rhinitis C. Viral rhinitis D. Allergic sinusitis B 121. A 60-year-old man presents with persistent hoarseness for the past 3 months. He has a history of smoking. What is the most appropriate next step in management? A. Advise gargling with warm salt water B. Prescribe voice rest and hydration C. Referral to an otolaryngologist for laryngoscopy D. Start a course of oral corticosteroids Cc 122. Your 25-year-old male patient presents to the primary care office with a complaint of sore throat, difficulty swallowing, and flu- like symptoms. Which of the following potentially life-threatening illnesses should you rule out in your evaluation? A. Tonsillitis B. Leukoplakia C. Lichens planus D. Retropharyngeal D 123. Your 24-year-old male patient has been admitted post-motor vehicle collision at a high rate of speed. A CT head is performed revealing a pyramidal fracture involving the lateral walls of the maxillary sinuses and inferior orbital rim. Which classification of fracB ture is this? A. Le fort IV B. Le Fort II C. Le Fort I D. Le Fort I 124. A young adult female presents with painful swelling of the right cheek anterior to the TMJ. The diagnosis is sialadenitis. To determine the appropriate treatment for this patient, the most common infecting organism in bacterial sialadenitis is: A. Moraxella catarrhalis B. Group A beta hemolytic Streptococcus C. Staphylococcus acurus Cc 125. An adult patient present with acute onset of right eye pain, redness and decreased vision. Suspecting open-angle glaucoma the nurse practitioner should: A. Refer to ophthalmology and prescribe topical steroid B. Refer to ophthalmology and prescribe pilocarpine C. Advise applying warm compresses and returning in the morning D. Prescribe antibiotic ointment and pilocarpine B 126. Your patient has a Le Forte III fracture and is admitted for close monitoring. Which of the following represent a potential complication of this type of fracture? A. Cerebrospinal fluid leak B. Sternoclcidomastoid impingement C. Tetany D. Loss of bowel tone C. Muscle relaxants D. Topical analgesia agents A 132. The nurse practitioner is caring for an acutely-ill 92 year old ICU intubated paticnt not responding to the best available care after a perforated gastric ulcer who underwent surgical exploration and washout two weeks ago. They have gone into ventricular tachycardia twice this morning and resuscitated with the use of DC cardioversion and IV amiodarone. Subsequent labs reveal profound lactic acidosis and they are not expected to survive the day due to a presumed diagnosis of mesenteric infarct. Before the first surgery, the patient told you and the family they did not want to undergo extreme measures to sustain their life and would like to "go out with some dignity". Which of the following would NOT be an appropriate consult to make at this time? Surgical consult for emergent abdominal re-exploration 133. An 87-year-old female has a history of ovarian cancer. She recently completed the tenth of 26 chemotherapy treatments. She informs the nurse practitioner that she plans to stop chemotherapy; she has lived a good life and is ready to die. She is alert and very active, and lives with her son. The family is determined that the patient will complete the chemotherapy. The nurse practitioner's most appropriate action is to: support the patient's decision 134.A 35/119 In a mass casualty situation with presumed anthrax exposure, the drug of choice for prophylaxis is: A. doxycycline (Doryx). B. tetracycline (Achromycin). C. chloramphenicol (Chloromycetin). D. amoxicillin (Amoxil). 135. Which of the following refers to the primary access point of medical care patients are encouraged to use to aid in providing continuity and reduction of cost per the Affordable Care Act? A. The Medical Home B. The Emergency Department C. Urgent Care D. Consulting Healthcare Providers A 136. A 65-year-old man presents for follow-up of his well-controlled hypertension and expresses concerns about maintaining bone health. He is a smoker and has a sedentary lifestyle. What is the most appropriate initial recommendation to reduce his risk of osteoporosis? A. Weight-bearing exercise and smoking cessation B. Start bisphosphonates C. Calcium and vitamin D supplementation D. Hormone replacement therapy A 137. Which following medical term refers to the concept of not intentionally harming the patient while providing care? A. Nonmaleficence B. Negligence C. Beneficence D. Assault A 138. D 36/119 A 14-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up examination after a recent hospitalization. It is most important to continue monitoring growth, development, and: A. fecal occult blood test. B. white blood cell levels. C. urine dipsticks. D. hemoglobin C. Redistribution of neutrophils to the spleen or vascular endothelium D. Decreased neutrophil production in the bone marrow A 145. A patient is taking warfarin, 4 mg daily for atrial fibrillation. The patient's current International Normalized Ratio (INR) is 5.5 mg/dL. The nurse practitioner would: A. hold the warfarin for 4 days and then recheck the INR. D B. increase the warfarin to 5 mg daily. C. decrease the warfarin to 3 mg daily. D. hold the warfarin for 1 day and then recheck in two days. 146. A 13 year old female who is diagnosed with iron deficiency anemia is being treated with ferrous sulfate. Proper treatment typically leads to the resolution of anemia within: A. 2 weeks. B. 4 weeks. C. 8 months. D.3 months D 147. All the following thrombocytopenic emergencies require immediate action except: A. Pregnancy with severe thrombocytopenia B. Blecding in the setting of severe thrombocytopenia C. Suspected acute leukemia, aplastic anemia, or other bone marrow failure syndrome D Scheduled surgical procedure with mild thrombocytopenia D 148. Treatment for symptomatic aplastic anemia includes all the following except: A. Prophylactic antibiotics B. Bone marrow transplant C. PRBC/Platelet/WBC transfusions D. Removal of bone marrow stimulants D 149. The best laboratory test to distinguish iron deficiency anemia from other anemias is: A. serum ferritin level. B. iron binding capacity. A 39/119 C. mean corpuscular volume. D. transferrin saturation 150. Which of the following is not a common mechanism of neutrophil expenditure and resultant neutropenia? A. Immune destruction B. Decreased neutrophil production in the bone marrow C. Loss of circulating neutrophils in acute blood loss D. Redistribution of neutrophils to the spleen or vascular endothelium c 151. A patient with chronic liver disease presents to Urgent Care after developing frequent, severe epistaxis, petechia, and hematuria. Which of the following conditions have they likely developed? A. Thrombocytosis B. Neutropenia C. Factor V deficiency D. Thrombocytopenia D 152. A patient with a known intrinsic factor autoantibody is at risk for developing which of the following conditions? A. B12 deficiency and pernicious anemia B. Bone marrow suppression and pancytopenia C. Liver disease A patient is newly diagnosed with multiple sclerosis. Treatment includes prednisone with physical therapy. The nurse practitioner advises the paticnt to begin discasc-modifying therapy: A. if MRI of the brain shows a new lesion. B. as soon as possible. C. if symptoms remain the same for 3 months. D. if symptoms worsen 159. Your patient has been noticing bilateral joint pain in the knees and feet for about 6 months and has been started on methotrexate. Which of the following diagnoses correlate to this treatment plan? A. Polymyalgia rheumatica B. Degenerative joint disease C. Osteoarthritis D. Rheumatoid arthritis D 160. Your paticnt has been started on sulfamethoxazole for a urinary tract infection and two days later states she feels painful blistering on her skin. Which of the following life-threatening disease states are you most concerned about? A. Erythema multiforme B. Scleroderma C. Stevens-Johnson Syndrome D. Vasculitis Cc 161. A 35-year-old woman presents with fatigue, joint pain, and a butterfly-shaped rash on her face. What is the most appropriate initial management in primary care? A. NSAIDs B. Referral to rheumatology B C. Corticosteroids D. Antivirals 162. What is the most likely diagnosis for an elderly patient with GI cancer who presents with skin pallor, conjunctival pallor, palpitations, and weakness? A. Autoimmune hemolytic anemia B. Gastroesophageal reflux disease C. Iron deficiency anemia D. Peptic ulcer disease Cc 163. What is the definitive treatment for uncomplicated skin abscess on the arm? A. Doxycycline IV q 3 days B. Prescription of gram-negative antibiotic coverage C. Incision and drainage D. NSAID pain relief and warm compresses Cc 164. A 45-year-old man presents with a 2-day history of a red, swollen, and painful lower Icg. Examination reveals crythema and warmth suggestive of cellulitis. He has no known allergies. What is the most appropriate initial antibiotic treatment? A. Trimethoprim-sulfamethoxazole B. Doxycycline C. Clindamycin D. Cephalexin D 165. Treatment of acute poison ivy includes: A. SoluMcdrol B. Synalar C. Prednisone 40mg for 10 days D. Sporonax Cc 166. C 43/119 common than basal cell carcinoma D. Squamous cell carcinoma is more likely to have metastasis than basal cell carcinoma D 172. An 87-year-old paticnt presents with round, pruritic plaques and small vesicles on the lower legs. The most likely diagnosis is: A. allergic contact dermatitis. B. cutaneous T-cell lymphoma. C. plaque psoriasis. D. nummular eczema D 173. During the preadmission history and physical, you examine your patient and find a new multicolored mole measuring 9mm with irregular borders. What is the most likcly diagnosis? A. Squamous Cell Carcinoma B. Melanoma C. Simple Nevus D. Cutaneous Horn B 174. A frail elderly male with a history of sun exposure and rough, scaly, brownish Icsions on the face, cars, and hands presents with a firm erythematous, ulcerated nodule on the dorsal surface of the hand. The most likely diagnosis is: A. Squamous cell carcinoma B. Melanoma C. Seborrheic keratosis D. Sebaceous hyperplasia 175. Your patient presents with darkened, velvety creases of the groin, neck, and axilla with skin tags present. What does this possibly indicate? A. Chronic hypertension B. Evidence of insulin resistance C. Actinic keratosis D. Chronic azotemia B 176. While evaluating your patient who presented to the emergency department with a panic attack, the patient states their reason for the panic attack was they found out they are going to die from skin cancer because their sister isa CNA and found melanoma on their skin. You perform a skin survey to find a 9mm seborrheic keratosis as the source of the concern. Which of the following is the most appropriate response to the patient? Fortunately, this is a benign lesion and poses no risk of malignancy. 177. Paticnts who present with decreased joint space of a lumbar vertebrae on x-ray are likely diagnosed with which of the following chronic discase states? A. Lumbosacral strain B. Spondylolisthesis C. Osteoarthritis D. Ankylosing Spondylitis c 178. A patient has moderate osteoarthritis. Which of the following dietary supplement could be recommended to reduce pain and joint space narrowing? A. cinnamon Cc 46/119 B. red yeast rice C. glucosamine D. garlic 179. A high school football player presents Monday morning after sustaining an injury Friday night. The injuring play involved a tackle to the lateral right leg. The player walked off the field but was B. Skin color C. Guarding D. Pain c 185. A 25-year-old athlete presents with shoulder pain and difficulty with overhead activities. Physical examination suggests impingement syndrome. What is the most appropriate initial treatment? A. Physical therapy focusing on rotator cuff strengthening B. Nonsteroidal anti-inflammatory drugs (NSAIDs) and physical activity modification C. Surgical intervention D. Corticosteroid injection A 186. Your patient has presented with an acute GI bleed. In working up potential causes, which of the following B scenarios is most probable as a reason for the blecd? A. Chronic low-dose acetaminophen for rheumatoid arthritis pain B. Four days of high dose of naproxen sodium for joint pain after a long hike C. Tapered dose of prednisone for a contact dermatitis D. Chronic topical use of diclofenac gel over a knee with arthritic pain 187. An adult female with a BMI of 31 has pain and weakness in her legs, buttocks, and upper thighs after prolonged walking or standing. She has osteoporosis of the hips. The patient obtains short term relief by leaning forward (stooping) when grocery shopping or sitting. The suspected diagnosis is: A. lumber spinal stenosis B. peripheral vascular disease C. herniated disc arterial insufficiency A 188. Patients who have been in a multi-car pileup should be evaluated for which of the following elements of the secondary survey? A. Deformities B. Evidence of adequate circulation C. Work and depth of breathing D. Airway patency A 189. The most spccific test for gout is: A. Synovial fluid with monosodium urate crystals B. Hyperuricemia greater than 7mg/dL C. Normalized uric acid level after a trial of allopurinol (Zyloprim) D. Scrum purine level A 190. Elevated calcium levels may suggest which of the following? A. Vitamin D deficiency B. Calcitonin deficit C. Bone cancer D. Effective bisphosphonate therapy Cc 191. An 84-year-old patient present with complaints of diffuse bilateral lower back pain which is made worse by standing. On exam the patient maintains a posture of forward flexing at the waist. The most likely diagnosis is? A. Nerve root impingement B. Lumbar strain C. Lumbar disk herniation D. Spinal stenosis A. Has a history of migraine headache with aura B. Used to smoke % a pack of cigarettes per day C. Has a history of fibrocystic breast disease D. Drinks alcohol more than 3 days per week A 198. C 51/11 Which of the following constellations of symptoms, lasting more than 3 months, is most common in fibromyalgia? A. Depression, anxicty, fatigue B. Tinnitus, joint stiffness and swelling C. Diffuse pain, slecp abnormality, fatigue D. Unilateral pain, headache, anxiety 199. An 88-year-old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? A. Minnesota Multiphasic Personality Inventory B. Myers-Briggs Test C. Geriatric Depression Scale D. Mini-Cog Test D 200. A geriatric male with trigeminal neuralgia who has a history of hypertension and depression is currently taking amlodipine besylate (Norvasc), 5 mg daily and sertraline (Zoloft), 25 mg daily. He is allergic to penicillin and imipramine (Tofranil). The patient has been treated unsuccessfully with gabapentin (Neurotin). The drug of choice for this patient would be: A. Pentazocine (Talwin) B. Carbamazepine (Tegretol) C. Fentanyl (Durgesic) D. Oxycodone-acetaminophen (Percocet) B 201. An adult female presents to the clinic with complaints of dizziness, weakness, fatigue, weight loss, and increased tanning of scars, areolas, and hand creases. The patient's husband states that she seems depressed and is eating a lot of salt. To determine A the suspected cause of the patient's symptoms, the nurse practitioner would order a: A. Morning cortisol level B. Liver function test C. Complete blood count (CBC) D. Random glucose test 202. What of the following represents an abnormal level for intracranial pressure? A. 12 cm H20 B. 10 cm H20 C.5 cm H20 D. 24 cm H20 D 203. An adult female presents with the following symptoms: clear nasal discharge, nasal obstruction and tenderness over the antrum, throbbing facial pain referred to the supraorbital area and worsened by head movements or stooping. Which antibiotic is appropriate for initial treatment of sinusitis? A. Cefdinir (Omnicef) B. Azithromycin (Zithromax) C. Amoxicillin-clavulanate (Augmentin) D. Ceftriaxone (Rocephin) Cc 204. The use of GABA-agonizing drugs is likely going to have which effect on seizure threshold? A. Nonc of the above B. Cold air C. Physical activity D. Seasonal allergies 210. A 5-year-old boy is brought to the clinic with a rash that started on his face and spread to the trunk. The rash is described as "slapped cheek" appearance. What is the most likely diagnosis? A. Roscola B. Measles C. Rubella D. Fifth disease D 211. A late adolescent is brought to the nurse practitioner's office by her mother, who is concerned about her daughter's recent weight loss and the potential of purging hersclf after meals. The daughter denies any self-induced vomiting, starvation or excessive activity. History reveals that the daughter was consistently in the 50th percentile for weight but is now in the 10th percentile. She does state that she jogs 5 miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment? Electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis 212. At what age should a child typically be able to sit without support? A. 4 months B. 9 months C. 6 months D. 12 months Cc 213. An 18-month-old child presents with a bulging, immobile tympanic membrane; T = 103°F (39.4°C). Assessment also reveals a grade II/VI systolic murmur at the left sternal border. After initiation of treatment for otitis media, the most appropriate intervention is B to: A. obtain an EKG. B. reevaluate the patient in 10 days C. obtain an echocardiogram. D. refer the patient to a cardiologist 214. A 4-year-old child presents with a chronic cough, wheezing, and difficulty breathing, especially at night. On cxamination, you hear expiratory wheezing and observe the use of accessory muscles for breathing. What is the most likcly diagnosis? A. Bronchitis B. Asthma C. Croup D. Pneumonia B 215. A 15-year-old adolescent athlete complains of chest pain and fainting during intense exercise. On examination, a systolic ejection murmur is heard that increases with standing. What is the most likely diagnosis? A. Pulmonary hypertension B. Aortic stenosis C. Mitral valve prolapse D. Hypertrophic cardiomyopathy D 216. A 5-ycar-old boy presents with a sore throat, fever, and a sandpaper-like rash. What is the most likely diagnosis? A. Scarlet fever B. Fifth disease C. Kawasaki disease D. Measles A 217. A 13-year-old is concerned because she has not yet begun to menstruate. Physical examination indicates "Your development is exactly as 56/119 223. Which of the following fine motor skills is typically expected of a 3-year-old child? A. Writing their own name B. Stacking 10 blocks C. Drawing a straight linc D. Using a pincer grasp to pick up small objects Cc 224. Which of the following is a common physical sign of bulimia nervosa? A. Persistant fever B. Enlargement of the thyroid gland C. Calluses or scars on the knuckles D. Rapid fluctuation in weight gain or loss Cc 225. Which of the following symptoms are not found in anti-depressant discontinuation syndrome? A. Imbalance B. Flu-like symptoms C. Hypersomnia D. Hyperarousal Cc 226. A 45-year-old man presents with episodes of feeling extremely happy and energetic for a few days, followed by periods of intense sadness and hopelessness. During the high periods, he engages in risky B behaviors and has little need for sleep. What is the most likely diagnosis? A. Major depressive disorder B. Bipolar I disorder C. Cyclothymic disorder D. Bipolar II disorder 227. Patients with altered mental state should be considercd for all the following potential causes except which of the following? A. Uremia B. Hypertriglyceridemia C. LSD use D. Ecstasy use B 228. Paticnts who present with agitation, confusion, tachycardia and hypertension, dilated pupils, loss of muscle coordination, twitching muscles, muscle rigidity, diaphoresis, and diarrhea should be worked up for which of the following conditions? A. Myxedema coma B. Depression C. Serotonin syndrome D. Hypothyroidism Cc 229. A patient and family education program for patients with clinical depression should include which of the following explanations? A. Improvement of symptoms can be expected within 48 hours of initiation of treatment B. Resolution of symptoms should be expected within the first 2 weeks of treatment C. Appropriate initial treatment prevents recurrence of symptoms D. Symptom remission is the aim of treatment D 230. Patients who overdose on beta blockers should be treated with which of the following agents? A. Sodium bicarbonate IV B. Calcium chloride IV C. Phenylephrine PO C. Ciprofloxacin 500mg BID x 7 days D. Nitrofurantoin 100mg BID x 5 days B 236. An older adult female presents with a 2-month history of incontinence. She specifically complains of an inability to make it to the bathroom without the loss of some urine most of the time, and denies incontinence due to laughing, coughing, or sneezing; she denies dysuria. Her medications include an angiotensin-converting enzyme (ACE) inhibitor. The initial plan of action for this patient would be: Obtaining a urinalysis for pyuria, hematuria, and glucosuria 237. Which portion of the renin-angiotensin-aldosterone mechanism is inhibited by lisinopril? A. Conversion of angiotensin I to angiotensin B. Efferent arteriole dilation C. Aldosterone secretion D. Juxtaglomerular cell stimulation of renin A 238. C 61/119 Your patient has presented with flank pain, CVA tenderness, frequency. Which diagnostic finding would be useful to differentiate between cystitis and pyelonephritis? A. Presence of hematuria B. UA C. UA with presence of RBC casts D. UC positive for proteus mirabilis 239. The hospitalized patient you are caring for has experienced a low blood pressure for a period of 2 hours before treatment with a fluid bolus. Which type acute renal dysfunction is being described in this scenario? A. Chronic kidney disease B. Intrarenal C. Postrenal D. Prerenal D 240. What is the standard treatment for women with uncomplicated urinary tract infection in a geographical area with more than 20% resistance? A. Sulfamethoxazole/Trimethoprim 800/160mg BID x 3 days B. Amoxicillin 875mg BID x 7 days C. Ciprofloxacin 500mg BID x 7 days D. Nitrofurantoin 100mg BID x 5 days D 241. Inability to reach the bathroom before urinating is a feature consistent with which of the following diagnoses? A. overflow incontinence B. urge-type incontinence C. stress incontinence D. functional incontinence B 6 242. A 24-year-old female reports urinary urgency with suprapubic tenderness relieved by bladder emptying. The patient has been evaluated by urology and urogynecology. Review of laboratory reports reveal negative urinalysis and cultures, negative results for sexually transmitted infections, and an unremarkable cystoscopy. Which of the following is an appropriate plan of care? Amitriptyline (Elavil) 25 mg oral once daily 243. Patients with an elevated creatinine after receiving contrast from an angiogram are cxhibiting which classification of renal dysfunction? A. Post renal B. Intrarenal