1
Q
Which of the following is not seen in the dx of acute cholecystitis?
- Elevated AST
- Elevated ALP
- Microcytic Anemia
- Inc. total WBC
A
Microcytic anemia
2
Q
Which of the following is usually found in a person with a PLT count of 20k-50k?
- No excessive bleeding risk
- Minor spontaneous bleeding risk
- Potential serious bleeding risk
- Major spontaneous bleeding risk
A
Minor spontaneous bleeding risk
3
Q
A 10yo boy is being tx’d c oral PCN for pharyngitis caused by GAS. Which of the following is the most accurate information about when he can return to school?
- Immediately after 1st dose of abx.
- Infectious for x1 wk even p starting abx.
- May return after on abx for 24 hrs and s fever
- Risk of transmitting disease is minimized since he is on abx.
A
May return after on abx for 24 hrs and s fever
4
Q
As long as certain criteria are met, “incident to” billing is an option in all of the following settings except:
- Office visits
- Hospital
- Nursing Home
- Home visits
A
Hospital
5
Q
A prostate cancer lesion detectable by digital rectal exam will likely be described as:
- Firm nodule
- Mobile and non-tender
- Boggy, tender lobe
- Rubbery in texture
A
Firm nodule
6
Q
To avoid rx errors when using symbols and abbrev., which of the following is not recommended?
- Use a zero before a decimal point when the dose is less then a whole unit (ie 0.5mg)
- Use a zero following a decimal point when the dose is a whole unit (ie 10.0mg)
- Write out Unit rather than U or u
- Write out mcg or microgram rather than using ng
A
Use a zero following a decimal point when the dose is a whole unit (ie 10.0mg)
7
Q
You are performing well examination on a 10yo c no documented immunizations. The immunizations "catch up" regimen does not need to include: 1 MMR 2 Haemophilus influenza type B 3 Tdap 4 Hep B
A
H influenzae type B
8
Q
A patient with IBS is likely to report all of the following except:
1 Abdominal discomfort relieved by defecation
2 Appearance of blood in the stool
3 Symptom onset associated c change in stool freq
4 Symptom onset associated c change in stool form
A
Appearance of blood in the stool
9
Q
First-line therapy for management of urge incontinence for an otherwise healthy 57yo woman who is not taking any medication can include behavioral therapy plus: 1 Oral biphosphonate 2 Oral anticholinergic 3 Botulinum toxin injection 4 Oral thiazide diuretic
A
Oral anticholinergic
10
Q
A first-line intervention for a 52yo pt with Cushing's syndrome who does not have a hx of taking corticosteroid medications is: 1 Low-dose oral prednisone 2 DPP-4 inhibitor 3 Thyroxine 4 Surgical intervention
A
Surgical intervention (pituitary gland tumor)
11
Q
Which of the following is most consistent with the presentation of the person with bipolar 1 disorder? 1 Increased need for sleep 2 Impulsive behavior 3 Fatigue 4 Anhedonia
A
Impulsive behavior
12
Q
With most maternal medication use, the level of the drug in breast milk is highest when: 1 mother's serum level is at its peak 2 drug's T1/2 is near its end 3 mother's serum level has waned 4 just prior to breastfeeding
A
mother’s serum level is at its peak
13
Q
A 52 year old woman of African ancestry complains of dark brown patches on her forehead. She is otherwise healthy and takes no medications other than hormone replacement therapy to manage vasomotor symptoms. Considering a diagnosis of melasma appropriate management would include: 1 topical metronidazole 2 benzoyl peroxide 3 topical corticosteroid 4 chemical peel
A
chemical peel
14
Q
Of the following test results which is most likely to be found in Graves disease?
1 increased TSH + free T4
2 single cold spot on thyroid scan
3 decreased TSH with elevated free T4
4 presence of a solid lesion on thyroid ultrasound
A
decreased TSH with elevated free T4
15
Q
What is the best approach to the pharmacologic care of a person with beta thalassemia minor?
- no special pharmacologic care
- folic acid supplementation
- long-term iron supplementation
- advice about possibility of hemolytic reaction with stress
A
no special pharmacologic care
16
Q
The most common source of hepatitis A infection is:
- Shared injection drug equipment
- contaminated water
- sexual contact
- cooked Seafood
A
contaminated water
17
Q
You have initiated therapy for a 16 year old man with acne vulgaris and have prescribed a systemic antibiotic as part of the treatment plan. He returns in 3 weeks complaining that his skin is no better. Your next action is to:
- add a second systemic antimicrobial agent
- discontinue the systemic antimicrobial
- counsel him that six to eight weeks of treatment is often needed before significant Improvement is achieved
- advise the patient that this antibiotic is likely not an effective treatment for him and change to a different systemic antimicrobial
A
counsel him that six to eight weeks of treatment is often needed before significant Improvement is achieved
18
Q
You see an 18 year old male with cystic acne who has been treated with oral doxycycline and topical retinoid for the past 8 weeks with no improvement. The most appropriate next course of action would be to:
- switch to oral ciprofloxacin therapy
- switch to topical erythromycin
- switch to isotretinoin (Accutane)
- continue with the current regimen for an additional four weeks
A
switch to isotretinoin (Accutane)
19
Q
Which of the following physical examination findings is consistent with a diagnosis of acute otitis media in a four-year-old child?
- submental lymphadenopathy
- tympanic membrane immobility
- itchiness and crackling at the affected year
- prominent bony landmarks
A
tympanic membrane immobility
20
Q
Bacterial vaginosis is in part a result of:
- a sexually transmitted organism
- protozoan infection
- alkaline vaginal secretions
- overgrowth of vaginal anaerobes
A
overgrowth of vaginal anaerobes
21
Q
Which of the following is most consistent with the diagnosis of bulimia nervosa?
- hyperkalemia often results from laxative abuse
- periods of anorexia can occur
- most patients with BN are significantly obese
- the person with BN usually seeks treatment
A
periods of anorexia can occur
22
Q
Which strategy would be favored in a practice that is under a capitated system of reimbursement?
- as few face-to-face visit and services as possible
- limiting the number of patients
- prefer that services are performed by physicians
- limiting the use of telephone calls for providing Healthcare
A
as few face-to-face visits and services as possible
23
Q
The US preventive Services Task Force recommends screening for Hepatitis C virus for all individuals:
- who have not received the hcv vaccine
- born before 1980 in greater or equal to one risk factor present
- born between 1945 and 1965 without regard of risk
- with an alt and or AST >3x ULN
A
born between 1945 and 1965 without regard of risk
24
Q
When evaluating a patient with lumbar radiculopathy red flags for a potentially serious underlying cause include all of the following except:
- history of recent trauma
- unexplained weight loss
- radiation of pain to buttocks
- bladder dysfunction
A
radiation of pain to buttocks
25
Symptoms characteristic of asthma include all of the following except:
1. a recurrent spasmodic cough that is worse at night and with exertion
2. recurrent shortness of breath and chest tightness
3. a congested cough that is worse during the day
4. wheezing with and without respiratory infections
a congested cough that is worse during the day
26
A 53 year-old woman with systemic lupus erythematosus presents with the following hemogram: hemoglobin 9.9 hematocrit 30% MCV 81 (80-96) reticulocytes 0.7% (1-2). These findings are most consistent with:
1. iron deficiency anemia
2. anemia of chronic disease
3. folate deficiency anemia
4. thalassemia trait
anemia of chronic disease
27
The nurse practitioner is evaluating an 18 year old patients understanding of the treatment plan for eczema. Assuming the patient understands her plan of care he expects that she will say:
1. when it flares up I will probably need to use a prescription corticosteroid cream
2. I can reduce the incidence of flare-ups by cleaning aggressively with soap
3. I need to keep a diet logs to look for food triggers for my Eczema
4. putting plastic wrap over the eczema can help reduce the number of flare-ups I have
when it flares up I will probably need to use a prescription corticosteroid cream
28
Which of the following examples describes a potential malpractice scenario?
1. a patient with no and penicillin allergy is prescribed amoxicillin but no allergic reaction occurs
2. a patient with diabetes mellitus is prescribed an inappropriate dose of sulfonylureas medication and experiences a severe hypoglycemic episode
3. a patient with acute bacterial sinusitis does not see any Improvement in signs and symptoms 3 days after given a dose appropriate prescription for Amoxicillin clavulanate
4. the patient realizes prior to taking any of the medication that the wrong drug was dispensed at the pharmacy
a patient with diabetes mellitus is prescribed an inappropriate dose of sulfonylurea medication and experiences a severe hypoglycemic episode
29
Which of the following adolescents can be seen for medical evaluation and treatment without parental consent?
1. a 15 year old female who wishes to initiate combined oral contraceptives
2. a fourteen-year-old who needs adjustment to his asthma medication regimen
3. a 16 year old who presents with conjunctivitis
4. a 13 year old with a suspected knee sprain
if 15 year old females who wishes to initiate combined oral contraceptives
30
The legal Authority for NPs to perform Healthcare Services as defined by state law is called:
1. scope of practice
2. duty of care
3. autonomy
4. beneficence
scope of practice
31
Appropriate management of a first degree burn on the forearm caused by exposure to boiling water can include all of the following except:
1. cold compresses to the affected area
2. topical silver sulfadiazine
3. analgesics
4. moisturizing lotion
topical silver sulfadiazine
32
You see an elderly woman with depression in recent acute coronary syndrome who is taking multiple medications. She feels anxious is sleeping poorly and has decreased appetite. Her score on the Beck depression inventory is 28, suggesting moderate depression. The best choice of antidepressant medication is:
1. bupropion
2. citalopram
3. amitriptyline
4. Fluoxetine
citalopram
33
When prescribing a medication to A lactating woman the NP considers that:
1. the nursing infant generally receives 1% or less of the maternal dose
2. lipid soluble medications do not pass into breast milk
3. few products are safe to use
4. pumping the breast and discarding the milk is an effective method of protecting the infant from drug exposure
the nursing infant generally receives 1% or less of the maternal dose
34
A 15 year old male presents with a 3-day history of sore throat and fatigue. During physical examination the nurse practitioner appreciates exudative pharyngitis anterior and posterior cervical lymphadenopathy but is slightly tender to palpation and upper abdominal tenderness bilaterally. This constellation of signs and symptoms is highly suggestive of:
1. infectious mononucleosis
2. gonococcal pharyngitis
3. Hodgkin's disease
4. pertussis
infectious mononucleosis
35
The most common causative organisms in acute cystitis are:
1. gram negative cocci
2. gram positive coccobacilli
3. gram-negative rods
4. gram positive cocci
gram-negative rods
36
Which of the following statements about migraine headache is most accurate?
1. the pain is described as pulsating
2. migraines are more common in men than women
3. migraine with aura is more common than without aura
4. the pain is typically bilateral
the pain is described as pulsating
37
All of the following are elements of malpractice except:
1. duty of care
2. a fee is charged to the patient and or third-party payer for the health care services related to the malpractice claim
3. breach of the standard of care
4. injury
a fee is charged to the patient and or third-party payer for the healthcare services related to the malpractice claim
38
Tammy, a 24 year old woman, presents with a 1-week history of thin green yellow vaginal discharge. Microscopic examination reveals greater than 20 WBC per hpf pH=5.5 and large motile organisms. These findings most likely represent:
1. Motile sperm
2. trichomoniasis
3. bacterial vaginosis
4. vaginitis caused by Candida albicans
trichomoniasis
39
The body's iron Supply is mainly derived from:
1. recycled content of aged red blood cells
2. vegetable based food sources
3. animal-based food sources
4. water supply
recycled content of aged red blood cells
40
A 45 year old man presents for a Well Visit examination. He states that he has not had a physical examination in over 10 years. He is generally healthy, does not smoke, and consumes one to two alcoholic drinks per week. Which of the following physical findings would be expected during the eye examination?
1. retinal arteries wider than veins
2. pale conjunctiva
3. brisk corneal reflex
4. yellow sclera
brisk corneal reflex
41
Which of the following is a common vision problem for the person with untreated open-angle glaucoma?
1. peripheral vision loss
2. difficulty with distant vision
3. blurring of near vision
4. need for increased illumination
peripheral vision loss
42
You see a 14 year old female with a BMI equal to 34 and hyperpigmented plaques with a velvet like appearance at the nape of the neck. She states that she has had this condition for a while. Laboratory assessment should include which of the following tests?
1. hemoglobin A1c
2. TSH
3. lipid profile
4. CBC with differential
hemoglobin A1c
43
All of the following changes in electrolytes can be seen with thiazide diuretics used except:
1. calcium wasting
2. potassium wasting
3. sodium wasting
4. magnesium wasting
calcium wasting
44
Which of the following statements about actinic keratosis is most accurate?
1. they are best described as raised red scaly plaque in a skin fold
2. they are best described as vesicular lesions on the trunk
3. they can evolve into basal cell carcinoma
4. they can evolve into squamous cell carcinoma
they can't evolve into squamous cell carcinoma
45
Mary Kate is a 39 year old woman who was recently started on sumatriptan 100 mg tablet orally for acute migraine pain. When evaluating her response to the medication the nurse practitioner can anticipate all of the following adverse effects except:
1. sedation
2. chest tightness
3. dry mouth
4. diarrhea
sedation
46
The nurse practitioner sees a 45 year old woman with well controlled hypertension with an Ace inhibitor and history of migraines. She states that she has started to take daily doses of Feverfew and her headaches have lessened in frequency. The nurse practitioner advises that caution should be used when taking Feverfew as it:
1. exhibits antiplatelet activity
2. can reverse the effects of her antihypertensive medication
3. can increase the risk of dyslipidemia
4. can increase the risk of type 2 diabetes mellitus
exhibits antiplatelet activity
47
Who is least likely to have drug-induced hepatic failure?
1. a 30 year old man who drinks about four beers in total over a two-day weekend
2. a 48 year-old woman with history of hepatitis B infection
3. a 78 year old man with hepatitis C infection
4. an 88 year old woman who takes daily acetaminophen for back pain
a 30 year old man who drinks about 4 beers in total over a two-day weekend
48
Simultaneous presentation of sore throat, low-grade fever, and maculopapular rash of 1 days duration in a 13 year-old including coincident posterior cervical and occipital lymphadenopathy, suggest a diagnosis of:
1. roseola
2. rubeola
3. scarlet fever
4. rubella
rubella
49
ECG of a 54 year old man is shown below. A history of myocardial infarction is indicated in this patient by the presence of:
1. T wave inversion
2. pathologic Q wave
3. ST segment elevation
4. tall R wave
pathologic Q wave
50
Stacy is a 17 year old female who presents for follow up after being started on a treatment plan for asthma. She continues to have symptoms, including cough and wheeze, but wake her at night and interfere with her job performance. Her Peak expiratory flow rate is 70% predicted. The nurse practitioner must evaluate:
1. her inhaler technique
2. her fev1/fvc ratio
3. her eosinophil count
4. her use of OTC medications
her inhaler technique
51
When examining a 22-year old man, you note a mid systolic murmur that gets louder with standing. This could represent a:
1. aortic stenosis
2. physiologic murmur
3. hypertrophic cardiomyopathy
4. still's murmur
hypertrophic cardiomyopathy
52
The presence of microalbuminuria is most likely an indication of:
1. kidney disease
2. drug-induced hepatotoxicity
3. CHF
4. hypotension
kidney disease
53
Which of the following is most consistent with untreated hyperthyroidism?
1. TSH=8.9, free t4=15
2. TSH<0.15, free t4=79
3. TSH<24, free t4=3
4. TSH<1.9, free t4=22
(tsh 0.4-4, t4 10-27)
TSH<0.15, free t4=79
54
For a 7 year old child with severe atopic dermatitis on the face and appropriate alternative to higher potency topical corticosteroid therapy is:
1. oral tacrolimus
2. topical NSAIDs
3. oral prednisone
4. adalimumab injection
oral tacrolimus
55
Which of the following women is the best candidate for post menopause hormonal therapy?
1. a 62 year old with osteopenia
2. a 54 year old with complaints of vasomotor symptoms
3. a 57 year old with a family history of myocardial infarction
4. a 66 year old with moderate renal impairment
a 54 year old with complaints of vasomotor symptoms
56
Which of the following is true concerning hepatitis C infection?
1. this is the most common form of infectious hepatitis transmitted by sexual contact
2. rate of infection in babies born to affected mothers exceeds 40%
3. acute infection stage is usually symptomatic
4. in the United States, this disease is the most common reason for hepatic transplantation
in the United States, this disease is the most common reason for hepatic transplantation
57
A thirty-three-year-old woman is 7 weeks pregnant. She has moderate persistent asthma, well-controlled with Daily Timed fluticasone used with albuterol used as needed and asks about continuing her current medications. You give her the following advice:
1. add Theophylline
2. discontinue inhaled corticosteroid
3. continue your current medication
4. most women find their asthma is improved with pregnancy
continue your current medication
58
Which of the following is the desired therapeutic action of tiotropium bromide when used in the treatment of COPD?
1. mucolytic agent
2. bronchodilator
3. increases mucociliary clearance
4. reduces total lung volume
bronchodilator
59
A middle school student presents, asking for a letter stating that he should not participate in gym class because he has asthma. The most appropriate response is to:
1. write the note since physical activity could trigger an asthma flare
2. excuse him from outdoor activities only in order to avoid pollen exposure
3. remind him that with appropriate asthma care, he should be capable of participating in gym class
4. excuse him from indoor activities in order to avoid dust mite exposure while allowing participation in outdoor activities
remind him that with appropriate asthma care, he should be capable of participating in gym class
60
A 45 year old woman with a 5-day history of vaginal itch presents with perineal excoriation, vaginal erythema, and white, clumpy discharge. On laboratory examination, you expect to find:
1. abundant white blood cells
2. clue cells
3. pseudohyphae
4. alkaline pH
pseudohyphae
61
According to the US preventive Services Task Force, a 46 year-old woman with normal risk for breast cancer should undergo a mammogram:
1. every year
2. every two years
3. every two years beginning at age 50 years
4. every five years beginning at age 50 years
every two years beginning at age 50 years
62
Which of the following is an expected finding for a patient with Meniere's disease?
1. a negative Rhomberg test
2. a normal rinne's test
3. absence of lateralization during the Weber test
4. normal hearing
a normal rinne's test
63
Which of the following agents represents the best choice for an otherwise well child taking no other medications who has a rash type of allergic reaction to penicillin and requires antimicrobial therapy for acute otitis media?
1. Ciprofloxacin
2. clarithromycin
3. amoxicillin
4. cefpodoxime
cefpodoxime
64
Identify which of the following individuals is most likely to have a diagnosis of reactive arthritis?
1. a 67 year old with bilateral knee pain that is alleviated with NSAIDs
2. a 54 year old with wrist pain and who is ANA positive
3. a 34-year-old experiencing heel pain 2 weeks following an episode of acute bacterial diarrhea
4. a 56 year old with recurrent sharp pain in the large toe, typically occurring after eating a large quantity of meat
a 34 year old experiencing heel pain 2 weeks following an episode of acute bacterial diarrhea
reactive arthritis is an acute non purulent arthritis that is secondary to an infection in another part of the body. The condition is typically seen days 2 weeks following an episode of acute bacterial diarrhea that can be caused by shigella species salmonella speciescampylobacter species chlamydia trachomatis or ureaplasma urealyticum. findings include asymmetrical oligoarthritis, dactylitis, toe or heel pain, conjunctivitis or uveitis, and genital ulceration
65
Any pregnant woman with asthma, symptoms and bronchospasm are likely to worsen during:
1. 6 to 14 weeks
2. 15 to 23 weeks
3. 24 to 33 weeks
4. 29 to 36 weeks
29 to 36 weeks
66
What is the anticipated language skill for a healthy 24 month old child?
1. speaks one to two words
2. speaks in sentences of two word
3. speaks in sentences of three words
4. speech includes plurals and personal pronouns
speaks in sentences of two words
67
The two most common reasons for lawsuits against nurse practitioners are missed diagnosis and:
1. lapsed follow up
2. declining to prescribe a medication that the patient request but is not clinically indicated
3. incorrect medication dosing
4. patient allergic reaction in response to a prescribed medication
lapsed follow up
68
Jamie is a 4 year old well child who presents in follow up two weeks after being treated for acute otitis media with Amoxicillin 90 mg per kilogram for 7 Days. Mom says he has not had any fever, still occasionally pulls at his ear, and sometimes doesn't seem to hear her. Otoscopic examination reveals a blunted light reflex and a pale yellow tympanic membrane with air fluid levels. The nurse practitioner understands that:
1. the patient probably has eustachian tube dysfunction and should be managed accordingly
2. otitis media with effusion often occurs following acute otitis media and this reflects the normal course of healing
3. the blunted light reflex suggest inadequate treatment and Amoxicillin with clavulanic acid should be started
4. this is consistent with an Allergic Disease component and should be managed with a second generation antihistamine
otitis media with effusion often occurs following acute otitis media and this reflects the normal course of healing
69
Proficient with crohn's disease involving the small intestines will likely report each of the following except:
1. abdominal cramping
2. weight loss
3. constipation
4. blood in the stool
constipation
70
In which of the following situations is postmenopausal hormone replacement therapy most helpful?
1. treatment of hypothyroidism
2. prevention of unstable angina
3. reduction in frequency and severity of hot flashes
4. reduction in death rates post MI in older women
reduction in frequency and severity of hot reduction in frequency and severity of hot flashes
71
Treatment choices for abortive migraine therapy in a 42 year old man with angina pectoris include:
1. ergotamine
2. ibuprofen
3. Verapamil
4. sumatriptan
ibuprofen
72
The S4 sound is heard during:
1. early systole
2. late systole
3. early diastole
4. late diastole
late diastole
73
A 54 year old woman presents with rosacea that has not resolved with Lifestyle Changes (ie monitoring diet, avoiding triggers). The nurse practitioner considers initiating treatment with an oral antimicrobial but considers that changes in skin pigmentation can occur with the use of:
1. tetracycline
2. metronidazole
3. Minocycline
4. erythromycin
Minocycline
74
The most common cause of acute pyelonephritis in a 62 year old woman who experienced recurrent urinary tract infections is:
1. E. Coli
2. k. Pneumoniae
3. P. Aeruginosa
4. s. Pneumoniae
E. Coli
75
Stasis dermatitis and is a clinical condition most often associated with or secondary to:
1. repeated sunburns
2. nursing home acquired infection
3. chronic venous insufficiency
4. poorly controlled diabetes mellitus
chronic venous insufficiency
76
Which of the following best describes a milestone of a normally developing 7 month old child?
1. a child that is able to sit with support
2. a child that resists being placed in a Supine position
3. a child that can stand by holding onto furniture
4. a child that will hand over an object upon request
a child that resists being placed in a Supine position
77
Physical or cognitive symptoms associated with generalized anxiety disorder include all of the following except:
1. restlessness
2. increased muscle aches and soreness
3. tension-type headaches
4. difficulty sleeping
tension-type headaches
78
All of the following are likely to be reported in acute pyelonephritis except:
1. Gross hematuria
2. fever
3. cloudy urine
4. costovertebral angle tenderness
gross hematuria
79
Which scenario is most consistent with Legionella pneumonia?
1. a 56 year-old heating and cooling repair person with a dry cough and abdominal pain
2. a 78 year old retired firefighter recovering from influenza with thick yellow sputum and abscess noted on chest x-ray
3. 24 year old with severe sore throat, hoarseness, and a hacking cough
4. 42 year old computer programmer with fever, chills, and Rusty sputum
a 56 year-old heating and cooling repair person with a dry cough and abdominal pain
80
According to jnc 8, the blood pressure goal for a 48 year old African American woman with type 2 diabetes mellitus is:
1. 130 / 80
2. 130 / 90
3. 140 / 90
4. 150 / 90
140 / 90
81
The most common cause of peptic ulcer disease is:
1. coffee consumption
2. helicobacter pylori infection
3. alcoholism
4. viral gastritis
helicobacter pylori infection
82
Blake is a 10-year old boy who is seen in the clinic one week ago with a 3-day history of sore throat, fever, and generally feeling unwell. The rapid strep test was negative but the physician prescribes empiric amoxicillin because he had a strong clinical suspicion for strep throat. Today the patient presents in follow up. He still feels unwell but now has a diffuse maculopapular rash. The nurse practitioner knows that Blake likely has:
1. a penicillin allergy
2. infectious mononucleosis
3. bacterial meningitis
4. viral exanthem
infectious mononucleosis
83
Which of the following is true about the Hepatitis B virus vaccine?
1. the vaccine contains live, attenuated HBV
2. children should have Hepatitis B surface antibody titers drawn after 3 doses of vaccine
3. Hepatitis B immunization should be universally offered
4. serologic testing for Hepatitis B surface antigen should be checked before hbv vaccination is initiated in children
Hepatitis B immunization should be universally offered
84
A rise in serum creatinine is indicative of:
1. decrease glomerular filtration rate
2. early renal damage
3. volume expansion
4. impaired renal perfusion
decrease glomerular filtration rate
85
A 27 year old woman presents with a urinary tract infection. She is otherwise healthy and has no reported drug allergies. The local E. Coli resistance rate to tmp - SMX is 25%. Which of the following is the most appropriate first-line treatment choice?
1. ampicillin
2. trimethoprim-sulfamethoxazole
3. nitrofurantoin
4. Ciprofloxacin
nitrofurantoin
86
The use of which of the following medications is most likely to cause granulocytopenia?
1. valproic acid
2. Fluoxetine
3. amitriptyline
4. carbamazepine
carbamazepine
87
All of the following practices are recommended when prescribing medications with confusing or similar sounding names except:
1. writing the purpose of the medication on the prescription order
2. considering selecting medications without nomenclature problems
3. including either the generic or brand-name in the prescription order, but not both
4. providing patients with written information about their drugs
including either the generic or brand-name in the prescription order, but not both
88
You see a 58 year-old manner pastry of poorly controlled hypertension. At this visit his blood pressure is 185 / 110 but does not report any symptoms. Auscultation will likely reveal:
1. s3 heart sound heard during early diastole
2. s3 heart sound heard during late diastole
3. S4 heart sound heard during early diastole
4. S4 heart sound heard during late diastole
S4 heart sound heard during late diastole
89
Mrs. B, a 49 year-old female, first came to the clinic with profound knee pain, hand pain, and a history of rheumatoid arthritis. She was started on Methotrexate and presents for her follow-up. In order to ensure that the drug is not causing adverse systemic effects, which of the following laboratory studies must be ordered?
1. BUN and creatinine
2. Hgb and Hct
3. WBC/RBC
4. AST/ALT (aspartate aminotransferase/alanine aminotransferase)
AST/ALT (aspartate aminotransferase/alanine aminotransferase)
90
Caution should be used when prescribing drospirenone/ethinyl estradiol COC to a woman who is also taking a:
1. beta adrenergic antagonist
2. Angiotensin converting enzyme inhibitor
3. calcium channel blocker
4. Alpha adrenergic antagonist
Angiotensin converting enzyme inhibitor
91
Tammy is a 52 year old woman who presents with a chief complaint of urinary incontinence. She states that she sometimes experiences urine loss while sneezing or coughing, but does not report nocturia. She has a history of well controlled hypertension with an Ace inhibitor and her BMI is 31. The nurse practitioner considers that Tammy is most likely experiencing:
1. stress incontinence
2. urge incontinence
3. functional incontinence
4. drug-induced adverse effect
stress incontinence
92
A patient in your practice has an abnormal pap test result and requires a follow-up visit. The patient repeatedly fails to show up for the follow-up visit. Which of the following is the best approach to inform the patient of the need and urgency for a repeat test?
1. a message left on her voicemail
2. a visit to her home
3. an email message via a secure service marked as urgent
4. a certified letter
a certified letter
93
Which of the following is the most common UTI organism in children?
1. pseudomonas aeruginosa
2. escherichia coli
3. klebsiella pneumoniae
4. proteus mirabilis
escherichia coli
94
A 43 year old woman presents with a 12-hour history of fever, pain, and positive Murphy's sign. The most likely diagnosis is:
1. hepatoma
2. chronic cholelithiasis
3. acute cholecystitis
4. acute viral hepatitis
acute cholecystitis
95
Which of the following is most consistent with a diagnosis of depression?
1. anhedonia
2. gastrointestinal complaints
3. difficulty initiating sleep
4. recurring headache
anhedonia
96
which of the following statements is most consistent with a patient experiencing vertigo?
I get light-headed when I stand up too fast
I get nervous when exposed to extreme Heights
the room seems to spend, even with my eyes closed
I passed out and found myself on the floor
the room seems to spend, even with my eyes closed
97
Which of the following provides an example of when a provider patient relationship is established?
1. a new patient makes an appointment over the phone for an initial Well Visit at the clinic
2. a nurse practitioner Witnesses a car accident and called nine-one-one
3. a nurse practitioner renew a prescription for a friend after she mentions that her medication is running out
4. a nurse practitioner recommends a specific urologist when a colleague mentions that his mother is having incontinence issues
a nurse practitioner has a prescription for a friend after she mentions that her medication is running out
98
The most important component of the initial assessment of an asthma exacerbation includes a:
1. Comprehensive Health history
2. objective measurement of lung function
3. chest x-ray
4. arterial blood gas
objective measurement of lung function
| peak flow
99
Under ordinary circumstances, how many drug half-lives are usually needed to reach steady-state?
1. 0.5-1
2. 2-3
3. 3-5
4. 6-7
3-5
100
When a pregnant woman takes a teratogenic drug, the fetal effects are usually seen in:
1. certain Target organs in a predictable manner
2. random body systems without a predictable pattern
3. select organ systems with random outcomes
4. a pattern of systemic injury
certain Target organs in a predictable manner
101
You see a twenty-six-year-old Well Woman of African ancestry. Hemogram results are as follows hemoglobin 10 (12-14) hematocrit 30 (36-42) MCV 69 (80-96) RDW 13% (11-15%) RBC 5.4 million (3.2-4.3). The most likely diagnosis is:
1. acute blood loss
2. beta thalassemia minor
3. iron deficiency anemia
4. Cooley's anemia
beta thalassemia minor
102
Which of the following is likely to have the greatest anticholinergic effects?
1. Venlafaxine
2. citalopram
3. Fluoxetine
4. nortriptyline
nortriptyline
103
A 36 year old man with asthma states that he has had excellent control of wheezing using albuterol two Puffs three to four times a day. You consider prescribing:
1. a long-acting beta-2 Agonist
2. an oral Theophylline
3. no medication as he has adequate symptom control
4. an inhaled corticosteroid
an inhaled corticosteroid
104
Which of the following individuals with untreated vision problems best describes a person with angle closure glaucoma?
1. 42 year old who reports having difficulty reading small print
2. 62 year old with poorly controlled hypertension and reports double vision
3. 54 year old with a long history of type 2 diabetes who reports seeing floaters
4. 57 year old who reports periorbital pain and seeing Halos around objects
57 year old who reports periorbital pain and seeing Halos around objects
105
Thyroid stimulating hormone is produced by the:
1. thyroid
2. adrenals
3. anterior pituitary
4. hypothalamus
anterior pituitary
106
A father presents his 4 week old daughter that was born healthy at 40 weeks gestation. He reports that she has had multiple vomiting episodes, cries uncontrollably, and has passed some blood and mucus in the stool. Physical examination reveals a tender abdomen and a palpable abdominal Mass. A likely diagnosis is:
1. pyloric stenosis
2. intussusception
3. ingestion of a foreign object
4. Clostridium difficile infection
intussusception
107
Combined oral contraceptive use can deplete which of the following vitamins?
1. D
2. B6
3. A
4. E
B6
108
One of the preferred treatment options for uncomplicated chlamydia trachomatis infection in pregnancy include oral:
1. ofloxacin
2. azithromycin
3. clarithromycin
4. doxycycline
azithromycin
109
Laboratory studies in a middle-aged man reveal the following: AST=52 (0-40), ALT=110 (0-50) HAV IgG=present. These results are consistent with:
1. continued risk for contracting hepatitis A
2. acute hepatitis A
3. evidence of Prior hepatitis A infection
4. chronic hepatitis A
evidence of Prior hepatitis A infection
110
Which of the following is a first-line therapy for the treatment of acute bacterial rhinosinusitis in an otherwise healthy 6 year old with no recent antimicrobial use and no known drug allergies and who has been experiencing persistent symptoms for 10 days?
1. clarithromycin
2. levofloxacin
3. trimethoprim-sulfamethoxazole
4. amoxicillin
amoxicillin
111
Which of the following is true about the MMR vaccine?
1. this vaccine contains live virus
2. it's use is contraindicated in persons with a history of egg allergy
3. revaccination of an immunized person is associated with risk of allergic reaction
4. one dose is recommended for young adults who have not been previously immunized
this vaccine contains live virus
112
Physical examination findings in Graves disease likely include:
1. muscle tenderness
2. hyperreflexia
3. dry skin
4. cold intolerance
hyperreflexia
113
A 46 year-old woman presents with complaints of fatigue, dizziness, and shortness of breath. She also mentions occasionally feeling numbness or tingling in her fingertips. Her medical history shows that she has had gastric bypass surgery two years ago. Physical examination reveals pale conjunctiva and a hemic murmur. Hemogram results are as follows: Hgb-6.2 (12-16), Hct-20% (36-42%), MCV - 132 (80-96), RDW - 19% (11-15). the most likely cause of this anemia is:
1. hemolysis
2. vitamin B12 deficiency
3. iron deficiency
4. alpha thalassemia
vitamin B12 deficiency
114
A 27 year old woman presents complaining of pain on her upper thighs related to spilled hot coffee on her lap. Physical examination reveals a burn site that is red and dry but without blisters. The nurse practitioner categorizes this burn as:
1. 1st degree
2. second degree
3. third degree
4. fourth degree
first degree
115
The S3 sound is heard during:
1. early systole
2. late systole
3. late diastole
4. early diastole
early diastole
116
The nurse practitioner is evaluating a 17 year old female for vulvovaginitis. On microscopic is game there are >10 clue cells per HPF. The nurse practitioner knows that this is indicative of:
1. chlamydia
2. gonorrhea
3. bacterial vaginosis
4. trichomoniasis
bacterial vaginosis
117
The most appropriate management option for a three-week-old infant with pyloric stenosis is:
1. watchful observation to see if it spontaneously resolves in 24 hours
2. oral amoxicillin with or without clavulanate
3. pneumatic enema
4. surgical correction
surgical correction
118
When evaluating a 54 year-old woman for a potential thyroid disorder, which of the following laboratory assessments would be least helpful?
1. total T4
2. free T4
3. TSH
4. TPO antibodies
total T4
119
Monica is a 25 year old woman who presented to the clinic for treatment of a lower urinary tract infection. She was prescribed the appropriate antibiotic therapy and was taught strategies to decrease urinary tract infection. When evaluating her understanding, the nurse practitioner knows that Monica needs more instruction when she says:
1. I will drink plenty of fluids while taking my medications
2. I will be sure to go urinate after I have intercourse
3. I will empty my bladder as soon as it feels full
4. I will be sure to wipe front to back after urinating
I will be sure to wipe front to back after urinating
120
Jennifer is a 27-year-old female who presents for family planning. she has no significant medical history and her only medication is a daily OTC multivitamin. The only form of contraception she has ever used his comments. Jennifer reports that her periods have been regular at 28 day intervals almost since the first one at age 14. she has recently started a sexual relationship with any male partner. She has considered all types, and wants to begin with a combined oral contraceptive pill to see how her body responds to warm up. Jennifer's history and physical examination are within normal limits, and last for this was two weeks ago. The first day of her last menstrual cycle was 7 days ago. the most appropriate action for the nurse practitioner would be to provide a prescription for COC and instructs Jennifer to begin to start the COC prescription:
1. today to ensure contraceptive protection this month
2. today and use an additional backup method for 1 week to ensure contraceptive protection this month
3. on the first day of her next menstrual cycle
4. on the first Sunday after her next menstrual cycle begins
today and use an additional backup method for 1 week to ensure contraceptive protection this month
121
The nurse practitioner knows that the most episodes of low back pain are caused by:
1. muscle or ligament strain
2. disk herniation
3. an acute precipitating event
4. nerve impingement
muscle or ligament strain
122
Which of the following is at greatest risk of developing iron deficiency anemia?
1. 62 year old woman with rheumatoid arthritis
2. healthy 42 year old man who does not eat red meat
3. 27 year old man with celiac disease
4. 54 year old man with a gastro duodenal ulcer
54 year old man with a gastro duodenal ulcer
123
When considering an end-of-life decision for a terminally ill person who cannot communicate, all of the following can be used as an advance directive except:
1. testimony from a family member or close friend
2. a living will
3. a do not resuscitate order
4. a durable power of attorney for health care
testimony from a family member or close friend
124
Which of the following is a common contributing bacterial pathogen in the development of an acute exacerbation of chronic obstructive pulmonary disease in a 59 year old man with an fev1=60% of predicted?
1. Haemophilus influenzae
2. streptococcus pyogenes
3. staphylococcus aureus
4. klebsiella pneumoniae
haemophilus influenzae
125
A 21 year old female patient presents with a chief complaint of a 4-day history of rhinorrhea, scratchy throat, headache, and cough. The patient is diagnosed with a viral upper respiratory infection and is sent home with recommendations for OTC symptom control measures. She returns to the office one week later and reports that her cough and sore throat result a few days ago, but in the past 24 hours, she has developed a low-grade fever, worsening nasal discharge, and a sharp pain on the left side, including a pressure headache above her left eye. This patient has likely developed:
1. a superimposed bacterial sinusitis
2. orbital cellulitis
3. dacryocystitis
4. scleritis
a superimposed bacterial sinusitis
126
At which of the following ages in a young child's life is parental anticipatory guidance about temper tantrums most helpful?
1. 8 to 10 months
2. 10 to 12 months
3. 12 to 14 months
4. 14 to 16 months
12 to 14 months
127
Treatment for reactive arthritis (reiter's syndrome) in a sexually active man usually includes:
1. Non-biologic DMARDs
2. antimicrobial therapy
3. acetaminophen
4. cyclosporine
antimicrobial therapy
128
A fifty-one-year-old post-menopausal woman asks about initiating hormone replacement therapy to help her hot flashes. The nurse practitioner considers that all of the following are contraindications for post-menopausal estrogen therapy except:
1. unexplained vaginal bleeding
2. acute liver disease
3. history of cluster headaches
4. thrombotic disease
history of cluster headaches
129
All of the following are risk factors for death from asthma except:
1. rural residence
2. low economic status
3. greater than 3 emergency department visits for asthma
4. use of more than two canisters of short-acting beta-2 Agonist per month
rural residence
130
A 16 year old presents with a 2-day history of fever, headache and a stiff neck. Which of the following would most support a diagnosis of meningitis?
1. absence of wbc's in CSF
2. presence of bacteria in urine
3. positive obturator and psoas signs
4. positive brudzinski and kernig signs
positive brudzinski and kernig sign
131
The placenta is best described as:
1. capable of impeding substances with MW <300 Da.
2. ineffective drug barrier
3. allowing the transfer of lipophilic substances
4. poorly permeable
allowing the transfer of lipophilic substances
132
When considering the use of emergency contraception following unprotected intercourse, all of the following are true except:
1. levonorgestrel is available without a prescription for women 17 years and older
2. copper containing IUD can be inserted within 5 days of unprotected intercourse for emergency contraception
3. ulipristal acetate will not impact embryo implantation when used within 5 days following unprotected intercourse
4. menstrual bleeding should occur within 3 to 4 weeks following emergency contraception use
ulipristal acetate will not impact embryo implantation when used within 5 days following unprotected intercourse
133
Tammy, a 24 year old woman, presents with a 1-week history of thin green yellow vaginal discharge. Microscopic examination reveals greater than 20 WBC per hpf pH=5.5 and large motile organisms.
for Tammy in the above question and appropriate treatment option would be:
1. oral Ketoconazole
2. clindamycin vaginal cream
3. oral metronidazole
4. oral azithromycin
oral metronidazole
134
The most common cause of hypothyroidism is:
1. radioactive iodine exposure
2. thyroid neoplasia
3. primary pituitary failure
4. autoimmune thyroiditis
autoimmune thyroiditis
135
A 68 year old man of Asian ancestry presents with his daughter for evaluation. He has little comprehension of the English language. When considering the use of an interpreter, the nurse practitioner realizes:
1. a family member should be used if possible
2. The Interpreter should match the gender and age as close as possible
3. the nurse practitioner should directly look and speak to The Interpreter
4. The Interpreter should be seated next to the patient
The Interpreter should match the gender and age as close as possible
136
Which of the following is most consistent with a person presenting with myocardial infarction?
1. continuous chest pressure lasting 15 minutes that occurs at rest
2. a 10-minute episode of chest tightness brought on by activity
3. retrosternal pain for 30 minutes with diaphoresis
4. localized chest pain that persists for 24 hours
retrosternal pain for 30 minutes with diaphoresis
137
When evaluating a 61 year old males response to Alpha blocker treatment for benign prostatic hypertrophy, the nurse practitioner expects with which of the following findings?
1. report of an increase in force of stream
2. an increase in strength of erection
3. a decrease in prostate pain
4. a softer prostate to digital exam
report of an increase in force of stream
138
Clinical findings in a patient with moderate to severe hypercalcemia can include all of the following except:
1. muscle weakness
2. nausea and vomiting
3. frequent urination
4. insomnia
insomnia
139
Which of the following is most likely found in a woman with ectopic pregnancy?
1. intrauterine gestational Sac visible on transvaginal ultrasound
2. negative urine HCG
3. pregnancy located in fallopian tube
4. quantitative HCG >15,500
pregnancy located in fallopian tube
140
One of the preferred antihypertensive agents for a 52 year old woman of European ancestry with type 2 diabetes mellitus is:
1. clonidine
2. Furosemide
3. Trandolapril
4. Atenolol
Trandolapril
141
A woman who is planning a pregnancy should increase her intake of which of the following:
1. vitamin C
2. folic acid
3. iron
4. niacin
folic acid
142
A 17 year old patient with a 6 cm abscess on the left upper arm presents one week post incision and drainage for a follow-up appointment. The area is still much improved, but has some residual erythema and discomfort. The nurse practitioner correctly interprets that:
1. the healing process is proceeding normally and she should continue to monitor progress
2. the presence of discomfort one week after incision and drainage suggest residual infection and antibiotics should be started
3. the wound should be packed with iodoform gauze and irrigated with normal saline twice-daily
4. topical Mupirocin should be initiated and monitored for development of systemic symptoms
the healing process is proceeding normally and she should continue to monitor progress
143
Which of the following is not a Criterion for a level 3 office visit?
1. at least one element of history of present illness and at least one positive or negative response to review of systems questions
2. at least six elements of physical examination
3. patient is seen by a physician
4. medical decision-making of low complexity
patient is seen by a physician
144
When prescribing a medication, the clinician considers that A drugs Half-Life is the amount of time needed to decrease its serum concentration by:
1. 25%
2. 50%
3. 75%
4. 100%
50%
145
The following ECG illustrates which of the following characteristics that is indicative of myocardial injury?
1. pathologic Q wave
2. tall R wave
3. T wave inversion
4. ST segment elevation
T wave inversion
146
Patient education for a person using Permethrin for the treatment of Scabies should include the following information:
1. it's use is associated with neurotoxicity risk
2. itch often persist for a few weeks after successful treatment
3. a marked reduction in lesions is noted within 48 hours
4. the medication should be rinsed off within 2 hours of application
itch often persist for a few weeks after successful treatment
147
Hemoglobin electrophoresis of a healthy 29 year-old woman of Asian ancestry with mild anemia reveals alpha thalassemia minor. Follow up care for this patient should include:
1. vitamin B12 supplementation
2. offering genetic counseling prior to pregnancy
3. repeat of hemoglobin electrophoresis every 5 years
4. annual fecal occult blood testing
offering genetic counseling prior to pregnancy
148
Which of the following is most consistent with subclinical hypothyroidism?
1. low total T4 with normal TSH
2. elevated total T4 with normal TSH
3. elevated TSH with normal free T4
4. low TSH elevated free T4
elevated TSH with normal free T4
149
At which of the following ages in a young child's life is Parental anticipatory guidance about protection from Falls most helpful?
1. at Birth
2. 2 months
3. 4 months
4. 6 months
at birth
150
Which of the following is an abnormal finding in a woman in the third trimester of pregnancy?
1. diastolic murmur
2. symphysis pubis tenderness
3. symmetric thyroid enlargement
4. early to mid systolic murmur
diastolic murmur
Fitzgerald Review
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