LEIK FNP Practice Questions with correct answers( verified marking scheme), Exams of Nursing

Download LEIK FNP Practice Questions with correct answers( verified marking scheme) and more Exams Nursing in PDF only on Docsity! LEIK FNP Practice Questions with correct answers( verified marking scheme)  A 72-year-old woman has been on hydrochlorothiazide 12.5 mg for many years to control her Stage II hypertension. Her blood pressure (BP) at this visit is 168/96. She is currently complaining of pain on her right hip and on both knees. She has increased her dose of ibuprofen (Motrin) from 400 mg 3 times day (TID) to 800 mg TID. She is still in pain and would like something stronger. Which of the following statements is the best explanation of the effects of ibuprofen (Motrin) on her disease? o It increases the chances of adverse effects to her health o It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic o It prolongs the therapeutic effects of hydrochlorothiazide and other diuretics o None of the statements are true - Correct answer B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic.  NSAIDs and ASA inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to ischemia. NSAIDs and diuretics can cause acute prerenal failure by decreasing renal blood flow.  2. All of the following are infections that affect mostly the labia and vagina except: o Bacterialvaginosis o Candidiasis o Trichomoniasis o Chlamydia trachomatis - Correct answer D) Chlamydia trachomatis  Infections that commonly affect the labia and vagina include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis commonly affects the cervix, endometrial lining , fallopian tubes, and pelvic cavity.  The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for: o Cholecystitis o Acute appendicitis o Inguinal hernia o Gastriculcer - Correct answer B) Acute appendicitis.  Signs and symptoms of an acute abdomen include invol- untary guarding, rebound tenderness, boardlike abdomen, and a positive obtu- rator and psoas sign. A positive obturator sign occurs when pain is elicted by internal rotation of the right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs with passive extension of the thigh while the patient is lying on his/her side with knees extended, or when pain occurs with active flexion of his/her thigh at the hip.  Treatment for mild preeclampsia includes all of the following except: o Bed rest except for bathroom privileges o Close monitoring of weight and blood pressure o Close follow-up of urinary protein, serum creatinine, and platelet count o A prescription of methyldopa (Aldomet) to control blood pressure - Correct answer D) A prescription of methyldopa (Aldomet) to control blood pressure  Recommended care for women diagnosed with preeclampsia includes bed rest with bath- room privileges, weight and BP monitoring, and closely following urine protein and serum protein, creatinine, and platelet counts. Oral medications are not used as first-line treatment.  All of the following services are covered under Medicare Part A except: o Inpatienthospitalizations o Medicines administered to a patient while hospitalized o Nursing home care o Surgeons - Correct answer C) Nursing home care  Medicare A coverage includes inpatient hospitalization and skilled care given in a certified skilled nursing facility. Most nursing home care is custodial care (help with bathing, dressing, using a bathroom, and eating). This care is not covered by Medicare A.  A 28-year-old student is seen in the school health clinic with complaints of a hacking cough that is productive of small amounts of sputum and a runny nose. He does not take any medications, denies any allergies, and has no significant medical history. Physical examination reveals a low-grade temperature of 99.9 degrees Fahrenheit, respirations of 16/min, a pulse of 90 beats per minute, and diffuse fine crackles in the base of the lungs. A chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe of the right lung. The total white blood cell count is 10,500/uL. What is the most likely diagnosis? o Streptococcal pneumonia o Mycoplasma pneumonia o Acute bronchitis  Common signs and symptoms of pregnancy-induced hypertension include edema of the face and the upper extremities, weight gain, blurred vision, elevated BP, proteinuria, and headaches.  Which of the following symptoms is associated with B12 deficiency anemia? o Spoon-shaped nails and pica o An abnormal neurological exam o A vegan diet o Tingling and numbness of both feet - Correct answer D) Tingling and numbness of both feet  Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symptoms of B12 deficiency anemia may include tingling or numbness in fingers and toes, difficulty walking, mood changes or depression, memory loss, disorientation, and dementia.  A second triple screen on a 35-year-old primigravida reveals abnormally low lev- els of the alpha fetoprotein and estriol and high levels of human chorionic gonad- otropin. Which of the following interventions is the best choice for this patient? o Order an ultrasound o Order a computed tomography (CT) scan of the abdomen o Order a 24-hour urine for protein clearance o Assess for a history of illicit drug or alcohol use - Correct answer A) Order an ultrasound  Abnormally low levels of alpha fetoprotein and estriol and high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultrasound should be ordered to further evaluate the fetus for characteristics of Down syndrome and/or fetal demise.  All of the following are true statements about diverticula except: o Diverticula are located in the colon o A low-fiber diet is associated with the condition o Most diverticula in the colon are infected with gram-negative bacteria o Supplementingwithfibersuchaspsyllium(Metamucil)isrecommended - Correct answer C) Most diverticula in the colon are infected with gram- negative bacte-  ria  Diverticuli in the colon can be infected with both gram-negative and gram- positive bacteria.  Patients who are diagnosed with gonorrhea should also be treated for which of the following infections? o Chancroid o Chlamydia trachomatis o Herpes genitalis o PID (pelvic inflammatory disease) - Correct answer B) Chlamydia trachomatis  When diagnosed with gonorrhea, the patient should also be treated for Chlamydia trachomatis.  Kyphosis is a late sign of: o Old age o Osteopenia o Osteoporosis o Osteoarthritis - Correct answer C) Osteoporosis  Kyphosis is a curvature of the spine that causes a rounding of the back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis) contributes to this curvature in the spine. Symptoms that may occur with severe cases of kyphosis include difficulty breathing, fatigue, and back pain.  A 35-year-old primigravida who is at 28 weeks of gestation is expecting twins. What would you would expect her alpha fetoprotein (AFP) values to be? o Normal o Higher than normal o Lower than normal o None of the above - Correct answer B) Higher than normal  Alpha fetoprotein is produced in the fetal and maternal liver. Higher levels of alpha fetoprotein are commonly seen in multiple gestations due to the growing fetuses and enlargement of the livers.  Which of the following antihypertensive medications has beneficial effects for an elderly White female with osteoporosis? o Calcium channel blocker o Angiotensin-converting enzyme (ACE) inhibitor o Beta-blocker o Diuretic - Correct answer A) Calcium channel blocker  Calcium channel blockers act by blocking the cal- cium channels in the heart muscle and the blood vessels, thereby keeping more calcium in the bones.  The Lachman maneuver is used to detect which of the following? o Knee instability o Nerve damage of the knee due to past knee injuries o The integrity of the patellar tendon o Tears on the meniscus of the knee - Correct answer A) Knee instability  The Lachman maneuver is a test performed to assess for knee instability. Knee instability indicates a tear of the anterior cruciate ligament.  When an adolescent male's penis grows more in length than width, at which of the following Tanner stages is he classified? o Tanner Stage II o Tanner Stage III o Tanner Stage IV o Tanner Stage V - Correct answer B) Tanner Stage III  Tanner Stage III in males consists of penis lengthening and darker, coarse pubic hair, which begins to curl  Fetal TORCH infections can cause microcephaly, mental retardation, hepatospleno- megaly, and intrauterine growth retardation. The acronym TORCH stands for: o Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes o Toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes  zoster  C) Tetanus, ophthalmic infections, roseola, cancer, and head abnormalities  D) Toxins, other infections, roseola, candidiasis, and head abnormalities - Correct answer A) Toxoplasmagondii, other infections, rubella, cytomegalovirus, and herpes  The acronym TORCH stands for Toxoplasma gondii, other infections, rubella, cytomegalovirus, and herpes. Although several of the conditions listed in the other answer options can also cause fetal problems, they are not included in the TORCH acronym.  Human papilloma virus (HPV) infection of the larynx has been associated with: o Laryngeal neoplasia o Esophageal stricture  Apraxia is a disorder of the nervous system in which the brain is affected and the patient is unable to move the arms/legs when asked to do so. Common signs of depression include anhedonia (loss of interest in activities that the patient finds pleasurable), unintentional weight loss or gain, fatigue, change in appetite, insomnia or hypersomnia, feelings of guilt and worthlessness, and recurrent thoughts of suicide.  Which of the following is an accurate description of eliciting for Murphy's sign? o Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle o Bend the patient's hips and knees at 90 degrees, then passively rotate hip exter- nally, then internally o Ask the patient to squat, then place the stethoscope on the apical area o Press into the abdomen deeply, then release it suddenly - Correct answer A) Upon deep inspiration by the patient, palpate firmly in the right upper quad- rant of the abdomen below the costovertebral angle  Murphy's sign is positive if pain occurs when performing RUQ palpation while the patient takes a deep inspiration, causing the patient to abruptly stop the deep breath due to pain. As the liver is palpated, it will descend and push up against the inflamed gallbladder and cause sharp pain (cholecystitis).  A 28-year-old multipara who is at 32 weeks of gestation presents to your office complaining of a sudden onset of small amounts of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely? o Placenta abruptio o Placenta previa o Acute cervicitis o Molar pregnancy (hydatidiform mole) - Correct answer B) Placenta previa  Placenta previa occurs when abnormal implantation of the placenta occurs. A common symptom of placenta previa is painless, bright red bleeding.  Epidemiologic studies show that Hashimoto's disease occurs most commonly in: o Middle-aged to older women o Smokers o Obese individuals o Older men - Correct answer A) Middle-aged to older women  Hashimoto's disease commonly occurs in middle-aged to older women.  A 48-year-old woman is told by a physician that she is starting menopause. All of the following are possible findings except: o Hot flashes o Irregular menstrual periods o Severe vaginal atrophic changes o Cyclic mood swings - Correct answer C) Severe vaginal atrophic changes  As women reach menopause, changes that may occur include hot flashes, irregular menstrual periods, and cyclic mood swings. Vaginal changes, such as dryness and thinning, may also begin to occur  A 63-year-old patient with a 10-year history of poorly controlled hypertension presents with a cluster of physical exam findings. Which of the following indicate target organ damage commonly seen in hypertensive patients? o Pedal edema, hepatomegaly, and enlarged kidneys o Hepatomegaly, AV nicking, bibasilar crackles o Renal infection, S3, neuromuscular abnormalities o Glaucoma, jugular vein atrophy, heart failure - Correct answer B) Hepatomegaly, AV nicking, bibasilar crackles  With long-term, uncontrolled hypertension, organ damage may occur. Organs commonly affected include: brain (stroke), eyes (retinopathy, AV nicking, bleeding, blindness), heart (heart dis- ease, left ventricular hypertrophy, MI, and/or CHF), and kidneys (renal failure, proteinuria).  A 30-year-old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threatened abortion? o Vaginal bleeding and cramping are present, but the cervix remains closed o Vaginal bleeding and cramping are present along with a dilated cervix o The fetus and placenta are all expelled o The products of conception and the placenta remain inside the uterus along  with a dilated cervix - Correct answer A) Vaginal bleeding and cramping are present, but the cervix remains closed  Threatened abortion is defined as vaginal bleeding and cramping with- out the presence of cervical dilation.  A 30-year-old female who is sexually active complains of a large amount of milk- like vaginal discharge for several weeks. A microscopy slide reveals a large amount of squamous epithelial cells that have blurred margins. Very few white blood cells are seen. The vaginal pH is at 6.0. What is most likely? o Trichomonas infection o Bacterial vaginosis o Candidal infection o A normal finding - Correct answer B) Bacterial vaginosis  Bacterial vaginosis is a bacterial infection of the vagina. Signs and symptoms include copious off-white to gray discharge with foul odor without vaginal erythema or irritation. Wet prep will show positive for clue cells. When performing a wet prep, the "whiff test" will be positive for a strong "fishy" odor when vaginal discharge is mixed with one drop of KOH.  The Pap smear result on a 20-year-old sexually active student who uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up action? o The NP needs to do cervical cultures to verify the presence of gonorrhea o Prescribe metronidazole vaginal cream for the patient over the phone o Call the patient and tell her she needs a repeat Pap smear in 6 months o Advise the patient to use a Betadine douche at bedtime x 3 days - Correct answer A) The NP needs to do cervical cultures to verify the presence of gonor-  rhea  Cultures should be taken at the time of the Pap smear, as the patient may not return for later diagnostic testing.  While performing a Pap smear on a postmenopausal patient, several areas of flat white skin lesions that are irregularly shaped are found on the patient's labia. The patient reports that the lesions are extremely itchy and have been present for several years without much change. Which condition is best described? o Chronic scabies infection o Lichen sclerosus o Chronic candidal vaginitis o A physiologic variant found in some older women - Correct answer B) Lichen sclerosus  Lichen sclerosus is a disease of the skin, in which white spots appear on the skin and change over time. It is most commonly seen in the genital and rectal areas, but can appear in other areas. The spots are usually shiny and smooth and can eventually spread into patches. The skin appears thin and crinkled. Then the skin  An 8-year-old male patient with the diagnosis of diabetes has a high risk of urinary tract infections. A large amount of leukocytes in the urinalysis is abnormal and he has been having symptoms of frequency and nocturia for the past 3 days. The urine culture would be ordered because he has a high risk of infection. The urine culture and sensitivity (C&S) is the best evaluation for diagnosing a urinary tract infection.  All of the following are not recommended for the outpatient treatment of mild preeclampsia except: o Severe sodium restriction o Restrict fluid intake to less than 1 liter per 24 hours o Aldomet (methyldopa) 250 mg PO (orally) BID o Bed rest on the left side with bathroom privileges - Correct answer D) Bed rest on the left side with bathroom privileges  Outpatient treatment for mild pre-eclampsia includes bed rest on the left lateral side with bathroom privileges.  The best test for diagnosing congenital glaucoma is which of the following? o Fluorescein staining o Tonometry o Snellen vision exam o The refractive index - Correct answer B) Tonometry  A tonometer is used to measure the intraocular pressure (IOP) of the eye to screen for glaucoma. Normal range IOP is 10-22 mm Hg.  Rocky Mountain spotted fever is caused by the bite of the: o Mosquito o Tick o Insect o Flea - Correct answer B) Tick  Rocky Mountain spotted fever is caused by a tick bite from a tick that was infected with the parasite Rickettsia rickettsii. The mortality rate is 1%-7% if left untreated.  All of the following are false statements about atopic dermatitis except: o Contact with cold objects may exacerbate the condition o It does not have a linear distribution o It is associated with bullae o The lesions have vesicles that are full of serous exudate - Correct answer B) It does not have a linear distribution  Atopic dermatitis is a skin condition in which the lesions occur in a linear fashion. They may have many different stages, including erythematous papules and vesicles, with weeping, drainage, and/or crusting. Lesions are commonly found on the scalp, face, forearms, wrists, elbows, and backs of the knees. Commonly pruritic. Also known as eczema.  A mother brings in her 4-year-old daughter who just started attending preschool. She tells the nurse practitioner that her child is complaining of burning and itching in both eyes along with a runny nose. During the physical exam, the child's eyes appear injected bilaterally. The throat is red and her inferior nasal turbinates are swollen. Which of the following is most likely? o Herpes keratitis o Corneal ulcer o Viral conjunctivitis o Bacterial conjunctivitis - Correct answer C) Viral conjunctivitis  Viral conjunctivitis is inflammation of the conjunctiva with common complaints of red, itchy eyes, without signs of infection.  A sexually active woman is complaining of amenorrhea and vaginal spotting. On exam, her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse practitioner initially order? o Flat plate of the abdomen o Complete blood count (CBC) with white cell differentials o Urine pregnancy test o Pelvic ultrasound - Correct answer C) Urine pregnancy test  A urine pregnancy test should be performed to rule out miscarriage and/or tubal pregnancy.  A toddler with congenital heart disease is seen for a 1-week history of facial and lower-extremity edema accompanied by shortness of breath. The child's mother reports that the child's appetite has been poor. The chest x-ray reveals that the child has congestive heart failure (CHF). Which of the following heart sounds are found in these patients? o S1 and S2 o S1, S2, and S3 o S1, S2, and S4 o Still's murmur and S4 - Correct answer B) S1, S2, and S3  Congestive heart failure is the inability of the heart to pump a sufficient amount of blood to the organs to meet the body's requirements. It is common to hear S1, S2, and S3 heart sounds on exam. Common signs and symptoms include fatigue, shortness of breath with activity, and edema of lower extremities.  A 53-year-old crossing guard complains of twisting his right knee while working that morning. The knee is swollen and tender to palpation. The nurse practitioner diagnoses a Grade II sprain. The initial treatment plan includes which of the following? o Application of cold packs the first 24 hours followed by applications of low heat at bedtime o Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours o Rechecking the knee in 24 hours and isometric exercises o The application of an Ace bandage to the affected kne - Correct answer B) Elevation of the affected limb and intermittent applications of cold packs for the next 48 hours  Elevation of the injured knee above the heart will reduce the amout of swelling that can occur. Use of ice packs immediately after the injury is most effective and will reduce swelling in the tissue. Ice the affected area for 15 minutes at a time intermittently to prevent frostbite and further damage to tissue. Allowing 30-45 minutes between icings of the limb is recommended.  Erythromycin 200 mg with sulfisoxazole 600 mg suspension (Pediazole) is contraindicated in which of the following conditions? o G6PD deficiency anemia o Lead poisoning o Beta thalassemia minor o B12 deficiency anemia - Correct answer A) G6PD deficiency anemia  Glucose-6-phosphate dehydrogenase (G6PD) defi- ciency is a hereditary condition that occurs when the red blood cells break down, causing hemolysis, due to a missing or lack of a sufficient enzyme that is needed to help the red blood cells work efficiently. Certain foods and medications may trigger this reaction and hemolysis will occur. Some of these medications include antimalarial drugs, aspirin, nitrofurantoin, NSAIDs, quinidine, quinine, and sulfa medications.  The mother of an 11-year-old boy with sickle cell anemia calls on the phone complaining that her son woke up because of a painful penile erection that will not go away. The nurse practitioner's most appropriate intervention is: o Td and oral polio - Correct answer C) Varicella  The data regarding efficacy of the varicella vaccine are insufficient; therefore, varicella vaccine is contraindicated in HIV-infected individuals.  A 44-year-old female who is undergoing treatment for infertility complains of not having a menstrual period for a few months. The night before, she started spotting and is now having cramp-type pains in her pelvic area. Her blood pressure (BP) is 160/80, the pulse rate is 110, and she is afebrile. Her labs reveal a mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is found above the symphy- sis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely? o Inevitable abortion o Threatened abortion o Incomplete abortion o Acute pelvic inflammatory disease - Correct answer A) Inevitable abortion  Inevitable abortion is defined as vaginal bleeding with pain and cervical dilation and/or effacement. Threatened abortion is defined as vaginal bleeding with absent or minimal pain and a closed, long, and thick cervix. Incomplete abortion is moderate to diffuse vaginal bleeding, with the passage of tissue and painful uterine cramping or contractions. Acute pelvic inflammatory disease is a sudden onset of inflammation and pain that affects the pelvic area, cervix, uterus, and ovaries, which is caused by infection.  A 14-year-old female who is sexually active is brought in by her mother for an immunization update. According to the mother, her daughter had 1 dose of hepatitis B vaccine. Which of the following vaccines would you administer at this visit? o Td and hepatitis B o DTaP (diphtheria, tetanus, acellular pertussis) and hepatitis B o Hepatitis B only o MMR (measles, mumps, rubella) and Td - Correct answer A) Td and hepatitis B  The CDC recommends Td and hepatitis B for 14-year-old females. It is recommended for her to continue the hepatitis series, which includes a total of 3 injections.  An Rh-negative pregnant woman with negative rubella titers should be vaccinated at what time period in pregnancy? o She can be vaccinated at any time in her pregnancy o During the second trimester o During the third trimester o During the postpartum period - Correct answer D)During the post partum period  Rubella should be administered to the woman during the postpartum period. Rubella is contraindicated during pregnancy.  Medicare Part B will pay for all of the following services except: o Outpatient physician visits that are medically necessary o Durable medical equipment o Outpatient laboratory and radiology tests o Eyeglasses and routine dental care - Correct answer D) Eyeglasses and routine dental care  Medicare Part B covers: 1) outpatient physician visits, labs, x-rays; 2) durable medical equipment; 3) mammograms/ colonoscopy after age 50 years annually; and 4) rehabilitation.  Which of the following is used to screen for color blindness in a 7-year-old boy? o Snellen chart o Ishihara chart o Cover/uncover test o Red reflex - Correct answer B) Ishihara chart  The Ishihara chart is used for screening for color blindness.  A 67-year-old retired clerk presents with complaints of shortness of breath and weight gain over a 2-week period. A nonproductive cough accompanies her symptoms. The lung exam is positive for fine crackles in the lower lobes with no wheezing. The exam is positive for egophony. Which of the following conditions is most likely? o Acute exacerbation of asthma o Left-heart failure o Right-heart failure o Chronic obstructive pulmonary disease - Correct answer B) Left-heart failure  Signs and symptoms of left-heart failure include tachypnea, labored breathing, and rales or crackles in the lower bases of the lungs, which can develop into pulmonary edema.  Which of the following drugs is most likely to relieve the patient's symptoms? o Atenolol (Tenormin) o Trimethoprim/sulfamethoxazole (Bactrim DS) o Furosemide (Lasix) o Hydrocodone/guaifenesin syrup (Hycotuss) - Correct answer C) Furosemide (Lasix)  Lasix would be used to help remove the extra fluid load.  A patient has recently been diagnosed with migraine headache with aura. She wants advice on what she should eliminate from her diet to reduce her risk of headaches. The best response is to advise this patient to avoid: o Foods with aspartame (Equal) because they can trigger migraines o Foods with monosodium glutamate because they promote diuresis o Foods with garlic because they promote hypertension o Foods with nitrates because they do not induce flushing - Correct answer A) Foods with aspartame (Equal) because they can trigger migraines  Dietary triggers for migraine headaches include foods that contain aspartame, tyramine, nitrites, MSG, and/or red wine. These foods are thought to cause a change in the blood vessels and increased blood flow to the brain.  A patient with a history of mitral valve prolapse (MVP) is requesting prophylaxis before her dental surgery. Which of the following would you prescribe this patient? o Amoxicillin a half hour before and 2 hours after the procedure o Amoxicillin 1 hour before the procedure o Amoxicillin 1 hour before and 3 hours after the procedure o Prophylaxis is not recommended for this patient - Correct answer D) Prophylaxis is not recommended for this patient  The American Heart Association does not recommend routine antibiotic prophylaxis prior to dental procedures except for patients who are at high risk for bacterial endocarditis (a prosthetic cardiac valve, previous history of bacterial endocarditis, congenital heart defects, etc.).  Koplik's spots are associated with: o Poxvirus infections o Measles o Kawasaki's disease o Reye's syndrome - Correct answer B) Measles o Primary hypertension - Correct answer B) Pregnancy-induced hypertension (preeclampsia)  The classic triad of symptoms of preeclampsia includes hypertension, edema (weight gain), and proteinuria.  The nurse practitioner who suspects that one of her hypertensive patients has Cushing's syndrome would expect to find which of the following laboratory results? o Hyponatremia o Hypoglycemia o Elevated serum cortisol levels o Decreased urine 17-ketosteroids - Correct answer C) Elevated serum cortisol levels  Elevated serum cortisol levels are seen with Cushing's syndrome.  The first teeth to erupt during infancy are which of the following? o First molars o Second molars o Incisors o Canines - Correct answer C) Incisors  The incisors are the first teeth to erupt during infancy.  The positive signs of pregnancy include: o Palpation of the fetus and auscultation of the fetal heart tones by the nurse practitioner o Palpation of the fetus and a positive quantitative serum pregnancy test o Fetal heart tones and a positive quantitative serum pregnancy test o Fetal heart tones and feeling of movement of the baby by the mother - Correct answer A) Palpation of the fetus and auscultation of the fetal heart tones by the nurse practitioner  Presumptive signs of pregnancy are symptoms experienced by the woman, such as amenorrhea, breast tenderness, nausea/vomiting, fatigue, and increased urinary frequency. Probable signs of pregnancy are signs detected by the examiner, such as an enlarged uterus. Positive signs of pregnancy are direct evidence of pregnancy such as audible fetal heart tones or cardiac activity on ultrasound.  Chadwick's sign is characterized by: o Softening of the cervix o Blue coloration of the cervix and vagina o Softening of the uterine isthmus o Nausea and vomiting during the first trimester of pregnancy - Correct answer B) Blue coloration of the cervix and vagina  Chadwick's sign is defined as a bluish discoloration of the cervix and vagina. These changes are caused by the increased vascularity and congestion in the pelvic area during pregnancy.  A college student has recently been informed that he has an HPV (human papilloma virus) infection on the shaft of his penis. Which of the following may reveal subclinical lesions on the penile skin? o Perform a KOH (potassium hydroxide) exam o Scrape off some of the affected skin and send it for a culture and sensitivity o Apply acetic acid to the penile shaft and look for acetowhite changes o Order a serum herpes virus titer - Correct answer C)Apply acetic acid to the penile shaft and look for acetowhite changes  Lesions of HPV infection will turn white with application of acetic acid.  Carol M. is a 40-year-old bank teller who has recently been diagnosed with obsessive-compulsive disorder by her therapist. Her symptoms would include: o Ritualistic behaviors that the patient feels compelled to repeat o Attempts to ignore or suppress the repetitive behaviors, which increase anxiety o Frequent intrusive and repetitive thoughts and impulses o All of the above - Correct answer D) All of the above  Signs and symptoms of obsessive-compulsive disorder include ritualistic behaviors that are repeated, increased anxiety with attempting to ignore repetitive behaviors, and frequent intrusive and repetitive thoughts and impulses.  Which of the following medications is indicated for the treatment ofobsessive- compulsive disorder? o Paroxetine (Paxil CR) o Haldoperidol (Haldol) o Lorazepam (Xanax) o Imipramine (Elavil - Correct answer A) Paroxetine (Paxil CR)  Antidepressants are the most common medications used for OCD. Those antidepressants that are approved for OCD by the Food and Drug Administration (FDA) include clomipramine (Anafranil), fluvox- amine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).  You would advise an 18-year-old female student who has been given a booster dose of MMR at the college health clinic that: o She might have a low-grade fever during the first 24 to 48 hours o She should not get pregnant within the next 4 weeks o Her arm will be very sore on the injection site for 24 to 48 hours o Her arm will have some induration on the injection site in 24to48hours - Correct answer B) She should not get pregnant within the next 4 weeks  MMR should not be administered to women known to be pregnant. In addition, women should be counseled to avoid becoming pregnant for 28 days following vaccination.  Jean, a 68-year-old female, is suspected of having Alzheimer's disease. Which of the following is the best initial method for assessing the condition? o Computed tomography scan of the brain o Mini Mental Status Exam o Obtain the history from the patient, friends, and family members o EEG (electroencephalography) - Correct answer B) Mini Mental Status Exam  Begin with administering the MMSE for a baseline assessment, followed by taking a history from the patient and others.  A 55-year-old woman who has type 2 diabetes is concerned about her kidneys. She has a history of 3 urinary tract infections within the past 8 months. She denies dysuria and frequency at this visit. Which of the following is the best initial course to follow? o Recheck the patient's urine and order a urine for culture and sensitivity o Order an IVP (intravenous pyelogram) o Advise the patient to follow up with a urologist o Evaluate the patient for a possible kidney infection - Correct answer A) Recheck the patient's urine and order a urine for culture and sensitivity  A urinary tract infection is defined as the presence of 100,000 organisms per mL of urine in asymptomatic patients or greater than 100 organisms per mL or urine with pyuria (more than 7 WBCs/mL) in a symptomatic patient  Patient confidentiality is breached when medical information is given to a spouse or any other individual without consent of the patient.  A 25-year-old woman's last menstrual period was 6 weeks ago. She is complaining of nausea with vomiting in the morning and fatigue. Her breasts feel bloated. The nurse practitioner suspects that she is pregnant. Her symptoms would be considered: o Positive signs of pregnancy o Probable signs of pregnancy o Presumptive signs of pregnancy o Possible signs of pregnancy - Correct answer C) Presumptive signs of pregnancy  Presumptive signs of pregnancy are symptoms experienced by the woman, such as amenorrhea, breast tenderness, nausea/ vomiting, fatigue, and increased urinary frequency.  A 55-year-old male patient describes to you an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved immediately when he stopped. Which of the following conditions does this best describe? o Angina pectoris o Acute myocardial infarction o Gastroesophageal reflux disease o Acute costochondritis - Correct answer A) Angina pectoris  Symptoms of angina pectoris include a pressing, squeezing, or crushing pain, usually in the chest or back, arms, neck, or ear lobes. Weakness, fatigue, and shortness of breath and pain radiating in the arms, shoulders, jaw, neck, and/or back may also occur. Angina pectoris is most commonly brought on by physical exertion, but can also be triggered by stress and other stressors to the body.  Which of the following would you recommend to this 55-year-old patient? o Start an exercise program by starting with walking instead of jogging o Consult with a cardiologist for further evaluation o Consult with a gastroenterologist to rule out acute cholecystitis o Take ibuprofen (Advil) 600 mg for pain every 4 to 6 hours PRN - Correct answer B) Consult with a cardiologist for further evaluation  Physical assessment and examination by a cardiologist are advised to rule out cardiac problems and deter- mine the safety of physical exercise.  Carol, a 73-year-old patient, complains of episodic vertigo, slight confusion, and weakness that last nearly an hour each time. Movement does not worsen the vertigo. She "rests" and her symptoms subside, but she is puzzled because the weakness "jumps from side to side," sometimes on the right and sometimes on the left of her body. Her symptoms suggest: o Benign paroxysmal positional vertigo o Ménière's disease o TIA (transient ischemic attack) o CVA (cerebrovascular accident) - Correct answer C) TIA (transient ischemic attack)  Transient ischemic attack (TIA) is caused by vascular occlusion. Symptoms of a TIA usually last less than 1 hour; however, the symptoms may also be permanent. Common signs/symptoms include neurologic deficits, vertigo, confusion, weakness, hemiparesis, temporary monocular blindness, ataxia, and diplopia.  All of the following measures have been found to help lower the risk of osteoporosis except: o Drinking organic juice o Eating low-fat dairy foods o Performing weight-bearing exercises o Vitamin D supplementation - Correct answer A) Drinking organic juice  Vitamin D levels must be sufficient for the body to absorb calcium. Eating foods high in vitamin D and calcium along with calcium and vitamin D supplements are advised to protect the bones and prevent bone loss. Performing weight-bearing exercises daily also increases bone strength.  A 28-year-old male nurse of Hispanic descent reports a history of a cold that resolved 2 weeks ago except for a dry cough and pain over his right cheek that worsens when he bends down. The patient denies fever. He tells the employee health nurse practitioner that he is very allergic to both cephalexin (Keflex) and erythromycin. The vital signs show that the patient's temperature is 99.2 degrees Fahrenheit, a pulse of 72 beats per minute, and a respiratory rate of 12 breaths per minute. Which of the following conditions is most likely? o Acute sinusitis o Acute bronchitis o Fever secondary to the previous viral URI (upper respiratory infection) o Munchausen's syndrome - Correct answer A) Acute sinusitis  Acute sinusitis symptoms include cough, facial pain, and low-grade fever.  A 38-year-old multigravida who is at 32 weeks of gestation calls the family nurse practitioner complaining of bright red vaginal bleeding. There is no watery dis- charge. She complains that her uterus feels hard and is very painful. Which of the following conditions is most likely? o Placenta previa o Placenta abruptio o A molar pregnancy o An ectopic pregnancy - Correct answer B) Placenta abruptio  Abruptio placenta symptoms are bright red vaginal bleeding, board-like uterus on palpation, and pain. However, there can be concealed hemorrhage and the patient may not have vaginal bleeding. Placenta previa is painless bleeding. Ectopic and molar pregnancy would not progress to 32 weeks gestation  The Jarisch-Herxheimer reaction is best described as: o An immune-mediated reaction precipitated by the destruction of a large number of spirochetes due to an antibiotic injection o Severe chills and elevated blood pressure o Caused by infection with either Chlamydia trachomatis or gonorrheal infection of the liver capsule o Associated with certain viral illnesses - Correct answer A) An immune- mediated reaction precipitated by the destruction of a large number of spirochetes due to an antibiotic injection  The Jarisch-Herxheimer reaction is defined as an immune-mediated reaction precipitated by the destruction of a large number of spirochetes due to the antibiotic injection.  During a breast exam of a 30-year-old nulliparous female, the nurse practitioner palpates several rubbery mobile areas of breast tissue. They are slightly tender to palpation. Both breasts have symmetrical findings. There are no skin changes or any nipple discharge. The patient is expecting her menstrual period in 5 days. Which of the following would you recommend? o Referral to a gynecologist for further evaluation o Tell her to return 1 week after her period so her breasts can be rechecked o Advise the patient to return in 6 months to have her breasts rechecked o Schedule the patient for a mammogram - Correct answer B)Tell her to return 1 week after her periods so her breasts can be rechecked  Prior to having menses, women will experience breast changes of tenderness with palpation, with symmetrical soft, mobile areas of breast tissue that are benign. Her symptoms should improve after her menses and repeating the exam in 1 week would be recommended. o Presumptive sign o Probable sign o Positive sign o Possible sign - Correct answer B) Probable sign  Probable signs of pregnancy are symptoms of pregnancy that are felt by the woman.  A 14-year-old teen is worried that she has not started to menstruate like most of her friends. During the gynecological examination, the nurse practitioner tells the mother, who is in the room with the patient, that her daughter is starting Tanner Stage II. What are the physical exam findings during this stage? o Breast buds and some straight pubic hair o Fully developed breasts and curly pubic hair o Breast tissue with the areola on a separate mound with curly pubic hair o No breast tissue and no pubic hair - Correct answer A) Breast buds and some straight pubic hair  Tanner Stage II in females includes breast buds and few straight, fine pubic hairs.  The Phalen test is used to evaluate: o Inflammation of the median nerve o Rheumatoid arthritis o Degenerative joint changes o Chronic tenosynovitis - Correct answer A) Inflammation of the median nerve  The Phalen test is used to identify inflammation of the median nerve seen with carpal tunnel syndrome. Phalen's test is performed by examining the wrist with full flexion of the wrist for 60 seconds. Positive findings are reproduction of the symptoms such as numbness and tin- gling of the thumb, index finger, and middle finger areas.  Physiologic anemia of pregnancy is due to: o An increase in the cardiac output at the end of the second trimester o A physiologic decrease in the production of RBCs in pregnant women o An increase of up to 50% of the plasma volume in pregnant women o An increase in the need for dietary iron in pregnancy - Correct answer C)An increase of up to 50% of the plasma volume in pregnant women  Physiologic anemia of pregnancy is caused by the increased volume of plasma during pregnancy when compared to the production of RBCs.  All of the following are implicated in causing chronic cough except: o Chronic bronchitis o Allergic rhinitis o Acute viral upper respiratory infection o Gastroesophageal reflux disease - Correct answer C) Acute viral upper respiratory infection  Chronic cough can be caused by chronic bronchitis, allergic rhinitis, and GERD.  Which of the following is a true statement regarding the effect of aspirin on platelet function? o The effect on platelets is reversible o The effect on platelets is reversible and lasts only 1 week o It has a minimal effect on platelet function o The effect on platelet function is irreversible and lasts 15 to 20 days - Correct answer D) The effect on platelet function is irreversible and lasts 15 to 20 days  The use of aspirin affects the platelet function, is irreversible, and can last up to 15-20 days  All of the following agents are used to control the inflammatory changes seen in the lungs of asthmatics except: o Albuterol inhaler (Proventil) o Triamcinolone (Azmacort) o Montelukast (Singulair) o Cromolyn sodium inhaler (Intal) - Correct answer A) Albuterol inhaler (Proventil)  Proventil inhaler is a short-acting bronchodilator and is used for immediate relief of shortness of breath. It acts quickly to dilate the tubes in the lungs. Medications that have steroids and leukotrienes help the inflamed channels to remain open and clear but take longer to get into the system to work.  Rovsing's sign is associated with which of the following? o An acute abdomen, such as during a ruptured appendix o Knee instability o Damage to the meniscus of the knee o Acute cholelithiasis - Correct answer A) An acute abdomen, such as during a ruptured appendix  Rovsing's sign identifies an acute abdomen, such as acute appendicitis. Rovsing's maneuver is per- formed with the patient in the supine position, palpating deep into the left lower quadrant of the abdomen and having referred pain to the right lower quadrant.  Which of the following is contraindicated in the care of pregnant women with placenta previa? o Echocardiogram o Intravaginal ultrasound o Abdominal ultrasound o Pelvic ultrasound - Correct answer B) Intravaginal ultrasound  No type of vaginal exam should be performed in patients diagnosed with placenta previa. Intravaginal ultrasound and pelvic exams are contraindicated  A patient is positive for anti-HCV (hepatitis C virus antibody). What is the next step to further evaluate this patient? o Refer the patient to a gastroenterologist o Order a hepatitis C PCR (polymerase chain reaction) test o Order a hepatitis B comprehensive panel o The patient is immune to hepatitis C and no further testing is indicated - Correct answer B) Order a hepatitis C PCR (polymerase chain reaction) test  When a patient tests positive for anti-HCV (hepatitis C virus antibody), labs ordered should include hepatitis C PCR to further evaluate the patient.  A 62-year-old female complains of chronic severe low back pain. She also reports mild episodes of fecal incontinence and numbness to her lower legs over the past week. You would suspect which of the following? o Fracture of the lower spine o A herniated disc o Cauda equina syndrome o Ankylosing spondylitis - Correct answer C) Cauda equina syndrome  Cauda equina syndrome is a surgical emergency. Signs and symptoms include a change in bowel and bladder control (incontinence). Acute pressure on the sacral  A high school teacher complains of a dry cough for the past 6 weeks. It worsens when he is supine. He has episodes of heartburn, which he self-treats with an over- the-counter (OTC) antacid. He chews mints for his "bad breath." Which of the fol- lowing is a possible cause for this patient's cough? o Asthma o Gastroesophageal reflux o Pneumonia o Chronic postnasal drip - Correct answer B) Gastroesophageal reflux  GERD is a condition in which food comes up from the stomach/esophagus due to a weak sphincter. It usually worsens with lying down and can cause a cough and esophageal irritation if not treated.  The red reflex is elicited by shining a light in the eyes of the infant at an angle with the light about 15 in. away. The nurse practitioner is screening for? o Cataracts o Strabismus o Blindness o The blinking response - Correct answer A) Cataracts  Screening for cataracts is performed by shining a light into the eyes at an angle, approximately 15 inches away. If the red reflex is not elicited, then cataracts are present.  A 44-year-old patient with Down syndrome starts to develop impaired memory and difficulty with his usual daily life routines. He is having problems functioning at the job that he has done for the past 10 years. The physical exam and routine labs are all negative. The vital signs are normal. His appetite is normal. The most likely diagnosis is: o Tic douloureux o A stroke o Alzheimer's disease o Delirium - Correct answer C) Alzheimer's disease  Delirium is an acute decline in mental status and is temporary. Common causes are fever, shock, drugs, alcohol, and dehydration. Alzheimer's disease is a permanent change to the brain that causes short-term memory loss, agnosia, apraxia, and aphasia. In this case, the patient's physical exam is normal; however, he is having memory loss and difficulty working and carrying out his normal tasks  Which of the following findings is associated with the chronic use of chewing tobacco? o Cheilosis and xerostomia o Glossitis o A geographic tongue o Leukoplakia and oral cancer - Correct answer D) Leukoplakia and oral cancer  The chronic use of tobacco increases the risk of oral cancer and leukoplakia. Cheilosis is skin fissures/maceration in the corner of the mouth, most commonly caused by anemia, bacterial infection, vitamin deficiencies, or oversalivation.  Which of the following is recommended treatment for erythema migrans or early Lyme disease? o Doxycycline (Vibramycin) 100 mg PO BID x 21 days o Ciprofloxacin (Cipro) 250 mg PO BID x 14 days o Erythromycin (E-mycin) 333 mg PO TID x 10 days o Dicloxacillin 500 mg PO BID x 10 days - Correct answer A) Doxycycline (Vibramycin) 100 mg PO BID x 21 days  The CDC-recom- mended treatment for erythema migrans or Lyme disease is doxycycline 100 mg PO BID x 21 days.  Nurse practitioners and clinical nurse specialists derive their legal right to practice from: o The Nurse Practice Act of the state where they practice o The laws of the state where they practice o The Medicare statute o The Board of Nursing in the state where they practice - Correct answer A) The Nurse Practice Act of the state where they practice  The Nurse Practice Act provides nurses with the legal right to practice nursing. The State Board of Nursing is the agency that enforces the Nurse Practice Act. The Medicare statute provides the funds for paying for health services at the age of 65 years and older.  You are checking a 75-year-old woman's breast during an annual gynecologi- cal exam. The left nipple and areola are scaly and reddened. The patient denies pain and pruritis. She has noticed this scaliness on her left nipple for the past 8 months. Her dermatologist gave her a potent topical steroid, which she used twice a day for 1 month. The patient never went back for the follow-up. She still has the rash and wants an evaluation. Which of the following is the best intervention for this patient? o Prescribe another potent topical steroid and tell the patient to use it twice a day for 4 weeks o Order a mammogram and refer the patient to a breast surgeon o Advise her to stop using soap on both breasts when she bathes to avoid drying  up the skin on her areolae and nipples  D) Order a sonogram and fine-needle biopsy of the breast - Correct answer B) Order a mammogram and refer the patient to a breast surgeon  A scaly, reddened rash on the breast that does not resolve after a few weeks of medical treatment may indicate breast cancer. She should have a mammogram performed and see a breast surgeon for evaluation and treatment.  The following children are considered at higher risk for tuberculosis (TB) except: o A child who has recently been diagnosed with leukemia o An infant whose family is homeless o A child who was born in Japan o A Hispanic child with asthma who is using a steroid inhaler - Correct answer C) A child who was born in Japan  Risk factors for tuberculosis include compromised immune system, high-risk populations (minorities, foreign-born people, prisoners, nursing home residents, indigents, migrant workers and health care providers). Steroid therapy and blood disorders also increase the risk of TB.  During a sports physical exam of a 14-year-old high school athlete, the nurse practitioner notices a split of the S2 component of the heart sound during deep inspiration. She notes that it disappears upon expiration. The heart rate is regular and no murmurs are auscultated. Which of the following is correct? o This is an abnormal finding and should be evaluated further by a cardiologist o A stress test should be ordered o This is a normal finding in some young athletes o An echocardiogram should be ordered - Correct answer C) This is a normal finding in some young athletes  It is common to hear a split of the S2 over the pulmonic area of the heart with inspiration as long as it disappears with expiration, with no other abnormal symptoms. This is caused by split- ting of the aortic and pulmonic components.  Mrs. J. L. is a 55-year-old female with a body mass index (BMI) of 24 and a history of asthma. She has hypertension that has been under control with hydrochlorothiazide 12.5 mg PO daily. Her total cholesterol is 230 g/dl. How many risk factors for coronary heart disease (CAD) does she have?  Carol, a 30-year-old type 2 diabetic, is on regular insulin and lente insulin in the morning and in the evening. She denies changes in her diet or any illness, but recently started attending aerobic classes in the afternoon. Because of her work- outs, her blood sugars have dipped below 50 mg/ dL very early in the morning.  Her fasting blood sugar before breakfast is now elevated and higher than normal. Which of the following is best described? o Somogyi phenomenon o Dawn phenomenon o Raynaud's phenomenon o Insulin resistance - Correct answer A) Somogi phenomenon  The Somogi phenomenon is when nocturnal hypoglycemia (2 a.m to 3 a.m.) stimulates the liver to produce glucagon to raise the blood sugar. The fasting blood glucose levels will be elevated from this glucagon production.  A 40-year-old female is positive for anti-hepatitis C virus (HCV). Which test is appropriate for follow-up? o HCV RNA o HCV antibodies o HCV core antigen o Hepatitis C surface antigen - Correct answer A) HCV RNA  HCV RNA is performed following a positive anti-hepatitis C virus test.  When the nurse practitioner is evaluating a patient for intermittent claudication, he/she would first: o Order a venogram o Order T.E.D. anti-embolism stockings o Check the ankle and brachial blood pressure before and after exercise o Check the pedal and posterior tibial pulses - Correct answer C) Check the ankle and brachial blood pressure before and after excercise  Initial evaluation for intermittent claudication would include checking the ankle and brachial blood pressure before and after exercise.  All of the following drugs can interact with theophylline (Theo-24) except: o Erythromycin o Montelukast (Singulair) o Phenytoin sodium (Dilantin) o Cimetidine (Tagamet) - Correct answer B)Montelukast(Singulair)  Medications that are contraindicated with theophylline include erythromycin, phenytoin sodium, and cimetidine.  You note a high-pitched and blowing pansystolic murmur in a 70-year-old male. It is Grade II/VI and is best heard at the apical area. Which of the following is most likely? o Ventricular septal defect o Tricuspid regurgitation o Mitral regurgitation o Mitral stenosis - Correct answer C) Mitral regurgitation  Mitral regurgitation is best heard at the apical area, and manifests as a high- pitched, blowing pansystolic murmur.  The cover/uncover test is a screening tool for: o Color blindness o Strabismus o Visual acuity o Cataracts - Correct answer B) Strabismus  The cover/uncover test screens for strabismus. Color blindness is evaluated by using the Ishihara tool. Visual acuity is evaluated using the Snellen chart. Cataracts are screened by using the ophthalmoscope and shining a light into the eyes at an angle, approximately 15 inches away. If the red reflex is not elicited, then cataracts are present  The mother of a 4-week-old infant is concerned that her infant's eyes are crossed for a few seconds occasionally. The nurse practitioner would: o Recommend referral to a pediatric ophthalmologist o Advise the mother that this is a normal finding in infants up to 2 months of age o Recommend that multivitamin supplements be given to the infant daily o Educate her on how to patch the infant's eye every 4 hours - Correct answer B) Advise the mother that this is a normal finding in infants up to 2 months of age  Infants' eyes commonly cross over at times, and this is a normal finding up to 2 months of age.  All of the following are factors important in determining the peak expiratory flow volume except: o Weight o Height o Age o Gender - Correct answer A) Weight  Peak expiratory flow volume is determined by using height, gender, and age.  You are reviewing a Pap smear report on a 25-year-old female. Which of the following cells should be on a Pap smear to be classified as a satisfactory specimen? o Clue cells and endometrial cells o Vaginal cells and cervical cells o Squamous epithelial cells and endocervical cells o Leukocytes and RBCs - Correct answer C) Squamous epithelial cells and endocervical cells  Squamous epithelial cells and endocervical cells must be obtained when performing a Pap smear to be considered satisfactory to evaluate the cells from the endocervix.  When assessing a patient suspected of having vertigo, which description provided by the patient is most consistent with the diagnosis? o A sensation of imbalance while walking o A sensation of spinning or rotating o A sensation of "passing out" o A sensation of lightheadedness when changing positions from reclining to standing - Correct answer B) A sensation of spinning or rotating  Vertigo is defined as having a sensation of spinning or rotating  A 56-year-old man complains of episodes of lancinating pain that shoots up to his right cheek when he eats or drinks. He has stopped drinking cold drinks because of the pain. Which of the following is most likely? o Trigeminal neuralgia o Cluster headache o Acute sinusitis o Sinus headache - Correct answer A) Trigeminal neuralgia  You are following up a 65-year-old male who has been on a new prescription of fluvastatin (Lescol) for 6 weeks. During a follow-up visit, he reports feeling extremely fatigued and having dark-colored urine. He denies any generalized muscle soreness. Which of the following is the most appropriate treatment plan? o Order a CBC with differential o Order a liver function profile o Recommend an increase in fluid intake and rest o Order a urine for C&S test - Correct answer B) Order a liver function profile  Statin medications, such as Lescol, can affect liver function and increase liver enzymes, as well as cause the patient to feel weak, fatigued, and have muscle aches. Therefore, checking the liver function profile is recommended.  Which of the following diagnoses is most likely in this patient? o Rhabdomyolysis o Acute drug-induced hepatitis o Acute mononucleosis o A major depressive episode - Correct answer B) Acute drug-induced hepatitis  Liver enzymes, such as ALT and AST, can be elevated with the use of medications, such as statin medications. High liver enzymes can cause an acute drug-induced hepatitis.  What would you advise him regarding his fluvastatin (Lescol) prescription? o Continue taking the medicine until the lab results are available o Take half the usual daily dose until the lab results are available o Take the medicine every other day instead of daily until the lab results are available o Stop taking the medicine until the lab results are available - Correct answer D) Stop taking the medicine until the lab results are available  When liver enzymes are affected by medications, such as statin medications, the patient is advised to stop taking the medicine until the lab results are available.  All of the following children are within the parameters of normal growth and development for their age group except: o A 2-month-old who coos and smiles o A 14-month-old who understands complex commands o A 20-month-old who can walk without support o A 3-year-old who can speak in three- to four-word sentences - Correct answer B) A 14-month-old who understands complex commands  A 14-month-old child should developmentally be able to say "mama" and "dada," know his own name, and know at least 2-4 words. A 2-year-old is able to understand simple commands.  You are reviewing the bilirubin level on a 3-day-old full-term neonate. You note that it is 10 mg/dL. The infant has a slight yellow color to his skin, mucous membranes, and sclera. The infant is feeding well, is not irritable, and has 8 to 10 wet diapers per day. Which of the following is a true statement? o Keep on monitoring the infant's bilirubin level until it returns back to normal in about 1 week o Recommend that the infant be treated with phototherapy 10 minutes a day until the bilirubin level is back down to a normal range o Refer the infant to a neonatologist as soon as possible o Refer the infant to the neonatal intensive care unit - Correct answer A) Keep on monitoring the infant's bilirubin level until it returns back to normal in about 1 week  Bilirubin is excreted through the urine and feces. Increased fluids and wetting 8- 10 diapers a day is sufficient fluid intake/excretion to help bring down the bilirubin level. Levels should continue to be monitored and should improve in approximately 1 week.  All of the following statements are correct regarding the Td vaccine except: o Fever occurs in up to 80% of the patients o A possible side effect is induration on the injection site o The Td is given every 10 years o The DPT and DT should not be given beyond the seventh birthday - Correct answer A) Fever occurs in up to 80% of the patients  Side effects of the Td vaccine include induration at the injection site. Td is given in adults every 10 years. The DPT and DT should not be given beyond 7 years of age. Fever may occur, but studies do not support 80% of patients having fever.  Which of the following is recommended by JNC 7 as first-line treatment for hypertension in patients with microalbuminuria? o Angiotensin-converting enzyme (ACE) inhibitors o Diuretics o Calcium channel blockers o Beta-blockers - Correct answer A) Angiotensin-converting enzyme (ACE) inhibitors  First line of treatment for hypertension in patients with microalbuminuria is ACE inhibitors. ACE inhibitors are renal protective.  A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH is 4.0. There are very few leukocytes and no RBCs are seen on the wet smear. Which of the following is most likely? o Atrophic vaginitis o Bacterial vaginosis o Trichomoniasis o This is a normal finding - Correct answer A) Atrophic vaginitis  Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0 (acidic).  A test called the visual fields by confrontation is used to evaluate for: o Peripheral vision o Central distance vision o Narrow-angle glaucoma o Accommodation - Correct answer A) Peripheral vision  The visual fields of confrontation test is used to evaluate peripheral vision. The Snellen chart is used to measure central distance vision. A tonometer is used to assess for glaucoma. The ophthalmoscope is used to assess for cataracts.  The following skin findings are considered macules except: o A freckle o Petechiae o Acne o A flat, 0.5-cm brown birthmark - Correct answer C) Acne  A macule is a flat, non-raised lesion on the skin. Acne lesions are pap- ules because they consist of raised, erythemic lesions on the skin. A freckle, petechiae, and a flat birthmark are all considered macules.  To perform the straight- leg test, have the patient lie supine on an exam table. Lift the patient's leg toward the head while the knee is straight. If the patient experiences sciatic pain when the straight leg is at an angle of between 30 and 70 degrees, then the test is positive and a herniated disc is likely to be the cause of the pain. The straight-leg test should be done on the pain-free side first to find out which range of movement is normal and to enable the patient to distinguish between "normal" stretching of muscles and a different sort of pain.  Which of the following would you recommend on an annual basis for an elderly type 2 diabetic? o Eye exam with an ophthalmologist o Follow-up visit with a urologist o Periodic visits to an optometrist o Colonoscopy - Correct answer A) Eye exam with an ophthalmologist  Elderly patients with type 2 diabetes should have a dilated eye exam done annually by an ophthalmologist. It is also recommended to see a podiatrist once or twice a year. Preventive care also includes receiving a flu shot annually, receiving a pneumovax vaccine if over 60 years of age, and taking a baby aspirin of 81 mg each day.  A 72-year-old female complains to you of a crusty and non-healing small ulcer on her upper lip that she has had for several years. Which of the following would you recommend? o Triamcinolone acetonide (Kenalog) cream BID for 2 weeks o Triple antibiotic ointment BID x 2 weeks o Hydrocortisone 1% cream BID for 2 weeks o The patient needs to be evaluated by a dermatologist - Correct answer D) The patient needs to be evaluated by a dermatologist  Non healing ulcers of the skin are a risk for skin cancer and should be evaluated by a dermatologist for treatment.  All of the following statements about phototherapy are correct except: o Light from the blue to white spectrum is used o It is not always necessary to use a shield for the infant's eyes o Unconjugated bilirubin in the skin is converted to a water-soluble nontoxic substance that is excreted in the bile o The infant's eyes should be shielded - Correct answer B) It is not always necessary to use a shield for the infant's eyes  When using phototherapy, the eyes should always be protected by using a shield or goggles to prevent damage to the eyes.  Heberden's nodes are commonly found in which of the following diseases? o Rheumatoid arthritis o Degenerative joint disease o Psoriatic arthritis o Septic arthritis - Correct answer B) Degenerative joint disease  Heberden's nodes are bony nodules on the distal interphalangeal joints, commonly seen in degenerative joint disease.  The red blood cells in pernicious anemia will show: o Microcytic and hypochromic cells o Microcytic and normochromic cells o Macrocytic and normochromic cells o Macrocytic and hypochromic cells - Correct answer C) Macrocytic and normochromic cells  The blood cells in pernicious anemia will display macrocytic, normochromic cells. RBCs in iron-deficiency anemia are microcytic and hypochromic.  You notice a medium-pitched harsh systolic murmur during an episodic exam. It is best heard at the right upper border of the sternum. What is most likely? o Mitral stenosis o Aortic stenosis o Pulmonic stenosis o Tricuspid regurgitation - Correct answer B) Aortic stenosis  Aortic stenosis is best heard at the right upper border of the sternum, radiating to the neck with a medium-pitched systolic murmur. Mitral stenosis is heard at the apex of the heart and sounds like a low-pitched diastolic rumbling murmur. It is suggested that this murmur is heard best with the bell side of the stethoscope.  A small abscess on a hair follicle on the eyelid is called: o Hordeolum o Pterygium o Pinguecula o Ptosis - Correct answer A) Hordeolum  Hordeolum is a painful, acute bacterial infection of the hair follicle on the eyelid. Pinguecula is a thickening of the bulbar conjunctiva, located on the inner and outer margins of the cornea. Pterygium is a thickening of the conjunctiva located on the nasal or temporal cornea. Pinguecula and pterygium are both caused by the UV light of long-term sun exposure. Sunglasses with UV protection are recommended to prevent damage to the conjunctiva. Ptosis is the drooping of the upper eyelid.  Which of the following is indicated for the prophylactic treatment of migraine headache? o Ibuprofen (Motrin) o Naproxen sodium (Anaprox) o Propranolol (Inderal) o Sumatriptan (Imitrex) - Correct answer C)Propranolol (Inderal)  Medications used to prophylactically prevent migraine headaches include beta- blockers (propranolol) and tricyclic antidepressants (ami- triptyline). Motrin, Anaprox, and Imitrex are all medications used to treat migraine headache.  A 40-year-old male complains to the nurse practitioner of severe stabbing pains behind his left eye for the past 2 days. It is accompanied by some nasal congestion and rhinorrhea, which is clear in color. The patient denies pharyngitis and fever. Which of the following conditions is most likely? o Migraine headache with aura o Cluster headache o Tic douloureux o Cranial neuralgia - Correct answer B) Cluster headache  Signs/symptoms of cluster headaches include severe stabbing pain behind the eyes, with nasal congestion and rhinorrhea. Migraine head- aches with aura include visual changes, such as blind spots or flashing lights that appear before the onset of the headache. Trigeminal neuralgia (tic douloureux) is a unilateral headache from compression or inflammation of the trigeminal nerve (cranial nerve 5).  Ken has type 2 diabetes mellitus and a "sensitive stomach." Which medication is least likely to cause him gastrointestinal distress? o Naproxen sodium (Anaprox) o Aspirin (Bayer's aspirin) o Erythromycin (E-mycin) o Sucralfate (Carafate) - Correct answer D) Sucralfate (Carafate) mother wants him to be checked before he enters the local high school. Which of the fol- lowing does this patient need? o Meningococcal o MMR o Tdap o All of the above - Correct answer D) All of the above  The measles, mumps, and rubella (MMR) is recommended as one of the "catch- up" immunizations for this patient's age group. The tetanus immunization that is recommended as a "catch-up" for that age group is the Tdap instead of just the Td.  Which cranial nerve (CN) is being evaluated when patients are instructed to shrug their shoulders? o CN IX o CN X o CN XI o CN XII - Correct answer C) CN XI Cranial nerves IX, X, XI, and XII are: glossopharyngeal, vagal, spinal accessory, and hypoglossal, respectively.  A lab technician has a 10.5-mm area of redness and induration in his left forearm after getting a Mantoux test 72 hours ago. The last test, which was done 12 months ago, was negative. He denies cough, night sweats, and weight loss. What is the next best intervention? o Obtain a sputum culture and a chest x-ray o Obtain a chest x-ray o Obtain a sputum for C&S and an acid fast stain o Obtain a CBC and chest x-ray - Correct answer B) Obtain a chest x-ray  Mantoux results are negative if results show less than 10 mm induration on the forearm for low-risk clients. If results are greater or equal to 10 mm, then a chest x-ray should be ordered for further screening.  Swim therapy for a 13-year-old with cerebral palsy is an example of: o Primary prevention o Secondary prevention o Tertiary prevention o Health prevention - Correct answer C) Tertiary prevention  Tertiary prevention is any type of rehabilitation for a particular condition. Examples include physical rehab (swimming), cardiac rehab, and/or speech therapy.  Which of the following individuals is most likely to be at higher risk for osteoporosis? o 70-year-old female of African ancestry who walks daily for exercise o 42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the last 12 years to control her severe asthma o 55-year-old Caucasian female who is an aerobics instructor o 4-year-old Asian female who has been on high-dose steroids for 1 week - Correct answer B) 42-year-old obese woman from Cuba who has been taking prednisone 10 mg daily for the last 12 years to control her severe asthma  Risk factors for osteoporosis include postmenopause, early menopause, use of chronic steroids, smoking, excessive use of alcohol, sedentary lifestyle, insufficient intake of calcium and Vitamin D in the diet, and being an Asian or Caucasian female.  What is the primary carbohydrate found in breast milk and commercial infant formulas? o Fructose o Lactose o Glucose o Sucrose - Correct answer B) Lactose  Lactose is the primary carbohydrate found in breast milk and formula  Which of the following patients is least likely to become an alcoholic? o A patient whose father has a history of alcoholism o A patient whose wife complains that he drinks too much o A patient who drinks one cup of wine nightly with dinner o A patient who feels he drinks all the time - Correct answer C) A patient who drinks one cup of wine nightly with dinner  Excessive use or exposure to alcohol puts that patient at risk for becoming an alcoholic. A patient who drinks one glass of wine at dinner has a lower risk of becoming an alcoholic than someone who has been exposed to alcohol while growing up, one who drinks all the time, or one whose family believes he is drinking excessively.  The following conditions are absolute contraindications for the use of oral contraceptives except: o Hepatomas o History of emboli that resolved with heparin therapy 15 years ago o A family history of migraines with aura o A history of gallbladder disease during pregnancy - Correct answer C) A family history of migraines with aura  All of the items are contraindications, but a family history does not substantiate a need to avoid oral contraceptives.  The most common cause of cancer deaths in males is: o Lung cancer o Prostate cancer o Colon cancer o Skin cance - Correct answer A) Lung cancer  Lung cancer is the most common cause of cancer deaths in men. Prostate cancer and colon cancer are the second and third causes of cancer death in men.  Which of the following findings are seen in a patient with folate-deficiency anemia? o Microcytic and hypochromic RBCs o Microcytic and normochromic RBCs o Normal size and color of the RBCs o Macrocytic and normocytic RBCs - Correct answer D) Macrocytic and normocytic RBCs  Folate-deficiency anemia is diagnosed by macrocytic, normocytic red blood cell.  When confirming a case of temporal arteritis, the erythrocyte sedimentation rate (ESR) is expected to be: o Normal o Lower than normal o Elevated o Indeterminate result - Correct answer C) Elevated  A lipid profile done on a newly diagnosed hypertensive patient shows a triglyceride level of 650 mg/dL, total cholesterol 240 mg/dL, LDL 145 mg/dL, and an HDL of 35 mg/dL. What is the best intervention for this patient? o Educate the patient about lifestyle changes that will help lower cholesterol levels o Initiate a prescription of pravastatin (Pravachol) o Recommend that the patient exercise at least every other day and avoid eating  fatty or fried foods  D) Initiate a prescription of nicotinic acid (Niacin, Niaspan) - Correct answer D) Initiate a prescription of nicotinic acid (Niacin, Niaspan)  Niacin is recommended for treatment of high triglyceride and cholesterol levels. Exercise and healthy eating lifestyle is also recommended, but with the high level of triglycerides at 650 mg/dL and total cholesterol 240 mg/dL, niacin is recommended.  Cullen's sign is most commonly associated with which of the following? o Acute pancreatitis o Myocardial infarction o Acute pyelonephritis o Preeclampsia - Correct answer A) Acute pancreatitis  Cullen's sign is commonly seen in acute pancreatitis. It is a yellowish-blue skin color change around the umbilicus. It is thought to occur due to the pancreatic enzymes that run along the ligament and subcutaneous tis- sues around the umbilicus.  The "gold standard" for the diagnosis of active Helicobacter pylori infection of the stomach or duodenum is: o A Helicobacter pylori titer o An endoscopy with tissue biopsy o An upper GI series o A urea breath test - Correct answer B) An endoscopy with tissue biopsy  The "gold standard" for diagnosing Helicobacter pylori infection is to perform tissue biopsy via endoscopy.  Which of the following foods would you advise a new mother to introduce to her 6-month-old infant first? o Iron-fortified rice cereal o Plain rice cereal o Iron-fortified pureed chicken meat o Plain pureed carrots - Correct answer A) Iron-fortified rice cereal  At 6 months of age, it is recommended that the infant be fed iron-fortified rice cereal. Introducing only one new food at a time is recommended; in case an allergy does develop, you will be able to identify which food caused the allergy.  Jim Wheeler is obese (BMI of 33), fatigued, and complaining of excessive thirst and hunger. You suspect type 2 diabetes mellitus. Initial testing to confirm diagnosis can include: o Fasting plasma glucose level o Glycosylated hemoglobin level (HbA1 c) o Glucose tolerance testing o All of the above - Correct answer D) All of the above  Type 2 diabetes mellitus screening tests include: fasting plasma glucose level (> 126 mg/dL), random plasma glucose level (> 200 mg/dL), and glucose tolerance testing (2 hr blood glucose level > 200 mg/dL) with 75 g glucose load. Normal HbA1c levels are < 6%  A bulla is defined as: o A solid nodule less than 1 cm in size o A superficial vesicle filled with serous fluid greater than 1 cm in size o A maculopapular lesion o A shallow ulcer - Correct answer B) A superficial vesicle filled with serous fluid greater than 1 cm in size  A bulla is defined as a superficial vesicle filled with serous fluid greater than 1 cm in size.  A newborn's mother is discovered to be HBsAg (hepatitis B surface antigen) positive. Which of the following would you recommend for this infant? o Give the baby hepatitis B immunoglobulin o Give the baby both hepatitis B vaccine and hepatitis B immunoglobulin o Give the baby hepatitis B vaccine only o Send the baby home because he is not infected - Correct answer B) Give the baby both hepatitis B vaccine and hepatitis  B immunoglobulin  For a mother who tests positive for HBsAg, the newborn infant should be given hepatitis B vaccine and hepatitis B immunoglobulin for protection.  Which of the following is the confirmatory test for the HIV screening test? o ELISA test for HIV o Western blot o HIV polymerase chain reaction test o HIV antibody - Correct answer B) Western blot  A positive Western blot test confirms an HIV screening test.  All of the following findings are associated with the secondary stage of an infection by the organism Treponema pallidum except: o Condyloma acuminata o Maculopapular rash of the palms and soles o Lymphadenopathy o Condyloma lata - Correct answer A) Condyloma acuminata  Findings consistent with the diagnosis of syphilis, caused by the Treponema pallidum organism, include maculopapular rash of the palms and soles, lymphadenopathy, and condyloma lata. Condyloma acuminata (genital warts) are caused by the human papilloma virus (HPV) and spread to oth- ers by skin-to- skin contact.  The following are acceptable methods of birth control for breastfeeding mothers except: o Diaphragm with spermicidal gel o Progesterone-only pills (Micronor) o Condoms o Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo- estrin) - Correct answer D) Low-dose oral contraceptives with at least 20 mcg of estradiol (Alesse, Lo-estrin)  Low-dose oral contraceptives that contain estradiol are contraindi- cated for breastfeeding mothers.  Women with a history of pelvic inflammatory disease (PID) have an increased risk for all of the following complications except: o Ectopic pregnancy o Scarring of the fallopian tube(s) o 10 kcal/30 mL o 15 kcal/30 mL o 20 kcal/30 mL o 25 kcal/30 mL - Correct answer C) 20 kcal/30 mL  The caloric content of infant formula and breast milk is 20k cal/30 mL.  A 19-year-old female has recently been diagnosed with acute hepatitis B. She is sexually active and is monogamous. She reports using condoms inconsistently. What would you recommend for her male sexual partner who was also tested for hepatitis with the following results: HBsAg (−), anti-HBs (−), anti-HCV (−), anti- HAV (+)? o A hepatitis B vaccination o Hepatitis B immunoglobulin o Hepatitis B vaccination and hepatitis B immunoglobulin o No vaccination is needed at this time - Correct answer C) Hepatitis B vaccination and hepatitis B immunoglobulin  Hepatitis B vaccination is given for long-term prophylaxis treatment to prevent hepatitis B infection. Hepatitis B immunoglobulin is given for prevention of hepatitis B infection when the person has been directly exposed to the hepatitis B infection. The immnoglobulin is not a vaccine and does not protect against long- term prophylaxis.  All of the following conditions are associated with an increased risk for normocytic anemia except: o Rheumatoid arthritis o Lupus o Chronic autoimmune disorders o Pregnancy - Correct answer D) Pregnancy  During pregnancy, women may experience microcytic, hypochromic anemia due to the dilutional effect of the increased blood volume during the pregnancy.  You can determine a pulse deficit by counting the: o Apical and radial pulses at the same time, then finding the difference between the two o Apical pulse first, then the radial pulse, and subtracting to find the difference between the two o Apical pulse and the femoral pulse at the same time and finding the difference between the two o Radial pulse first, then counting the femoral pulse, and subtracting to find the difference between the two - Correct answer A) Apical and radial pulses at the same time, then finding the difference between the two The pulse deficit is determined by counting the apical and radial pulses at the same time, then subtracting to find the difference between the two.  An infant who does not have a history of reactive airway disease and allergy has both inspiratory and expiratory wheezing accompanied by fever and profuse clear nasal discharge. Which of the following is most likely? o Tracheobronchitis o Bronchiolitis o Croup o A small foreign body that is lodged on the left main bronchus - Correct answer B) Bronchiolitis  Symptoms of tracheobronchitis include prominent dry, non- productive cough; later, coughing up phlegm is common. Bronchiolitis is a viral infection caused by RSV that is commonly seen during the winter/spring months in infants and young children. Typical signs/symptoms include fever, inspiratory/expiratory wheezing, with clear drainage. Croup is a viral infection with the classic "barking" cough; the patient may have a runny nose, but typically no fever. When a child swallows a foreign object, choking, wheezing, and shortness of breath may occur, but no fever or clear drainage is present.  Patients who are being screened for TB and are immunocompromised should be evaluated for anergy. Which of the following is the best description of anergy testing? o Apply Candida or mumps antigen to the right forearm and the PPD on the left forearm and read results in 48 to 72 hours o Apply Candida or mumps antigen and PPD on left forearm only and check for a reaction in 24 hours o Mix the Candida or mumps antigen with the PPD and apply it to both forearms o Apply the Candida or mumps antigen 24 hours before the PPD on the left forearm - Correct answer A) Apply Candida or mumps antigen to the right forearm and the PPD on the left forearm and read results in 48 to 72 hours  Anergy is when the immune system is unable to perform a healthy, normal immune response when the body is challenged with a particular antigen.  A nurse practitioner is evaluating an 80-year-old woman from a nursing home. She is instructing the patient to remember the words "orange," "house," and "world." A few minutes later, the patient is told to recall these 3 words. Which of the following is being described? o The Lachman test o A neurologic exam o The Romberg test o The Mini Mental Status Exam - Correct answer D) The Mini Mental Status Exam  The Lachman test is performed on the knee to assess stability; the Romberg test is performed to assess for balance; a neurologic exam is performed by assessing the 12 cranial nerves; the MMSE is performed to assess for cognitive impairment.  In most states, patients younger than age 18 years may consent to healthcare without parental or legal guardian consent except for which of the following? o Contraception o Pregnancy o School physicals o STD evaluation and treatment - Correct answer C) School physicals  Any student younger than 18 years of age must have paren- tal permission to have a school physical exam done  A hypertensive middle-aged man who is Native American has recently been diagnosed with mild renal insufficiency. He has been on lisinopril (Accupril) for many years. Which of the following laboratory values should be carefully monitored? o Hemoglobin, hematocrit, and the MCV (mean corpuscular volume) o Serum creatinine and potassium levels o Aspartate aminotransferase and alanine aminotransferase o Serum sodium, potassium, and magnesium - Correct answer B) Serum creatinine and potassium levels  Native Americans have a much higher rate of kidney disease and renal failure when compared to other races. Native Americans have a 1 in 3 incidence of hypertension. Hypertension is the second leading cause of kidney failure. BUN, creatinine, estimated GFR, and urinalysis are performed to assess the function of the kidneys.  You suspect an enterobiasis infection in a 6-year-old girl. Which of the following tests would you recommend? smell and taste, cough (especially at night due to the nasal drainage), sore throat, bad breath, and fatigue.  Which of the following findings is associated with thyroid hypofunction? o Graves disease o Eye disorder o Thyroid storm o Myxedema - Correct answer D) Myxedema  Myxedema is a rare, and sometimes fatal, disease in which the thyroid is severely underactive and causes life-threatening symptoms. These symptoms include low blood pressure, decreased breathing, decreased body temperature, unresponsiveness, and even coma. Graves' disease, thyroid storm, and eye disorder are seen with an overactive thyroid disease known as hyperthyroidism.  What is the best procedure for evaluating a corneal abrasion? o Tonometry o Fluorescein stain o Visual field test o Funduscopy - Correct answer B) Fluorescein stain  Fluorescein stain is an eye stain used to detect abrasions or foreign objects in the cornea of the eye. Orange dye (fluorescein) is used to stain the eye and a blue light is used to detect/visualize any foreign bodies or abrasions in the eye. Visual field test assesses vision. Tonometry measures the pressure inside the eye. The funduscopic exam is performed with an ophthalmoscope to visualize the inside of the eye.  You are examining a patient who has just been diagnosed with Bell's palsy. Bell's palsy is characterized by all of the following except: o Drooling o Inability to swallow o Inability to close the eye on the affected side o Drooping of the corner of the mouth on the affected side - Correct answer B) Inability to swallow  Bell's palsy affects cranial nerve VII, which affects the ability to smile, close the eye on the affected side; drooping and drooling on the affected side can also occur. Swallowing is not affected by the facial nerve.  A new mother who is on her fourth day of breastfeeding complains to the nurse practitioner of very sore breasts. The nurse practitioner would: o Recommend a decrease in the number of times she breastfeeds her infant per day o Recommend that she stop breastfeeding and use infant formula for the next 48 hours o Educate the mother that this is normal during the first week or 2 of breastfeeding and the soreness will eventually go away o Recommend that she purchase plastic nipple pads for her nursing bra and use them daily - Correct answer C) Educate the mother that this is normal during the first week or 2 of breastfeeding and the soreness will eventually go away  Nursing during the first 2 weeks after delivery may cause tenderness and soreness of the nipples and usu- ally resolves after this. The mother should continue to breastfeed as she has been advised, and she should make sure the infant is latching on appropriately.  A 12-year-old male's peak expiratory flow results indicate 60 to 80% of the predicted range. How would you classify his asthma? o Mild intermittent asthma o Mild persistent asthma o Moderate persistent asthma o Severe asthma - Correct answer C) Moderate persistent asthma  Asthma classifications: Intermittent: normal FEV between exacerbations, FEV > 80%; mild persistent, FEV > 80%; moderate persistent, FEV 60-80%; severe persistent, FEV < 60%.  Which of the following conditions is associated with a positive Auspitz sign? o Contact dermatitis o Seborrheic dermatitis o Systemic lupus erythematosus o Psoriasis - Correct answer D) Psoriasis  Auspitz sign is the presence of pinpoint bleeding spots from psoriasis where the skin is scraped off.  Which of the following is used to confirm a diagnosis of Hashimoto's thyroiditis? o Serum TSH o Free T4 test o Antimicrosomal antibody test o Any of the above - Correct answer D) Any of the above  In addition to conducting a physical examination and taking a thorough history and symptoms into account, 1 or more laboratory tests are used to diagnose Hashimoto's thyroiditis. The 3 most common diagnostic tests that detect this common thyroid disorder are: serum thyroid-stimulating hormone test (TSH), anti-thyroid antibodies tests, and the free T4 hormone test.  A first-grader presents to a school nurse practitioner with a few blisters on one arm and on the face. The child keeps scratching the affected areas. Some of the lesions have ruptured with yellow serous fluid that crusts easily. This best describes: o Acute cellulitis o Herpes zoster o Bullous impetigo o Erysipelas - Correct answer C) Bullous impetigo  Bullous impetigo is a skin infection, commonly seen on the face and hands, with yellow, honey-colored fluid blisters with drainage that turn into scabbed lesions that continue to spread until treated.  All of the following statements reflect inadequate breast milk production except: o Full-term infant is at birth weight by the second week of life o Less than 6 wet diapers per day or less than 4 stools per day o Infant is nursing fewer than 8 times per 24-hour period o Weight loss of > 10% of birth weight - Correct answer A) Full-term infant is at birth weight by the second week of life  The full- term infant should be back to birth weight at 2 weeks of age. The infant should be nursing every 2-4 hours and should wet 6-10 diapers a day (24 h).  The best screening test for detecting and monitoring both hyperthyroidism and hypothyroidism is: o The total T3-4 o Thyroid-stimulating hormone (TSH) o Thyroid profile o Palpation of the thyroid gland - Correct answer B) Thyroid-stimulating hormone (TSH) heard over the trachea. These sound harsh and similar to air being blown through a pipe.  The most current recommendation from the Joint National Commission on the Evaluation and Treatment of High Blood Pressure in Adults (JNC 8) for the blood pressure goal in diabetics is: o <140/90 o <130/85 o <130/80 o <125/75 - Correct answer A) < 140/90  JNC 8 bp goals include < 140/90 in patients with diabetes.  All of the following pharmacologic agents are used to treat inflammation in the lungs of asthmatics except: o Nedocromil sodium (Tilade) two sprays QID o Cromolyn sodium inhaler (Intal) two puffs QID o A long-acting oral theophylline (Theo-Dur) 200 mg every 12 hours o Fluticasone inhaler (Flovent) two puffs BID - Correct answer C) A long- acting oral theophylline (Theo-Dur) 200 mg every 12 hours  Theophylline is used to control inflammation of the lungs. Tilade, Intal, and Flovent help to treat inflammation.  All of the following clinical findings are considered benign oral findings except: o A patch of leukoplakia o Fordyce spots o Torus palatinus o Fishtail uvula - Correct answer A) A patch of leukoplakia  An early sign of HIV is a hairy patch of leukoplakia on the tongue.  The nurse practitioner examines a 4-week-old boy whose mother reports that he has cried for at least 3 hours a day at the same time of day since birth. What is the main goal in the clinical evaluation of this infant? o Rule out any physiologic cause for the crying spells o Make sure that the infant is well clothed o Evaluate the environment o Order laboratory and diagnostic testing - Correct answer A) Rule out any physiologic cause for the crying spells  For infants that cry for several hours during the day, ruling out a physiological problem that may be causing the distress is recommended.  During a routine physical exam of a 90-year-old woman, a low-pitched diastolic murmur Grade II/VI is auscultated. It is located on the fifth ICS on the left side of the midclavicular line. Which of the following is the correct diagnosis? o Aortic regurgitation o Mitral stenosis o Mitral regurgitation o Tricuspid regurgitation - Correct answer B) Mitral stenosis  Mitral stenosis is best heard at the fifth ICS to the left of the midclavicular line. It is ausculated as a low-pitched diastolic murmur, grade II/ VI. Aortic regurgitation is a high-pitched diastolic murmur, heard at the second ICS to the right of the sternum. Mitral regurgitation is a pansystolic murmur that radiates to the axilla, loud and high pitched when ausculated.  Which of the following situations is considered emergent? o A laceration on the lower leg of a patient on aspirin (Bayer) 81mg every other day o Rapid breathing and tachycardia in a patient with a fever o An elderly man with abdominal pain whose vital signs appear stable o A 37-year-old male biker with a concussion due to a fall who appears slightly agitated and does not appear to understand instructions given by the medical assistant checking his vital signs - Correct answer D) A 37- year-old male biker with a concussion due to a fall who appears slightly agitated and does not appear to understand instructions given by the medical assistant checking his vital signs  The biker who had the concussion is the emergent situation due to his agitation and his inability to follow directions, which could mean he has some type of brain trauma. The laceration can be treated with pressure to stop the bleeding until help arrives. The man with abdominal pain has normal vital signs. Tachycardia is common with fever.  Which of the following is considered an objective finding in patients who have a case of suppurative otitis media? o Erythema of the tympanic membrane o Decreased mobility of the tympanic membrane as measured by tympanogram o Displacement of the light reflex o Bulging of the tympanic membrane - Correct answer B) Decreased mobility of the tympanic membrane as measured by tympanogram  Fluid behind the ear drum will decrease the mobility of the TM when measured by a tympanogram. When perforation occurs, discharge will flow through the pars tensa portion of the ear drum.  Pulsus paradoxus is more likely to be associated with: o Sarcoidosis o Acute bronchitis o Status asthmaticus o Bacterial pneumonia - Correct answer C) Status asthmaticus  Pulsus paradoxus is most likely to be seen with status asthmaticus. With inspiration, systolic pressure drops due to the increased pres- sure (positive pressure). Some pulmonary risks of having increased pressure include asthma and emphysema. Cardiac causes for pulsus paradoxus include tamponade, pericarditis, and cardiac effusion.  A 17-year-old boy reports feeling something on his left scrotum. On palpation, soft and movable blood vessels that feel like a "bag of worms" are noted underneath the scrotal skin. It is not swollen or reddened. The most likely diagnosis is: o Chronic orchitis o Chronic epididymitis o Testicular torsion o Varicocele - Correct answer D) Varicocele  Palpation of varicose veins, known as "bag of worms" in the scrotum, is a classic symptom of a varicocele. Chronic epididymitis and chronic orchi- tis are caused by a bacterial infection and commonly have burning, frequency, and pain. Testicular torsion is an emergent condition in which the testicle becomes twisted, interrupting the blood supply to the testis; to avoid damage, the condition must be corrected within 6 hours.  All of the following are true statements regarding elder abuse except: o Those aged 80 years or older are at the highest risk for abuse o A delay in medical care is a common finding o A new onset of an STD in an elderly patient may signal sexual abuse o Calcitonin (Miacalcin) o Medroxyprogesterone (Depo-Provera) o Calcium with Vitamin D - Correct answer C) Medroxyprogesterone (Depo- Provera)  Common treatments for osteoporosis include calcium and Vitamin D, Evista, Miacalcin, and bisphosphonates. Depo- Provera is a type of contraception.  A fracture on the navicular area of the wrist is usually caused by falling forward and landing on the hands. The affected wrist is hyperextended to break the fall. The nurse practitioner is aware that all of the following statements are true except: o It has higher rate of nonunion compared with the other bones in the wrist when it is fractured o The fracture frequently does not show up on an x-ray film when it is taken immediately after the injury o The x-ray film will show the fracture if the film is repeated in 2 weeks o These fractures always require surgical intervention to stabilize the joint - Correct answer D) These fractures always require surgical intervention to stabilize the joint  A fracture of the navicular area of the wrist occurs when one tries to break a fall with the hands, thus hyperextending the wrist. Immediately following the injury, the fracture may not show on x-ray; however, fracture is usually visible on x-ray if the x-ray is repeated in 2 weeks. The need for surgery is dependent on the extent of the fracture.  John, a 10-year-old boy, has type 1 diabetes. His late afternoon blood sugars over the past 2 weeks have ranged between 210 mg/dL and 230 mg/ldL. He is currently on 10 units of regular insulin and 25 units of NPH in the morning and 15 units of regular insulin and 10 units of NPH insulin in the evening. Which of the following is the best treatment plan for this patient? o Increase both types of the morning dose o Increase only the NPH insulin in the morning o Decrease the afternoon dose of NPH insulin o Decrease both NPH and regular insulin doses in the morning - Correct answer  The mother of a 13-year-old male with Down syndrome is in the family nurse practitioner's office and wants a sports physical done for her son. She reports that he wants to join the football team in his school. You would tell the mother that her son: o Can play a regular football game as long as he wears maximum protective football gear o Cannot play some contact sports because of an increased risk of cervical spine injury o Can play certain contact sports after he has been checked for cervical instability o None of the above - Correct answer B) Cannot play some contact sports because of an increased risk of cervical spine injury  Children with the diagnosis of Down syndrome are at higher risk for atlantoaxial instability, congenital heart defects, and early onset of Alzheimer's disease. Therefore, due to the risk of cervical spine injury, some contact sports are not advised  The mother of an 8-year-old boy reports the presence of a round red rash on the child's left lower leg. It appeared 1 week after the child returned from visiting his grandparents, who live in Massachusetts. During the skin exam, the maculopapular rash is noted to have areas of central clearing making it resemble a round target. Which of the following is best described? o Erythema migrans o Rocky Mountain spotted fever o Meningococcemia o Larva migrans - Correct answer A) Erythema migrans  Erythema migrans is an annular lesion that enlarges and with time has central clearing. This is commonly caused by a bite from an infected tick and can cause Lyme disease if not treated appropriately. Lyme disease is most commonly seen in the northeastern United States.  Some pharmacologic agents may cause confusion in the elderly. Which of the following pharmacologic agents is most likely to cause confusion in this population? o Cimetidine (Tagamet), digoxin (Lanoxin), diphenhydramine (Benadryl) o Acetaminophen (Tylenol), aspirin (Bayer), indomethacin (Indocin) o Sucralfate (Carafate), docusate sodium (Surfak), psyllium (Metamucil) o Cephalexin (Keflex), amoxicillin (Amoxil), clarithromycin (Biaxin) - Correct answer A) Cimetidine (Tagamet), digoxin (Lanoxin), diphenhydramine (Benadryl)  Medications that commonly cause confusion in the elderly include cimetidine, lanoxin, and diphenhydramine.  A 55-year-old female with a history of migraine headaches has recently been diagnosed with Stage II hypertension. Her EKG strips reveal second-degree heart block. The chest x-ray is normal. Which of the following drugs should this patient avoid? o ACE inhibitors o Angiotensin receptor blockers o Diuretics o Calcium channel blockers - Correct answer D) Calcium channel blockers  Common side effects of calcium channel blockers include headaches, edema of the lower extremities, and heart block or bradycardia. Contraindications for calcium channel blockers include second- or third-degree AV block, bradycardia, and congestive heart failure.  Which of the following cranial nerves is evaluated when a wisp of cotton is lightly brushed against the corner of the eye? o CN II o CN III o CN IV o CN V - Correct answer D) CN V  Cranial nerves are assessed as follows: II (optic): distance vision, near vision . III, IV, VI (oculomotor, trochlear, abducens): EOMs, visual fields of gaze. V1 (trigeminal 3 branches: V19 ophthalmic), V2 (maxillary), V3 (mandibular): motor portion, clench jaws; sensory portion, corneal reflex/facial sensation  When a patient is suspected of having acute pancreatitis, initial testing should include all of the following except: o Electrolyte panel o Serum amylase level o Serum lipase level o A barium swallow - Correct answer D) Barium swallow  For an acute abdominal pain, initial labs performed are serum electrolytes, amylase, and lipase. Barium swallow would not be performed initially.  Which of the following is a true statement regarding pes planus in an infant?  A newborn infant who is small for gestational age is noted to have shortened palpebral fissures and microcephaly with a small jaw. This infant is most likely to be diagnosed with: o Down syndrome o Fetal alcohol syndrome o Growth retardation o Hydrocephalus - Correct answer B) Fetal alcohol syndrome  Classic symptoms of fetal alcohol syndrome include small palpebral fissures and microcephaly with a small jaw.  Which of the following is the most common cause of cancer deaths for women in the United States? o Breast cancer o Lung cancer o Colon cancer o Heart disease - Correct answer B) Lung cancer  Lung cancer is the most common cause of cancer deaths in women as well as men.  Human papilloma virus infection in women has been associated with the development of: o Ectopic pregnancy o Infertility o Cervical cancer o Pelvic inflammatory disease - Correct answer C) Cervical cancer  HPV is a virus associated with cervical cancer. HPV vaccine is now available for girls and boys between the ages of 15-21 years of age to help prevent 4 strains of this virus that is linked to cervical cancer.  All of the following are included in the criteria used to diagnose patients with AIDS except: o Profound fatigue o Thrush o Kaposi's sarcoma o Hairy leukoplakia of the tongu - Correct answer A) Profound fatigue  Criteria used to diagnose AIDS include hairy leukoplakia of the tongue, Kaposi's sarcoma, and thrush.  Which of the following conditions is the most common cause of sudden death among athletes? o Brain aneurysm o Hypertrophic cardiomyopathy o Left ventricular hypertrophy o Aortic stenosis - Correct answer B) Hypertrophic cardiomyopathy  Hypertrophic cardiomyopathy is the most common cause of sudden death in athletes.  The span of the normal adult liver is: o 15 to 18 cm in the midclavicular line o 12 to 16 cm in the right midclavicular line o 2 to 6 cm in the midsternal line o 4 to 8 cm in the midsternal line - Correct answer A) 15 to 18 cm in the midclavicular line  This range is considered the normal span for adults.  A patient who is complaining of a new onset of severe headache is being examined. The patient is instructed to lie down on the examining table while the nurse practitioner flexes his head and neck forward to his chest. The patient reacts by quickly flexing his hip and knee. What is the name of this positive finding? o Kernig's sign o Brudzinski's sign o Rovsing's sign o Drawer's sign - Correct answer B) Brudzinski's sign  Brudzinski's sign is positive for meningitis when a patient spontaneously flexes his/her hips and knees after lying down and having his/her head and neck flexed forward to the chest.  A neighbor's 14-year-old son, who is active in basketball, complains of pain and swelling on both knees. On physical exam, there is tenderness over the tibial tuberosity of both knees. Which of the following is most likely? o Chondromalacia patella o Left knee sprain o Osgood-Schlatter disease o Tear of the medial ligament - Correct answer C) Osgood-Schlatter disease  Osgood-Schlatter disease is characterized by bilateral pain over the tibial tuberosity upon palpation, along with knee pain and edema with exercise.  A woman at 32 weeks gestation has a positive throat culture for strep pyogenes. She denies allergies but gets very nauseated with erythromycin. Which of the fol- lowing is the best choice for this pregnant patient? o Clarithromycin (Biaxin) o Trimethoprim/sulfamethoxazole (Bactrim DS) o Ofloxacin (Floxin) o Penicillin (Pen VK) - Correct answer D) Penicillin (Pen VK)  Pen VK is safe to use for strep throat during pregnancy. Pen VK is a category B medication for pregnancy and lactation.  During a sports physical exam, a1 6-year-old patient is noted to have a few beats of horizontal nystagmus on extreme lateral gaze that disappear when the eyes move back toward midline. Which statement best describes this clinical finding? o It is caused by occult bleeding of the retinal artery o This is a normal finding o It is a sign of a possible brain mass o This is a borderline result and requires further evaluation - Correct answer B) This is a normal finding  Horizontal nystagmus is a normal variation on physical exam  An urgent care nurse practitioner is assessing a 45-year-old White woman with a BMI of 32 for complaints of intermittent right upper quadrant abdominal pain over the past few weeks that is precipitated by eating fried foods and peanut butter. On exam, the patient's heart and lungs are normal. There is no pain over the costovertebral angle. During abdominal exam, the bowel sounds are present in all quadrants. While palpating deeply on the right upper quadrant during deep inspiration, the patient complains of severe sharp pain to the nurse practitioner.  Which of the following is best described? o The patient should be evaluated by an ophthalmologist o The patient should be evaluated for acute glaucoma - Correct answer B) The patient should be evaluated for hyperlipidemia  Arcus senilis is caused by lipid deposits deep in the edge of the cornea.  The cones in the retina of the eye are responsible for: o Central vision o Peripheral vision o Night vision o Double vision - Correct answer A) Central vision  The cones of the eyes are responsible for central vision.  The nurse practitioner would refer all of the following to a physician except: o Severe facial burns o Electrical burns o Burns that involve the cartilage of the ear o Second-degree burns on the lower arm - Correct answer D) Second- degree burns on the lower arm  First- and second-degree burns are appropriately treated by a nurse practitioner. Third-degree burns should be referred to a physician. Examples of third-degree burns include electrical burns, severe burns on the face, and burns involving cartilage, such as the ear and nose.  On auscultation of the chest, a split S2 is best heard at: o Second intercostal space, right sternal border o Second intercostal space, left sternal border o Fifth intercostal space, midclavicular line o Fourth intercostal space, left sternal border - Correct answer A) Second intercostal space, right sternal border  A split S2 is best heard at the second ICS, right of the sternal border.  According to the guidelines outlined in JNC 8 in those younger than 60 (without comorbitidites), the normal blood pressure should be: o <140/90 o <130/85 o <120/80 o <110/75 - Correct answer A) <140/90  The JNC VIII Guidelines recommended that bp be less than 140/90 in those less than 60. Those older than 60, BP should be less than 150/90.  Which of the following would be classified as a second-degree burn? o A severe sunburn with blistering o Burns that involve the subcutaneous layer of skin o A reddened finger after touching a hot iron o Burns that involve escha - Correct answer A) A severe sunburn with blistering  Burns: First degree: erythema without blistering, painful; second degree: red skin with superficial blisters, painful; third degree: entire skin layering, involving the subcutaneous tissue and may include soft tissue facia, painless.  The mother of a 16-year-old boy is concerned that her son is not developing normally. On physical exam, the patient is noted to have small testes with no pubic or facial hair. What is the most appropriate statement to the mother? o Her son is developing normally o Her son's physical development is delayed and should be evaluated by a pediatric endocrinologist o Her son should be rechecked in 3 months; if he still does not have secondary sexual characteristics, a thorough hormonal workup should be initiated o Her son's physiological development is slower than normal but is within the lower limit of normal for his age group - Correct answer B) Her son's physical development is delayed and should be evaluated by a pediatric endocrinologist  A 16-year-old male without secondary sexual characteristics should be referred to an endocrinologist. If there is no testicular development by 14 years of age, referral to an endocrinologist is recommended.  The most common type of skin malignancy is: o Squamous cell cancer o Basal skin cancer o Melanoma o Dysplastic nevi - Correct answer A) Squamous cell cancer  Squamous cell cancer is the most frequent type of skin cancer. It can occur in normal skin or inflamed skin. Common areas involved are those which are exposed to the sun or UV light. The earliest form of squamous cell cancer is known as Bowen's disease, in which the cancer has not involved the tissue nearby.  The posterior fontanel should be completely closed by: o 3 months o 4 months o 5 months o 6 months - Correct answer A) 3 months  The posterior fontanelle normally closes by 3 months of age. The anterior fontanelle closes between 12 and 18 months of age.  Which cranial nerve is being evaluated when Rinne testing is done? o CN VII o CN VIII o CN IX and X o CN XI - Correct answer B) CN VIII  The acoustic nerve, cranial nerve VIII, is being evaluated when the Rinne test is performed.  Jane, a middle-aged nurse, complains of localized pain on the sole of her left foot that is located between the third and fourth toes. The pain is aggravated by weight bearing and feels like "a pebble in my shoe." During the physical examination, the nurse practitioner palpates a tender nodule in the metatarsal interspace on the left foot. No redness or swelling is noted. Which of the following conditions is being described? o Plantar wart o Foreign body o Morton's neuroma o Metatarsalgia - Correct answer C) Morton's neuroma  Morton's neuroma is characterized by experiencing pain, burning, or numbness with weight bearing between two toes. Some experience a sense or feeling like they are walking on a pebble between two adjacent toes.  Laura, who is 18 years old, is being followed up for acne by the nurse practitioner. The facial exam reveals that papules and pustules are present mostly on the forehead and the chin areas. The patient has been using