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NSG 6440Predictor test (336 question &answers and explanation)_latest,100% CORRECT

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A 15 years old high school student with a mild sore throat andlow-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects mononucl... eosis. Which of the following is the LEAST appropriate intervention? a. Palpate the lymph nodes and spleen b. Examine the posterior oropharynx for petechiae c. Obtain a CBC, throat culture, and heterophil antibody test. d. Obtain an urinalyses and serum for LFTs and amylase 2) A 32 years old male patient complaint ofurinary frequency and burning on urination for 3 days. Urinalyses reveals bacteriuria and positive nitrites. He denies any past hx. Of urinary tract infections. The initial treatment should be: a. trimethoprim-sulfamethoxazole (Bactrim, Sulfatrim) for 7-10 day b. ciprofloxacin (Cipro) for 3-5 days c. Trimethoprim-Sulfamethoxazole for 3 days d. 750 mg ciprofloxacin as a one-time dose 3) Which agent is most effective for the treatment of nodulocystic acne? a. Benzoyl peroxide (Benzac) b. Retinoic acid (Retin A) c. Topical tetracycline d. Isotretinoin) 4) An 18 y/o woman is taking a combined hormonal oral contraceptive. She should be instructed to use a backup method for the prevention of pregnancy a. Throughout the week of placebo pills b. If prescribed topiramate (Topamax) for the treatment of migraines. c. If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection d. if she forgets to take a single dose of the contraceptive 5) A 44 years old female patient has diabetes. Her total cholesterol (TC) is 250 mg/dl (6.5 mmol/L), LDL= 190 mg/dL (4.94 mmol/L), HDL= 25 mg/dL (65 mmol/L), and triglycerides= 344 mg/dL (8.94 mmol/L). What agent have the greatest effect on improving her lipid profile and reducing morbidity and mortality associates with dyslipidemia? a. Niacin (Niaspan) b. Atorvastatin c. Omega 3 fatty acids d. Fenofibrates 6) A 30 years old female comes into a clinic with classic signs and symptoms of appendicitis. The NP fails to refer the patient to a surgeon. The appendix ruptures and the woman die. This is an example of a. Failure of diligence b. Professional liability c. Negligence d. Malpractice 7) A NP has recently been hired to work in a fast track facility. The NP employer asked if she has “a problem prescribing medications for emergency contraception.” The NP replies affirmatively. This is: a. Grounds for dismissal b. An ethical dilemma for the NP c. Illegal according to the standards of nursing d. Patient abandonment. 8) A patient presents with pruritic lesions on both knees. There are visible silver scales. How Should this condition be managed? a. Topical antifungal cream or ointment b. Oral antibiotics c. Topical corticosteroids cream d. Topical anti-fungal/ steroid cream 9) Antidepressant discontinuation syndrome is less likely if the patient a. Is male b. Is less than 35 y/o c. Has taken an SSRI with a short half life d. Gradually tapers SSRI use 10) Patient with benign prostatic hyperplasia (BPH) should be taught to avoid which one of the following drug classes? a. Alpha adrenergic antagonist b. Anti-androgen agents c. Tricyclic antidepressant (TCA) d. Sulfonamides 11) Which of the following is the best response to a woman who has just admitted she is a victim of spousal abuse? a. What was if you did to make him angry? b. You must seek refuge immediately c. I am concerned about your safety d. I am going to call a shelter for you 12) For which patient group does the US Preventive Services Task Force recommend routine screening for asymptomatic bacteriuria a. pregnant woman b. Children c. Patients with diabetes d. patients over the age of 70 13) What diabetic complications result from hyperglycemia? 1. Retinopathy 2. Hypertension resistant to treatment 3. Peripheral neuropathy 4. Accelerated atherosclerosis a. 1,2,3 b. 2,3,4 c. 1,3,4 d. 1,2,4 14) A 6 y/o presents w/ complaints of sore throat and fever for 2 days. He has multiple vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. What is the most likely diagnosis? a. Viral pharyngitis b. Herpangina c. Epiglottitis d. Tonsillitis 15) A patient has Kawasaki syndrome. Which characteristics would be UNUSUAL? a. Age > 15 years b. Fever > 101 F (38.3 C) c. Exudative pharyngitis d. Painful rash 16) According to the JNC 8 guideline hypertension in a 40 y/o can be diagnosed when blood pressure exceeds a. 140/90 b. 130/90 c. 125/85 d. 150/100 17) A 48 y/o female complains of pain and stiffness in her right hip and knee that is mild on awakening in the morning, get worse as the day progresses and is relived with hot baths and ibuprofen. Crepitus is palpated on range of motion of the knee. Signs of inflammation are notably absent. What is the most likely diagnosis? a. Rheumatoid arthritis (RA) b. Gout c. Osteoarthritis (OA) d. Osteoporosis 18) A 7-year old female patient presents with severe injuries that are inconsistent with the explanation given for them. The nurse practitioner questions the mother about abuse. She admits that her husband, the child’s father, beat the child. How should the nurse practitioner proceed? a. Inform the mother that the abuse must be reported to child protection authorities. b. Counsel the mother that if it happens again it will be reported to child protection service. c. Ask the child what she did to cause the punishment d. Refer the family to the National Domestic Violence hotline. 19) A 1-month-old presents with reported recurrent diarrhea, screaming, and drawing up of the legs followed by periods of lethargy. On physical examination, a “sausage-like” mass in the upper right quadrant of the distended abdomen. Which of the following is the most likely diagnosis? a. Intussusception b. Volvulus c. Crohn’s disease d. Foreign body in the GI tract 20) A middle-aged female complains of insomnia, night sweats, feeling intensely hot, emotional lability, extreme nervousness and impatience. The LEAST likely cause of her symptoms is a. Thyrotoxicosis b. Menopausal vasomotor instability c. Alcohol or another drug withdrawal d. New onset type 2 diabetes mellitus 21) Which of the following indicated need for further evaluation? a. A 7 y/o girl with vaginal bleeding b. A 7years old girl with no true pubic hair c. A 12 years old boy with sparse, slightly pigmented pubic hair d. A 12-year-old girl with breast buds 22) A young couple is being seen by the NP for preconception counseling. They express a wish for pregnancy within the next 3 month and are very eager to know what they can do now to “make the baby as healthy as possible”. Which of the following should the NP encourage to decrease the chance of neural tube defect in the fetus? a. Maternal alpha-fetoprotein level b. Folic acid 0.4 mg daily c. Rubella vaccine today d. Vitamin E 400 IU daily 23) A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several time p…. which is relived with nitroglycerin. Which is the most appropriate initial action for the NP? a. Refer to a cardiologist as soon as possible b. Prescribe long-acting nitroglycerin c. Order treadmill stress test d. Prescribe an ACE inhibitor and re-evaluate in 24 to 48 hours 24) A 3 y/o has enlarged, warm, tender cervical lymph nodes, indicating: a. Infection proximal to the nodes b. A possible cancer diagnosis c. Shorty nodes, a common normal variant in children d. An infectious process distal to the nodes 25) The NP examines a 2-month-old with unequal gluteal and thigh skin folds. What should the NP do next? a. Send the infant for x-ray of the hips b. Send the infant for ultrasound of the hips c. Perform Ortolani and Barlow test d. Examine the infant for unequal arm length 26) A very active 35 years old male has painful hemorrhoid, but he does not want hemorrhoidal surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most appropriate recommendation is for him to select food that are: a. Low in fiber such as milk and other dairy products b. High in simple carbohydrates such as white bread and mashed potatoes c. High in fiber such as bran, complex carbohydrates and fresh fruit d. High protein such a meat, poultry and fish 27) Correct instructions to give new parent who are transporting their newborn infant is a. A rear-facing infant car seat secured in the backseat is required until the infant weight 20 lbs. b. The infant car set may be secured in the back or front seat, but must rear-facing c. The infant car seat may be front facing when the infant is 1 year old d. A rear or front-facing infant car seat must be secured in the back seat until the infant weight 20 lbs. 28) A 13 y/o pt. complains that he fell while running during football practice. Now his knee hurts and sometimes “lucks”. The NP conducts McMurrays test. Which of the following is TRUE about this test? a. An audible or palpated “click” is positive for a torn meniscus b. A various stress is applied to the flexed knee c. The straight leg is internally rotated with the patient supine and flat d. The knee is grasped with the examiner’s fingers placed laterally. 29) A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels heavy but denies pain. On examination, the NP notes transillumination of the scrotum. What is the most likely diagnosis? a. Hydrocele b. Orchitis c. Testicular torsion d. Indirect inguinal hernia 30) A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of this information, it is essential for the NP to teach him about a. Testicular self-examination b. Protection of the testes during sports activities c. Risk of testicular torsion d. Practicing safer sex . 31) A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He is instructed in lifestyle modification, and drug initialed. Two month later, he returns and report that he still has symptoms. The next steps are to. a) Refer for surgical interventions such as partial or complete fundoplication. b) Refer for endoscopy, namometry, and/or PH testing c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications. d) Review proper proton pump inhibitor dosing time and adherence with the patient. 32) A 51 –year- old post-menopausal female, request guidance regarding osteoporosis risk. The NP would be correct to recommend all of the following EXCEPT a. Moderate weight bearing exercise 3 times per week b. 1200 – 1500 mg calcium daily c. Avoidance of alcoholic beverages d. Weight loss 33) According to Erickson, the developmental task of the elderly adult is: a. Intimacy VS isolation b. Ego integrity VS despair c. Industry VS self-doubt d. Trust Vs mistrust 34) Moderate weight loss, particularly of visceral adipose tissue in patients with type 2 diabetes mellitus may have all of the following beneficial effects EXCEPT: a. Improved insulin sensitivity b. Increased glucose uptake and utilization by the cells c. Increase lean muscle mass’ d. Improved lipid profile . 35) A 12 y/o presents with eat pain or 36 hours duration. The NP diagnoses acute otitis media because the a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly b. Tympanic membrane is retracted against boy landmarks c. Bony landmarks are obscured, and the tympanic membrane is mildly erythematous, dulls and immobile. d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact. 36) The NP should instruct the mother of an infant with thrush to: a. Take oral nystatin since she is breastfeeding b. Stop breast feeding until the thrush has resolved c. administer antifungal medication to the infant prior to feeding d. sterilized pacifiers and bottle nipples 37) A 26 y/o patient, 18 weeks pregnant with twins, has been healthy and has followed recommendations of her nurse midwife. She is in the office to discuss results of her maternal serum alpha-fetoprotein (MSAFP) test. which show elevation in this particular pregnancy? a. Elevated MSAFPO is an indicator of Down Syndrome b. Low MSAFP is expected at 18 weeks’ gestation c. Neural tube defects are highly probable d. Elevated MSAFP is an expected finding 38) The hallmark of neurofibromatosis (von Recklinghousen disease) present in almost 100% of patients is: a. Acoustic neuroma b. Astrocytoma of the retina c. Distinctive osseous lesion d. Café au lait spots 39) The NP correctly teaches an elderly patient with pernicious anemia that food sources of B12 include a. Red meat, poultry, fish, eggs, dairy products b. Canned and frozen fruit c. Whole grain breads, cereals and pastas d. Fresh vegetables 40) An 18-year-old female applying for college admission present to the health clinic because evidence of rubella vaccination is required for admission. She says, “don’t remember ever getting that shot” She has negative serologic evidence of rubella antibody. The NP should: a. Tell her that her serologic evidence demonstrates that she is immune to the rubella and that she probably has the disease as a child b. Administer the vaccination after a negative pregnancy test and advise the patient that she must not get pregnant for 28 days c. Tell her that she needs the immunization and can get today if her pregnancy test is negative d. Administer the rubella vaccination after a negative pregnancy test and advise her not to get pregnant for at least 6 months. 41) A 45 y/o obese pre-menopausal female complains of indigestion, flatulence, RUQ pain and epigastric “crampy pain”. Symptoms are exacerbated by high-fat meal. What is the most likely diagnosis? a. Hepatitis b. Chronic cholecystitis c. Acute pancreatitis d. Myocarditis 42) A 16 y/o male presents w/ mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechia. With for this patient, what drug would be the LEAST appropriate to prescribe? a. Ibuprofen b. Erythromycin c. Ampicillin d. Doxycycline 43) A characteristic of delirium that is typically absent in dementia is a. Acute onset of confusion in a previously alert and oriented patient b. Gradual loss of short-term memory c. Loss of language skills d. Long term memory gaps filled in with confabulation 44) It is imperative that the NP teach patients taking oral contraceptives to report any of the danger signs of complications. Which of the following would be the LEAST concern to the NP? a. Lower leg pain b. Upper abdominal pain c. Chest pain d. Weight gain 45) Which of the following oral medications should be avoided in a child under 8 years of age? a. Cephalexin (Keflex) b. Tetracycline c. Rifampin d. Metronidazole (flaggyl) 46) Which of the following descriptions of Denver II Developmental Screening Test is most accurate? a. Applicable to children from birth to 2 years; evaluates four major categories of development: motor, intellectual, emotional, and language to determine whether a child is within normal range for various behaviors or is developmentally delayed b. Applicable to children from birth to 5 years; evaluates four major categories of development: motor, vision, hearing and psychosocial to determine whether a child is normal or developmentally compromised c. Applicable to children from age 6 months to 6 years; evaluates 4 major categories of development: intellectual, verbal, social and memory to determine IQ and aptitude d. Applicable to children from birth to 6 years; evaluates four major categories of development: gross motor, fine motor-adaptive, language, and personal social to determine whether a child is within normal range for behaviors or is developmentally delayed. 47) A 12-month-old has conjunctivitis in his right eye with a mucopurulent discharge. The mother asks if the child can forego for antibiotic eye drops because he does not’s like drops in his eyes. The NP replies that: a. If untreated, conjunctivitis may permanently damage the cornea b. Conjunctivitis is usually caused by a virus. Let’s wait a few days c. If no one else at the daycare has it, we can wait a few days. d. An oral antihistamine may be prescribed instead of eye drops. 48) which oral hypoglycemic agent would be safest for an elderly patient if hypoglycemia is a major concern? a. Tolbutamide (orinase) b. Glipizide (Glucotrol) c. Metformin (Glucophage) d. Chlorpropamide (diabinese) . 49) the components of the Denver II Developmental screening test are: a. Personal/social, fine motor, gross motor, language b. Intelligence, motor performance, language development c. Vocabulary, clarity of speech, abstract thinking d. Problem-solving, speech, gross motor, fine motor 50) A patient has been taking fluoxetine (prozar) since being diagnosed with major depression 7 month ago. She reports considerable empowerment in her symptoms and her intention to discontinue the medication what should be the NP’s recommendation? a. Advice the patient to stop the antidepressant medication b. Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication c. Recommend that the patient continue the antidepressant medication for at least 4 more month d. Discuss with the patient that need to take the antidepressant medication indefinitely 51) for the general adult population, total dietary fat intake should be no more than what percent of total calories? a) 10% b) 20% c) 30% d)40% 52) A 30 y/o female patient is being seen by the NP for the first time. She is seeking advice from the NP about becoming pregnant. She is currently taking an oral contraceptive. She gives a hx of having hydatidiform molar pregnancy 2 years ago. An appropriate plan of care for this a. patient should include b. Delaying pregnancy for 1 more year c. Measuring serum chorionic gonadotropin level d. Discontinuing oral contraceptive e. Recommending permanent sterilization . 53) which of the following is NOT a goal for treatment for the patient with cystic fibrosis? a. Prevent intestinal obstruction b. Provide adequate nutrition c. Promote clearance of secretions d. Replace water soluble vitamins 54) A 24 y/o female taking oral contraceptive has missed her last 2 pills. What should the NP advise her to do to minimize her risk of pregnancy? a. Take today’s dose and do not miss any more during this month b. Double today’s dose and use a barrier method for the rest of this month c. Double today’s dose and tomorrow’s dose and use a barrier method for the rest of this month d. Stop the pills and restart a new pill pack in one week. 55) Which red blood cell (RBC) index is most useful for differentiating types of anemias? a. Mean corpuscular volume (MCV) b. Mean corpuscular hemoglobin concentration (MCHC) c. Hematocrit (HCT d. Platelet count 56) what is a Tzanck test used to diagnosed? a. Mastoiditis b. Trichomoniasis c. Hyphema d. Herpes virus 57) a 40 y/o female with hx. Of frequent sun exposure present with multicolored lesion on her back it has irregular borders and is about 11 mm in diameter. What should the NP suspect? a. Squamous cell carcinoma b. Malignant melanoma c. Common Nevis d. Basal cell carcinoma 58) a 16 y/o sexually active female presents to the clinic. She has never had vaccinations for hepatitis A or B. She has had one MMR immunization, and her last tetanus vaccination was 4 years ago. which vaccination would be contraindicated without further testing? a. Hepatitis B b. Hepatitis A c. MMR d. Tetanus 59) following the finding of prostate gland abnormalities on DRE, The NP orders appropriate labs. When preparing to review with the patient, the NP knows all of the following are true EXCEPT a. Normal PSA is 10 mg/ml or less b. PSA is elevated in the presence of malignant prostate epithelium c. PSA is elevated in the presence of BPH d. Positive serum acid phosphatase reflects malignancy of the prostate gland with bone metastasis. 60) in which of the following presentations is further diagnostic testing NOT warranted? a. Bilateral gynecomastia in a prepubertal male of average weight; Tanner stage 1 b. Bilateral gynecomastia in a 13 y/o male with normal testicular size and volume c. Recent onset gynecomastia in a 20-year-old male with breast tenderness d. Unilateral breast mass which is 5 centimeters in diameter 61) a 59 years old post-menopausal woman has atrophic vaginitis. She has a hx. Of breast cancer at age 40 years. What is the appropriate initial treatment for this patient? a. Oran conjugated estrogens b. Oral medroxyprogesterone aetate c. Topical medroxyprogesterone aetate d. Topical conjugate estrogen cream 62) Advances in obstetric and neonatal care have a. Helped to identify the cause of cerebral palsy b. Demonstrated the cerebral palsy is a direct result of birth asphyxia c. Has no effect on the incident of cerebral palsy d. Resulted in a dramatic decrease in the incidence of cerebral palsy 63) which of the following physical modalities recommended for treatment of rheumatic arthritis provides the most effective long-term pain relief? a. Superficial and deep heat b. Application of cold c. Transcutaneous electrical nerve stimulation (TENS) d. Exercise 64) The NP is counseling a 25 y/o sexually active male patient about condom use, which of the following statement is INCORRECT a. Adequate lubrication is needed to prevent damage to the condom b. Roll the condom over an erect penis before any sexual contact c. Make sure the condom is tight against the head of the penis d. Withdraw while the penis is erect, so that the condom stays in place . 65) a patient with moderate persistent asthma will probably be most effectively managed with daily a. Oral leukotriene blockers b. Short and long acting bronchodilators c. Inhaled steroids and long acting bronchodilators d. Oral steroids and short acting bronchodilators 66) diagnosis of systemic lupus erythematosus (SLE) is made a. On the basis of demonstrable anti-nuclear antibodies (ANA) b. Consideringsymptom complex with confirmation by laboratory test c. Using renal function studies and rheumatoid factor for confirmation d. On the basis of renal or cutaneous biopsy 67) which of the following would not be considered a developmental red flag to a NP assessing a 4 y/o? a. Persistent fear of going to sleep b. Missing speech sounds c. Fire-setting d. An imaginary friend 68) A 44 y/o patient complains of stuffiness and soreness in his hands, hips and knees. There is noticeable PIP and DIP joint enlargement in his hands.. The NP suspects arthritis. All of the following questions are helpful in differentiation between rheumatoid arthritis (RA) and osteoarthritis (OA) EXCEPT a. on the joint of your fingers never feel particularly warm or hot? b. tell me about your usual energy level c. does the soreness and stiffness get better or worse as the day progresses? d. Have you noticed decreased joint movement or flexibility? 69) An adult presents w/ tinea corpus. What comment by the patient would be the LEAST likely explanation of how he acquired this disease? a. "I trap animals" b. "my wife has this also" c. "I have diabetes" d. "I live in the Northern US" 70) Acute rheumatic fever is diagnosed using the modified Jones criteria. Which is NOT a major criterion in the Jones System? a. Jaundice b. Carditis c. Polyarthritis d. Subcutaneous nodules 71) A pt is taking an ACE inhibitor for the blood pressure control. The NP decides to add a diuretic which of the following is the best choice? a. a thiazide diuretic b. a loop diuretic c. a potassium-sparing diuretic d. Fitness bar 70) Acute rheumatic fever is diagnosed using the modified Jones criteria. Which is NOT a major criterion in the Jones System? e. Jaundice f. Carditis g. Polyarthritis h. Subcutaneous nodules 71) A pt is taking an ACE inhibitor for the blood pressure control. The NP decides to add a diuretic which of the following is the best choice? e. a thiazide diuretic f. a loop diuretic g. a potassium-sparing diuretic h. Fitness bar 72) which of the following drugs classes would be most effective in decreasing elevated triglycerides levels (650 mg/dL)? a. bile acid sequestrants b. nicotinic acid c. fibrates d. statins 73) the mother of a 16 y/o high school student athlete is concerned that her daughter has not had a menstrual period yet. on physical examination, the NP finds normal growth and development including appropriate secondary sexual characteristics what is the most appropriate NP action? a. refer to a endocrinolist b. order a pelvic ultrasound c. attempt progesterone challenge d. prescribe oral contraceptive 74) factors known to be associated with early sexual activity include. a. early development of secondary sex characteristics, living in an urban area, and easy access to contraceptives b. legalized abortion, frequent viewing of adult television and movies, and lack of church affiliation c. lower socioeconomic status, use of tobacco, alcohol or other drugs, and single parent household d. exposure to sex education information at school 75) the finding which is most consistent with a diagnosis of benign prostatic hyperplasia is digital palpation of prostatic gland that is a. enlarged, symmetrical, semi firm and non-tender b. enlarged, symmetrical, boggy and exquisitely tender c. asymmetrical and nodular d. exquisitely tender with absence of median sulcus 76) The NP correctly diagnoses iron deficiency anemia in a female patient whose lab report reveals a. an increase reticulocyte count b. a mean corpuscular volume (MCV) > 100 c. hemoglobin (hgb) 140 mg/dL (140 g/L) d. an increased total iron binding capacity (TIBC) 77) Strabismus is observed in a 13-month-old child. The most appropriate action for the NP to take a. refer the patient to an ophthalmologist b. patch the child affected eye c. follow the child closely for 2 more month d. teach the patient and parent, eye muscle exercises 78) giving appropriate patient education by the primary care provider, poor compliance with medical recommendations is most often due to: a. willful disobedience b. vision and/or hearing deficits c. anxiety d. limited cognitive ability 79) the physical exam findings in an infant are most effected by which item listed below? a. what was the Apgar score at one minute? b. is the child breast of bottle fed? c. are the immunizations current? d. what was the gestational age at birth? e. 80) Babies should begin oral iron supplementation: a. when they are able to eat iron enriched cereal b. 2 months of age c. 4-6 months d. any time after their teeth have erupted 81) the most common cause of cerebral palsy is a. unknown b. intra-partial hypoxia c. in utero infection d. intraventricular hemorrhage 82) A patient with diabetes bring his glucose dairy from the past 7 days for the NP to review and evaluate what changes should be made? DAY 1234567 AM 67, 52, 61, 48, 39, 68, 70 PM138, 161, 148, 168, 171, 142, 176 a. increase the PM dose of NPH insulin b. increase the PM dose of regular insulin c. decrease the PM dose of NPH insulin d. decrease the PM dose of regular insulin 83) which of the following patient is at highest risk of suicide? a. 65 y/o female b. 70 y/o male c. 35 y/o white divorce male d. 42 y/o single mother 84) a 17 y/o male is brought into the clinic by his mother who says that is there are no medical consequences or risk known, she will allow her son to get a possible. How should the NP respond? a. tattoos distort one’s body image resulting in high possible of depression b. tattoos and body piercing are possible sources of hepatitis C infection if there is a common use of contaminated needles. c. the tattoo should be applied to an area that will not be exposed to sun to avoid increase risk of skin cancer d. the only medical consequence of tattoos is the scarring associated with removal. 85) A diagnostic finding of Hodgkin’s lymphoma is the presence of: a. granulocytopenia b. reed Sternberg cells c. lymphoblast d. Howell -lolly bodies 86) A child with type 1 diabetes mellitus brings in a glucose dairy indicating consisted morning hyperglycemia. How you differentiate the Somogy effect from the dawn phenomenon? a. experiment with a smaller insulin dose in the evening b. increase the insulin dose and liberalize the child's diet c. check HbA1C today and again in 3 months d. instruct the parent to monitor the blood glucose at 3 am 87) practitioners working with physically active girls need to be aware of the "female athlete triad" in order to develop an effective pain for prevention, recognition and treatment. the components of the female athlete triad are: a. distorted body image, low self-esteem, and generalized anxiety. b. stress fractures, osteoarthritis and plantar fasciitis c. eating disorders, amenorrhea and osteoporosis d. iron deficiency anemia, steroid abuse and bradycardia. 88) palpable thyroid nodule is benign. How does it feel on palpation? a. smooth b. hard c. non-tender d. fixed 89) A 53 y/o postmenopausal female with a 38 BMI and gastric esophageal reflux disease, takes a daily calcium supplement for protection against osteoporosis. All of the following are appropriate teaching points for this patient, except a. take the calcium supplement with milk to facilitate absorption b. the addition of HRT may further decrease osteoporosis risk c. take an OTC calcium containing antacid to increase calcium intake d. avoid caffeine containing beverages. 90) A 65 y/o immunocompetent man with no underlying medical condition presents in mid-October and request the "flu and pneumonia shots" Records show he received the influenza and PCV13 ten month ago. The NP recommends that he a. receive the PCV13 and influenza vaccine today, and return in Januaryfor the PPS23 b. should return in January to receive both the influenza and PPSV23 c. receive the influenza vaccine at this time and return in January for the PPSV23 d. receive the PPSV23 and the influenza vaccine today and again in January 91) when discussing treatment option with a patient. The NP would be correct to say that surgery can be curative for: a. ulcerative colitis b. irritable bowel syndrome c. crohn's disease d. inflammatory bowel disease 92) A patient has developed blood clot in his lower extremity and is receiving warfarin (Coumadin) therapy. Which outpatient laboratory measurement best measures the therapeutic effect of warfarin? a. International normalized ratio b. activated clotting time c. PT d. PTT 93) A female patient asks, "how do I calculate my ideal body weight?" The NP appropriately answers: a. Starts with 100 pounds, and add 5 pounds for every inch in height over five feet b. add 6 pounds to every inch over 5 feet, then add 100 pounds c. start with 100 pounds, and add 10 pounds for every inch in height over five feet d. multiply your height in inches times 2 94) which term most accurately describes the prostate gland of patient with prostate cancer? a. hard b. rubbery c. boggy d. spongy 95) Ideally, ante-partum care should begin: a. as soon as the pregnancy is identified b. at 6 weeks gestations c. with preconception counselling d. in the first trimester 96) which of the following must bepresent for the diagnosis of bacterial vaginosis? a. presence of clue cells b. vaginal pH <4.0 c. presence of pseudo hyphae on HPF d. negative amine test 97) The patient Self Determination Act of 1991 requires all health care agencies receiving Medicare or Medicaid funds to give patients written information about their rights to make decisions regarding their medical care. A document which declares in advance what type of medical care a person wants ... he provided or withheld should he or she be unable to express his or her wishes is called: a. an advance directive b. a durable power of attorney c. informed consent d. a right to die statement 98) Thalassemia should be included in the differential diagnosis of an infant with microcytic anemia when the infant’s parents are of what ethnicity? a. Italian b. Swedish c. Japanese d. European 99) What is the earliest age that MMR immunization can be administered? a. 2 months b. 4 months c. 6 months d. 1 year 100) A male patient with chronic atrial fibrillation takes a genetic brand of Coumadin (Warfarin). He should report all of these to his health care provider EXCEPT a. Brand name substitution for his genetic warfarin b. On missed dose of warfarin c. Chest pain or weakness d. Blood in his urine 101) which of the following is not an appropriate treatment for chronic bacterial prostatitis (CBP)? a) Doxycycline (Vibramycin) b) Ciprofloxacin (Cipro) c) Trimethoprim/sulfamethoxazole (Bactrim DS) d) Nitrofurantoin (Macrobid) 102) A new patient presents to the NP clinic stating she wants a second opinion. She started propiluracil (PTU, Propyl Thyracil) 75 mg 3 times a day a week ago as therapy for newly diagnosed Grave’s disease. She still feels irritable and jittery. How should the NP response? a) Obtain a serum TSH and serum T4 today b) Increase the PTU dose to 100 mg 3 times a day c) Recommend radioactive therapy d) Inform the patient that improvement requires 2 – 2 weeks. 103) A 15 y/o patient has a complaint of vaginal discharge. She is sexually active with multiple partners. Which of the following symptoms should lead the NP to suspect pelvic inflammatory disease (PID)? a. A report of dyspareunia b. A complaint of low back pain c. A yellow vaginal discharge d. Cervical motion tenderness (CMT) 104) Which of the following is NOT a component of the fetal biophysical profile? a) Gestational age estimate b) Fetal breathing c) Amniotic fluid volume d) Fetal movements 105) Which murmur is associated with radiation to the neck? a. Pulmonic stenosis b. Aortic stenosis c. Hypertrophic obstructive cardiomyopathy d. Mitral valve insufficiency 106) When examining a pregnant patient, where should the fundal height be at 22 weeks? a) Slightly above the symphysis pubis b) At the level of the umbilicus c) Midway between the symphysis pubis and the umbilicus d) Above the umbilicus 107) Education of women with fibrocystic breast disease should include which of the following statement a. Fibrocystic breast disease is often a precursor of breast cancer b. Annual mammography is recommended beginning at age 40 c. Caffeine may trigger breast pain d. Oral contraceptives are not useful in the treatment of this disease 108) An 18 y/o college student lives in the dormitory. He has been treated for scabies infestation with permethrin (Nix). He was asymptomatic for 2 weeks but now complains again of itching and skin burrows. How should the NP proceed? a. Retreat with a different scadicide b. Refer him to a physician for treatment c. Tell him that itching can last 2-4 weeks after infection is clear d. Retreat him with primethrin and have him launder all of his bedding and clothing. 109) An 83 y/o has heart failure (HF) . He takes Prinivil (lisinopril), metoprolol (Lopressor), ASA, and low dose furosemide every morning. After assessing the patient today, the NP determines that he is having a mild exacerbation of HF (heart failure) the LEAST likely cause of this a. Three skipped doses of the Prinivil b. Daily doses of ibuprofen for arthritis in his knees. c. Atrial fibrillation d. Consumption of antacid, calcium carbonate 3X yesterday 110) Antibiotic administration has been demonstrated to be of little benefit in the treatment of which of the following disease process? a) Chronic sinusitis b) Acute bronchitis c) Bacterial pneumonia d) Lobar pneumonia 111) Which of the following is a medication or medication class that does NOT have dizziness or vertigo as potential adverse side effect? a. Aminoglycosides antibiotics b. high dose salicylates c. central acting antihypertensive d. meclizine (Antivert) 112) The NP CORRECTLY teaches an insulin dependent patient the signs and symptoms of early hypoglycemia, which include a. Facial flushing and dilated pupils b. Frequent urination and abdominal pain c. Diplopia and irregular pulse d. Blurred vision, pallor and perspirations 113) The most effective treatment for a non-infective bursitis included a. Systemic antibiotic therapy effective against penicillin-resistant staphylococcus aureus b. Rest, an intra-articular corticosteroid injection, and a concomitant oral NSAID c. A tapering regimen of oral corticosteroid therapy d. Frequent active range of joint motion 114) Tunner’s syndrome present exclusively in a. Male infant b. Female infant c. African American infants d. Asian infants 115) Once a competent patient is identified as a victim of domestic violence a. Recommend join counseling sessions for the pair b. Suggest resources that will help the victim to develop survival skills c. Refer the abuser for individual psychological counseling d. Insist that the victim leave the abusive environment immediately 116) A 60 y/o female patient complains of sudden unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal. The patient had a negative dental examination. CT scan is normal. Erythrocyte sedimentation rate (ESR) is normal. Which of the following is the most likely diagnosis? a. Trigeminal neuralgia b. Temporal arteritis c. Parotiditis d. Bell’s palsy 117) A 45-year-old pre-menopausal female complains of indigestion, flatulence RUQ and epigastric “crampy pain” that radiates to the right scapula. Symptoms are exacerbated by a high fat meal. What is the most likely diagnosis? Chronic cholecystitis 118) Sings and symptoms of anemia, regardless of the specific cause or type, include all of the following EXCEPT: a. Weakness, dizziness , fatigue b. Shakiness and jitteriness. c. Dyspnea on exertion d. Shakiness or …..ness 119) Advance directives are: Documents that guide medical decision making in the event an individual becomes incompetent or unable to convey his wishes. 120) The CAGE, MAST and AUDIT questionnaires to detect problem drinking should be used: a. To detect early problems and hazardous drinking b. As supplements to the standard patient history c. As a diagnostic tool for the early detection of problem drinking d. To determine the level and pattern of alcohol use 121) Which of the following scenarios in a 75 y/o patient would be inappropriately managed in an outpatient setting (i.e. the patient should be referred for a hospital admission? a. Secondary hypertension b. Unstable angina c. Orthostatic hypotension d. Vasovagal syncope 122) An adult female present with a hordeolum. A topical antibiotic is prescribed. Which of the following instructions is NOT appropriate for the nurse practitioner to give the patient? a. Apply warm, moist compresses several times per day b. Do not use soap near the affected eyelid c. Do not wear eye makeup and discard all used eye makeup d. Do not rub your eyes 123) The cornerstone of treatment for stress fracture of the femur or metatarsal stress fracture is Absolute rest from activities which may further stress the bone 124) Group A Beta hemolytic streptococcal (GABHS) pharyngitis is most common in which age group? a. Under 3 years of age b. Preschool children c. 6 to 12 years of age d. Adolescent 125) Which of the following is NOT a component of CAGE questionnaire? a. Have you ever felt the need to cut down on drinking? b. Have you gotten into fights when drinking? c. Have you ever taken a morning eye opener? d. Have you ever felt annoyed by criticism of drinking? 126) A 62 years old female has been diagnosed with osteoporosis. She refuses hormone replacement therapy as well as new medication shown to increase bone density. Important education for this patient should include: a. Information about joint replacement surgery b. The need for annual bone density studies c. The benefits of increasing calcium intake and daily weight bearing exercise d. A list of occupational therapists in the community 127) The NP wants to assess intactness of a patient cerebral function. Which of the following clinical test will provide information relative to cerebral function? a. Kinesthesia b. Sterogenesis c. Romberg d. Graphesthesia 128) The most appropriate medications for elderly patients a. Are highly protein-bound b. May be dose once daily c. Have a narrow therapeutic index d. Have anticholinergic effect 129) A 66 y/o female presents to your clinic. She states that yesterday evening she has chest pain for 20-30 minutes. Which finding most strongly correlates with myocardial infarction? a. ST segment depression of EKG b. Elevated troponin levels c. Elevated CK-MB d. Elevated CK 130) The NP is evaluating a 35 y/o female nurse. She has a history of hospitalization for hepatitis B infection 2 years ago. Her laboratory test demonstrates positive HBsIg. The nurse practitioner would most likely diagnose: a. Chronic hepatitis B infection b. Acute hepatitis B infection c. Recovered hepatitis B infection d. Recent hepatitis B vaccination 131) A 55 y/o male patient complains of blood in his urine for the past 2 weeks. He denies dysuria. Urinalyses is positive for red blood cells and negative for leukocytes and nitrates. The initial evaluation of this patient should include: a. Magnetic resonance imaging (MRI) b. Cystoscopy c. Bladder biopsy d. Renal ultrasonography 132) A good sunscreen lotion or sunblock may contain all of the following components. Which provides the LEAST protection against the sun’s harmful rays? a. Zinc oxide b. Benzophenones c. Para-aminobenzoic acid (PABA) d. Lanolin 133) When examining 5 years old the NP knows that this is an appropriate age to teach the child about: a. Washing his hands before eating b. Not allowing anyone to touch his private parts without permission c. The importance of balanced meals so that he can grow tall and strong d. Getting his preschool immunizations 134) A mother presents with her 12-year-old son who has chills, fever, headache, malaise, and myalgias. On examination the NP finds an erythematous lesion, 7.5 cm diameter, with annular edges and central clearing. The boy first noticed the lesion when he was preparing to go back home from a 2-week summer camp in the mountains. Of the following, which is the most likely diagnosis? a. Pityriasis rosea b. Impetigo c. Lyme disease (erythema migrans) d. Tinea corporis 135) A NP is holding a prenatal nutrition class for a group of patients. Considering knowledge about cultural variations, which of the following women may be at increased risk for inadequate calcium intake? a. A 30-year-old orthodox Jew b. A 35 years-old Caucasian c. A 27 years-old Native American d. A 24 years-old Hispanic 136) Which behavior would NOT be expected of a 2 y/o? a. Kicking a ball b. Running around a corner without falling down c. Riding a tricycle d. Climbing on a chair and standing up to reach and object 137) A 49 years-old Hispanic female has a blood pressure of 145/95 mmHg during a routine annual evaluation. She has no previous history of hypertension. She takes a statin for dyslipidemia. How should the NP proceed with this patient? a. The patient’s blood pressure should be checked in about 2-4 weeks b. The patient should be started on 25 mg HCTZ (hydrochlorothiazide) once daily in the morning c. She should be diagnosed with hypertension today and lifestyle modifications should be initiated d. The statin should be stopped because it may be the cause of elevated blood pressure 138) A 37 y/o female patient with a history of a single episode of depression and frequent complaints of PMS is being treated for hypothyroidism. Today she complains of poor concentration and fatigue. Initially the NP should: a. Provide information about PMS b. Perform a TSH c. Resume her antidepressant medication d. Question her further 139) When a patient presents with symptoms of acute gallbladder disease, what is the appropriate a. Order abdominal x-rays b. Order abdominal ultrasound c. Refer the patient to a surgeon for evaluation d. Prescribe a second-generation cephalosporin 140) The client with iron deficiency anemia should be advised to take the iron supplement a. With milk to avoid stomach upset b. With milk of magnesia at bedtime to avoid constipation c. On an empty stomach between meals d. For 30 days to 6 weeks 141) A 2-week-old infant presents with projectile vomiting, weight loss, dehydration, constipation and history of insatiable appetite. An olive shaped mass is palpable to the right epigastrium. The NP, suspecting pyloric stenosis, refers the infant for an upper GI series. The expected finding is: a. Double bubble pattern, secondary to air in the stomach, and a distended duodenum b. Dilated loops of bowel c. Bowel loops of varying width, with a grainy appearance d. The “sling sign,” indicating a narrow and elongated pyloric canal 142) Which of the following diagnostic assessment must be considered before developing any plan of care for a 27-year-old female presenting to a family practice clinic? a. Pregnancy test b. Family social history c. Hematocrit and hemoglobin d. Blood pressure 143) An 8 y/o is sent home from school with mucopurulent discharge from his eye. He is brought to the NP for treatment. What is the most appropriate intervention? a. Cromolyn sodium (opticrom, Nalcrom) ophthalmic solution for 4 days b. Doxycycline (vibramycin) orally for 10 days. c. Bacitracin/polymyxin (Polisporin) ophthalmic solution for 7 to 10 days. d. No pharmacologic interventions are needed because this will resolve overnight without treatment. 144) The NP would be correct to tell a 27 y/o newly diagnosed hypertensive patient that: a. The older you are, the more difficult is to control blood pressure with medication b. Lifestyle modifications such as losing excess weight, exercising, limiting salt and alcohol intake, and reducing stress will help to maintain a normal blood pressure c. For about 10 to 20 percent of people with primary hypertension, the cause is unknown d. Isolated systolic hypertension is typical of young adults who are drug abusers 147) A 50 years old patient has abnormal vaginal bleeding with heavy periods and intermenstrual watery discharge with a small amount of blood. What is the most likely diagnosis? a. Uterine fibroids b. Normal perimenopause c. Endometrial cancer d. Cervical cancer 148) Which choice below is NOT a symptom of COPD? 149) Therapeutic international normalized ratio (INR) for a patient taking warfarin (Coumadin) for chronic atrial fibrillation is expected to be: 150) A healthy 50-year-old patient presents to the clinic for a routine physical examination. He has no significant personal or family history of clinical heart disease. What should be part of his CV assessment? 151) The NP is initiating levothyroxine (Synthroid) for primary hypothyroidism in a 71-year-old female. The usual starting dose of levothyroxine is 50 (0.05 mg) to 100mcg (0.100mg) per day. What would be the most appropriate initial therapy in this patient? 152) An example of an indirect role of the nurse practitioner is: . 153) In July 1996, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) issued which of the following recommendations for the use of the live attenuated varicella vaccine? 154) A patient presents with a furuncle in his right axilla. The NP should prescribe an oral antibiotic and: 155) Which of the following signs and symptoms is typical of hyperthyroidism? 156) What is the most common chronic condition in the elder population in the U.S? 157) A 7-year-old male presents with a painless limp, antalgic gait, muscle spasm, mildly restricted hip abduction and internal rotation, proximal thigh atrophy, and slightly short stature. The most likely diagnosis is: 158) A 73-year-old presents with a very sore, glossy, smooth, beefy-red tongue. This clinical presentation most likely reflects: . 159) All patients with renal calculi should be taught that the best prevention is: 160) A patient complains of “very puffy feet” since beginning a new medication 3 months ago. There is no underlying physiological cause for this condition. Which medication is most likely causing the problem? 161) The diagnosis of human papilloma virus (HPV) infection in males is usually made by: 162) A patient that has 20/80 vision acuity can see: 163) The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may: 164) A 73-year-old patient has HTN, CHF, and atrial fibrillation. The patient’s adult daughter phones the NP to report that her mother has been nauseated for several days and has vomited for the past 18 hours. She is confused but has no other neurological deficits. The NP should: . 165) A 27-year-old female patient with epilepsy is well controlled with phenytoin (Dilantin). She requests information about contraception. The NP should instruct her that: 166) An 18-year-old female applying for college admission presents to the health clinic because evidence of rubella vaccination is required for admission. She says, “I don’t remember ever getting that shot.” She has negative serologic evidence of rubella antibody. The NP should: 167) A 44-eyar-old patient has a dark multi-colored mole on his back which is about eight millimeters in diameter and has an irregular border. The NP should: 168) The typical description of a tension headache i 169) A 48-year-old female presents with a chief complaint of insomnia. On further investigation, she reports fatigue, nervousness and agitation during the daytime, and feeling hot most of the time. Which of the following would NOT be included in the differential diagnoses? 170) Which of the following medications is useful in the treatment of patients with chronic emphysema? 171) A 4-year-old female complains of leg pain at night which resolves by morning. This has lasted for the past 4 months. The NP should tell the patient’s mother that: 172) A common finding associated with temporal arteritis is: 173) Persons with Thalassemia should avoid: 174) Which of the following is LEAST likely to be the cause of ophthalmia neonatorum? 175) Two siblings, 4-years-old and 8-years-old, present with impetigo. The older sibling has multiple lesions over the arms and legs, and some are confluent. The younger sibling has 3 minor lesions on one leg. The most appropriate intervention is to advise the mother to wash the lesions thoroughly and: 176) Screening for increased intra-ocular pressure or early glaucoma is: 177) Which of the following accurately describes the appropriate use of influenza vaccine? 178) A NP is examining the gluteal folds of a 6-month-old and notices a 7 to 8 cm bluish discoloration in the sacral area. The NP should: 179) What medication would be best to relieve symptomatic wheezing in a patient who has asthma? 180) Strabismus is observed in a 13-month-old child. The most appropriate action for the NP to take is to: 181) Which of the following findings would raise the NP suspicious of bulimia in a 17-year-old female? 182) A new patient presents to the NP clinic stating she wants a second opinion. She started propylthiouracil (PTU) 75mg 3 times a day a week ago as therapy for newly diagnosed Grave’s disease. She still feels irritable and jittery. How should the NP respond? 183) Health Maintenance Organization (HMOs) and Preferred Provider Organizations (PPOs) are: 184) Which of the following is a microcytic hypochromic anemia? 185) Which drug class is associated with elevated serum lipid levels? 186) A 16-year-old presents for a sports physical for football. The NP auscultates a diastolic murmur. It is a grade II/IV. He has no history of a murmur. The patient denies symptoms. What is the most appropriate action for the NP? 187) The NP is performing a routine assessment of a 47-year-old female who wants to lose weight. She has truncal obesity with relatively slender forearms and lower legs. Her BMI is 38. Upon review of her history, physical examination, and laboratory reports, the NP diagnoses “Syndrome X.” This diagnosis is based on the previous findings plus all of the following EXCEPT: 188) Which of the following is NOT a form of diaper dermatitis? 189) Which of the following diseases is NOT acquired trans placentally? . 190) A 2-week-old infant presents with projectile vomiting, weight loss, dehydration, constipation, and history of insatiable appetite. An olive-shape mass is palpable to the right of the epigastrium. The NP, suspecting pyloric stenosis, refers the infant for an upper GI series. The expected finding is: 191) Which of the following is an example of secondary prevention? 192) An 80-year-old Caucasian female has heart failure (FH). Which symptom below is an early indication of failure? 193) A patient presents to the NP with complaints of diarrhea and malaise which started at 2:00 am the morning of the visit. After history and examination, the nurse practitioner advises the patient that the problem should be self-limiting. If the diarrhea does not resolve, when should the NP advise the pt to return? 194) A mother presents with a 3-year-old who has croup. The plan for home care would appropriately include: 195) An early sign of multiple sclerosis (MS) is: 196) The mother of a 6-month-old infant asks about the use of an infant walker. The most appropriate response is to: 197) Which of the following is LEAST likely to be the cause of ophthalmia neonatorum? 198) An 18-year-old female applying for college admission presents to the health clinic because evidence of rubella vaccination is required for admission. She says, “I don’t remember ever getting that shot.” She has negative serologic evidence of rubella antibody. The NP should: 199) A 19-year-old sexually active female is being counseled by the NP about contraception. The NP is accurate when she tells the patient that a diaphragm: 200) A 2-week-old infant is brought to the NP clinic after a difficult delivery. The mother says the infant fusses when handled or picked up. On physical examination, the NP notes decreased movement of the right arm during the Moro reflex, and crepitus on palpation of the right clavicle. The diagnosis is fracture of the clavicle. The recommended management is: 201) A 4-year-old presents to the clinic with circumoral pallor and an intense red eruption on both cheeks which appeared last night. The child has low grade fever but no other symptoms. What is the most likely diagnosis? 202) The most effective intervention (s) to prevent stroke is (are): 203) A 30-years-old female has varicose veins. These are: 204) A 3-year-old has worn a new pair of plastic sandals at the beach. When her mother takes them off, she notices that the straps of the sandals have left red marks and the child complains of itching and burning in the area of redness. What is the most likely diagnosis and how should the nurse practitioner manage the problem? 205) Which of the following is NOT a symptom of irritable bowel syndrome? 206) After a thorough examination, a 2-month-old infant is diagnosed with infantile colic. What should be included in the initial education of the mother about this condition? 207) Of the following signs and symptoms of heart failure (HF), the earliest clinical manifestation is: 208) After a thorough history, physical examination, and laboratory tests, a patient is diagnosed with irritable bowel syndrome. Which of the following initial treatment plans is currently considered most effective? 209) A 2-week old African American male infant has ecchymotic-like marks over his lower back and upper buttocks. The most appropriate intervention is to: 210) An elderly patient is taking an effective dose of doxepin (Sinequan) for treatment of agitated depression with insomnia. Constipation has become a significant problem, even though the patient has been vigilant about maintaining adequate hydration and uses bulk laxatives frequently. Which of the following is the course of action most likely to be successful? 211) Which of the following is NOT true about Carpal Tunnel Syndrome? 212) A 17-year-old female presents with painful vesicular lesions on her vulva. Which of the following would be the most definitive diagnostic test? 213) Which of the following findings are usually associated with atopic dermatitis in infants? 214) Today, a patient is diagnosed with iron deficiency anemia and started on a daily iron supplement. In order to best assess the adequacy of supplementation, the NP would appropriately order a follow-up: 215) Appropriate nutritional guidance for the pregnant patient is: 216) An 8-month-old male presents with hemarthrosis of both knees and hematuria. The parents give no history of trauma but say “he has always bruised easily.” The most likely diagnosis is: 217) At 3 years old female with palpable right upper quadrant abdominal mass, anemia, and fever is been evaluated for wilms tumor. Which of the following diagnostic test would be the most useful a) intravenous polygram b) flat an erect xray of the abdomen c) abdominal ultrasound d) Voiding sistourethrogram . 218) Which class of drugs increases a patient's risk of developing rhabdomyolysis ? a) anti hypertensives b) thiazide diuretics c) the statin d) anticoagulant 219) When, in childhood, do the frontal sinus is usually present? a) 2 to 3 years b) 4 to 6 years c) 10 to 11 years d) Birth 220) Which of the following is an example of Piaget’s concrete logical operation? a) A 4 years old child insist that a bowl of clay has more ones it is shaped into a snake b) a 5 years old child demonstrate their ability to read a paragraph to decode the words c) a 7 years old maintains that a bowl of clay wait the same amount after it has been shaped into a snake d) an 8 years old child must recalculate basic mathematic facts each time he attempts to solve a word problem 221) A 23 years old college student present to the campus health clinic with a generalized rash on the trunk deletions are oriented in a Christmas tree pattern and are mildly pruritic. she describes around ringworm that that appeared about one week ago coma but now how has disappeared. What is this patient's diagnosis and how should be treated? a) Tinea corporis: treat with a topical antifungal cream for 10 to 14 days b) secondary syphilis: treat with penicillin c) viral exanthem: not specific treatment is needed except rest and fluids d) Pityriasis rosea: treat with a topical anti pruritic 222) The nurse practitioner is caring for a 19 years old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate initial treatment for this patient is: a) intramuscular iron dextran b) a daily oral multi vitamin with iron c) oral ferrous sulfate d) increase intake of dietary iron 223) The initial management of an adult with hypertension should include: 224) Which of the following statements about medication in a 45 years old patient with diabetes is correct? 225) A 25 years old female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses an intrauterine for contraception. of the following, which is the most likely underlying condition for disposing her to recurrent candida vaginitis? a) hyperthyroidism b) diabetes mellitus c) trichomoniasis d) pregnancy 226) It is recommended that the therapeutic management of children with juvenile rheumatoid arthritis shoot include a) avoidance of exercise b) immunosuppressing agents c) ophthalmologists examination at least annually d) avoidance of aspirin therapy 227) Stress urinary incontinence is: a) associated with the normal aging process b) may be caused by anti cholinergic or anti depressant medication c) due to the truther muscle instability d) might be aggravated by caffeine or alcohol 228) Which immunization is contraindicated in an immunedeficiency individual? 1. Varicella, 2. IPV, 3. MMR, 4. HBV a) 4 b) 1,3 c) 1, 3, 4 d) all of the above 229) Enlargement of the scrotum and testis with little change in the size of the penis characterizes which Tanner stage sexual development ? a) Tanner 1 b) Tanner 2 c) Tanner 3 d) timer 5 230) the most commonly recommended method for prostate cancer screening in a 55 y/o man is: 231) a 75 y/o patient is well controlled on timolol maleate (timoptic) for chronic open-angle glaucoma. Prescribing propranolol (Inderal) for this patient may precipitate: a) Hyperglycemia b) Elevated intraocular pressure c) Bradycardia d) Hypotension ? 232) A patient presents with periorbital erythema and edema, fever, and nasal discharge. The nurse practitioner should a) start aggressive antibiotic therapy b) start treatment with steroid c) recommend cool compresses and oral antibiotic d) order sinus xray 233) which of the following is appropriate to teach a patient who is using a daily nitrate agent for treatment of chronic angina? . 234) Prescriptive authority for APRN is 235) All of the following are included in the differential diagnosis of hyperthyroidism except: 236) A patient with uncontrolled primary hypertension present with a complain of frequent headaches. Headaches which might be attributed to the patients blood pressure elevation are typically described as: 237) Upon ophthalmoscopic examination of a 70 year old patient, the nurse practitioner observed dark spots against a retina. what diagnosis is this finding most consistent with? 238) The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is: 239) Her mother has been breastfeeding her infant since giving birth 6 weeks ago. Her right breast is engorged, erythematous, hot to touch, and very painful. she says the problem began 48 hours earlier. she has been feeding exclusively with the left breast. the nurse practitioner diagnosis acute mastitis and recommends all of the following except : 240) which medication or medication class used in the treatment of heart failure (HF) is NOT associated with decrease mortality? 241) A 19 y/o pregnant patient, at 20 weeks gestations, complains of pain in the right lower quadrant . she is afebrile and denies nausea vomiting. The most likely diagnosis is: 242) At 23 years old female present with his scaly hypopigmented macular lesion on her trunk, shoulders, an upper arms. The lesion fluorescent under the wood lamb. appropriate treatment for this condition is: 243) A child complains of “hurting a lot” with swallowing and state that his “throat feels full”. his sore throat that started 4 days ago. he is hyperextending his neck. examination reveals asymmetrical swelling of the tonsils. his uvula is deviated to the left .what is the most likely diagnosis ? 244) 15 years old pregnant patient present to her first prenatal visit. on an physical examination, her uterus is approximately 24 weeks growth in size. she doesn't know when her last menstrual period was nor does she know when she might have conceived. Gestational age for this patient can most accurately be assessed by? 245) Which APRN is the exception to the graduate level preparation requirement for certification for advanced practice registered nurses? 246) A 72 years old male present with fluid collected in his scrotum. He states that the size of his scrotum does not fluctuate during the course of a day. He is also likely to describe. 247) All of the following intervention with pediatric patient patients are appropriate EXCEPT: 248) Siri what is the recommendation of the US Department of Health and human resources regarding nicotine replacement therapy ? 249) A patient takes Theophylline twice daily from Bronchospastic disease. today he presents with thick, discolored, tenacious sputum, fever and mild shortness of breath. what drug should he avoid? 250) Beneficiaries 21 years of age and older are allowed a specified number of outpatient visits per year. 251) which group is considered to be high risk for the development of testicular tumors? 252) a 45 y/o diabetic patient has periorbital cellulitis secondary to a sinus infection. What course of action should the nurse practitioner take? 253) An adult female patient is seeking information about her ideal weight. she is 5 feet 7 inches tall. using the height weight formula, what is her ideal body weight? 254) The mother of a 2 years old uncircumcised male patient is concerned that she cannot retract the foreskin over the glans penis. the appropriate response by the nurse practitioner is to? 255) After following, the patient who should be referred for periodic colonoscopy is the patient with: 256) A patient complaints of a stomach pains on and off for the past month in this team win in distinguishing between a gastric and duodenal ulcer, What question is least important to ask? 257) The first step when taking a patient history is the: 258) Characteristics of prescription and OTC drug use in the elder population include all of the following except: 259) A patient has laboratory studies performed which demonstrate increased TSH, decrease free T4 and T3. which symptoms my she complain of? 260) a 16 y/o athlete complains of pain underneath his hell every time he walks. There is a verrucous surface level with the skin of the heel. What pharmacologic intervention (s) should the nurse practitioner prescribe for this patient? 261) A 22 years old patient has a single, non tender, freely movable lump in her right breast. she denies any nipple discharge following diagnosis is this clinical presentation most consistent with: 262) Which of the following patients is least likely to exhibit secondary hypertension? 263) Which of the following medication is indicated for primary prevention are febrile seizures? a) phenobarbital b) Acetaminophen (Tylenol) c) aspirin d) phenytoin (Dilantin) 264) The anatomical site currently believed to be the best location for subcutaneous insulin administration is the: a) buttocks b) thigh c) Abdomen d) arms 265) An 85 years old Caucasian male request screening for prostate cancer. What is the best approach to his request? a) give him objective information about the potential benefits of early detection and treatment b) tell him that screening is only done for men with life expectancy greater than 10 years c) Perform a digital rectal exam (DRE), obtain a prostatic specific antigen (PSA), an order at transrectal ultrasound (TRUS)at this time. d) perform a digital rectal exam (DRE) and PSA at this visit, reserving that TRUS for patients with abdominal DRE or PSA. 266) The nurse practitioner diagnosis eczema on the cheeks of a 2 years old female. the patient's mother explained that she is embarrassed to take the child to public because her face is so red, dry, and crusted. she asked for a strong QWERTY sun cream so that eczema will clear rapidly. The nurse practitioner knows that: a) a high potency cortisone preparation applied to the face will shorten the duration of the eczema flare up. b) a high potency cortisone cream on the face will only be helpful if used in conjunction with hydrating lotion c) a high potency cortisone cream is not recommended for use in children's under 7 years of age d) A high potency cortisone cream might cause atrophy, telangectasia, purpura, or stanae if used on the face. 267) An adult present with tinea corporis. what comment by the patient would be the least likely explanation of how he acquired this disease? a) I trap animals b) my wife has this also c) I have diabetes d) I live in the northern US 268) Which of the following can result from chronic inflammation of a meibomian Gland? a) A chalazion b) uveitis c) keratitis d) a pterygium 269) A 23-year-old female patient of Italian descent has been diagnosed with anemia secondary to glucose-6-phosphate dehydrogenase (G-6PD) deficiency. It is important to teach this patient to avoid: a) beef or pork liver b) fava beans c) phenylalanine d) milk and milk products 270) A 62-year-old with Type 2 diabetes mellitus complains of increased nocturia, fatigue, and weakness. His fasting blood glucose is 110 mg/dL (6.2 mmol/L), he is slightly anemic, and his serum creatinine level is slightly elevated. All other laboratory tests and physical examination are within normal limits. What is the most likely diagnosis? 271) A 12-year-old has a fasting serum cholesterol of 190 mg/dl (4.94 mmol/L). Her mother asks if this value is “ok”. The FNP responds: 272) The correct treatment for ankle sprain during the first 48 hours after injury includes: a) alternating heat and ice, and ankle exercises. b) resistive ankle exercises, ankle support, and pain relief. c) rest, elevation, compression, ice, and pain relief. d) referral to an orthopedist after x-rays to rule out fracture 273) A 52-year-old female has a firm, non-tender, one-centimeter mass in the right lower quadrant of her breast. There are no palpable axillary lymph nodes. A mammogram the month before her examination was negative. The most appropriate NP action today is to: a) reassure the patient that the mass is benign b) refer the patient to a surgeon for evaluation c) schedule an ultrasound of the breast d) plan a repeat mammogram in 6 months to evaluate the presence of a mass, but not adequate in assessing ii is fluid filled or not. 274) A 25-year-old married woman is being taught the natural family planning method (NFP) of contraception by the NP. Which of the following statements by the patient demonstrates her understanding of NFP? 275) A significant barrier to treatment of depression in the elderly population is: 276) Oral and parenteral contraceptive methods: 277) Infants born to women who smoke are at risk for. a) premature delivery b) congenital abnormalities c) low birth weight d) nicotine withdrawal symptoms 278) A patient is diagnosed with Bell’s Palsy. He is placed on high doses steroids. After 4 days of prednisone, the patient states that his eye still not close completely. How should the NP manage problem? a) This patient should be referred to a neurologist b) This is not unusual. He should continue the plan. c) The NP should increase the dosage of prednisone d) The patient should have a CT scan to rule out other etiologies. 279) A 45-year-old patient voices concern about her “hot flashes” and irregular menstrual periods. What diagnostic test would be appropriate for the NP to order for confirmation of menopause or perimenopausal? A) serum follicular stimulating hormone (FSH) b) serum prolactin level c) pelvic ultrasound d) serum gonadotropin releasing hormone (GnRH) 280) A 50-year-old patient with diabetes complains of pain bilaterally in her lower legs while walking. The pain disappears at rest. What else would you expect to identify on her lower extremities? a) A finding of lower extremity edema, erythema, hair growth b) Peripheral artery insufficiency c) Acanthosis nigricans d) Deep vein thrombosis (DVT) 281) A middle aged patient has a history of smoking, chronic cough, and sputum production. He reports chronic dyspnea. A diagnosis of COPD should be confirmed with: a) spirometry b) chest X-ray c) ABG’s d) alpha-1 antitrypsin deficiency 282) A widowed 85-years-old was recently moved from her home of 65 years to a bedroom in her daughter’s home. According to reports by family members, she is now “cantankerous,” “gets mixed up” easily, and cries for no apparent reason. Factors in the client history that are consistent with delirium may include all of the following EXCEPT: a) Insidious onset and chronic progressive course b) a new anticholinergic medication c) dehydration and/ or malnutrition d) recent changes in surroundings and routines 283) Standards of practice are: 284) Which of the following is NOT a risk for a transient ischemic attack (TIA)? a) Age b) Hypertension c) Common migraine headache d) Smoking 285) According to the American Diabetes Association, what is the lowest fasting plasma glucose level which warrants a diagnosis of diabetes Mellitus if confirmed on a subsequent day? a)121 mg/dL (6.7 mmol/L) b)126 mg/dL (7 mmol/L) c)130 mg/dL (7.2 mmol/L) d)140 mg/dL (7.8 mmol/L) 286) Which of the following patients is most likely to have a diagnosis of Type 2 diabetes mellitus? a) An underweight 9-year-old with frequent staphylococcal infections, glucosuria, and ketonuria b) A 49-year-old male with impotence and HbA1C 10.0% c) A 35-year-old obese female with frequent vaginal yeast infections and 120 fasting serum glucose d) A 55-year-old female with HTN, hyperlipidemia, and 130/dL 2 hour/75 g glucose tolerance test 287) Which of the following are the classic features of ulcerative colitis? a) Right lower quadrant pain, frequently accompanied by a palpable mass, fever, and leukocytosis b) Massive painful hematemesis, occasionally accompanied by melena c) Rapidly progressive dysphagia to solid foods, anorexia, and weight loss out of proportion to the dysphagia d) Remissions and exacerbations of bloody diarrhea, tenesmus, fecal incontinence, abdominal pain, and weight loss 288) A 37-year-old female is found to have a negative rubella titer. How long after immunization should she avoid pregnancy? a) 28 days b) 60 days c) 90 days d) 120 days 289) Successful management of a patient with attention deficit hyperactivity disorder (ADHD) is best achieved with: a) Stimulant medication along with behavioral and family interventions b) Methylphenidate (Ritalin) in conjunction with an antihistamine c) treatment by a pediatric psychiatrist d) firm discipline and removal of offending foods from the diet 290) Which of the following signs and symptoms are typical of hypothyroidism? a) Constipation b) Heat intolerance c) Weight loss d) Nervousness 291) A first-time mother asks the NP how much her baby will grow in the first 3 months of life. The NP explains that the normal baby will grow. a) ½ to 1 ounce per day b) 1 to 2 ounces per week c) one inch per week d) more than 6 inches 292) The requirement that a NP practice under the direct supervision of a physician is: a) Not a requirement in any state b) Dependent on state regulations c) Illegal, according to standards of nursing care d) A standard national requirement 293) The NP correctly diagnoses iron deficiency anemia in a male patient whose lab report reveals: a) hemoglobin (Hgb) 15.0 g/dL (150g/L) b) a decreased total iron-binding capacity (TIBC) c)mean corpuscular volume (MCV) < 80 fL d) increased mean corpuscular hemoglobin concentration (MCHC) 294) All of the following are medical emergencies which may be attributed to acute cocaine intoxication EXCEPT: . 295) A male patient presents 24 hours after having been bitten on the arm during a fight with his spouse. His wound is swollen, red. Has a discolored exudate and a 5-centimeter tissue scar. Which action by the NP is LEAST appropriate at this time? 296) Adolescents are at increased risk for contracting the human immunodeficiency virus (HIV) due to: 297) A 50-year-old female complains of urinary incontinence. Which patient response supports a diagnosis of stress incontinence? 298) A 14-year-old female cheerleader reports gradual and progressive dull anterior knee pain, exacerbated by kneeling. She also complaints of a “sore lump on my knee.” The NP notes swelling and point tenderness at the tibial tuberosity. X-ray is negative. What is the most likely diagnosis? 299) The NP correctly diagnoses a 2nd degree burn injury which is described as: 300) The first sign of puberty in girls is: a) enlargement of the ovaries, uterus, and clitoris b) development of breast buds c) the occurrence of menarche d) acne resulting from stimulation of the sebaceous glands 301) A patient presents with distorted areas and blind spots in the visual field. The painless condition was first noticed on awakening this morning. The NP would most appropriately include all of the following plan of care EXCEPT: a) refer the patient to an ophthalmologist if the condition has not resolved in 24 hours b) schedule the patient for a fluorescein angiogram and retinal exam as soon as possible c) examine the retinal filed for edema, infarcts, exudates, and retinal detachment d) screen the patient for diabetes mellitus 302) The most accurate measure of diabetes control is: a) micro and macro vascular complications b) insulin sensitivity c) early morning glucose levels d) HbA(1C) 303) A 70-year-old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpate abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition? a) Diverticulosis b) Diverticula c) Diverticulitis d) Diverticulum 304) At what age does vision normally become approximately 20/20? a) 6 weeks b) 4 months c) 3 to 4 years d) 6 years 305) Salmeterol (Serevent) in combination with an inhaled steroid is prescribed for a patient with moderate persistent asthma. What is the most important teaching point about salmeterol? a) It is not effective during an acute asthma attack b) It may take 2-3 weeks to begin working c) This drug works within 10 minutes d) This drug may be used by patients 6 years and older 306) At what age is screening most helpful in detecting scoliosis? a) 4 to 6 years b) 8 to 10 years c) 12 to 14 years d) 18 to 20 years 307) A first time mother asks the NP when she should start feeding her baby cereal. The NP replies: 308) Which symptoms is NOT typical in a female during the peri-menopausal period? 309) An 85-year-old is diagnosed with shingles. The patient states that she became “miserable”. What is the pharmacologic interventions should the NP offer this patient? 310) The mechanism by which nurses are held accountable for practice, based on the quality of nursing care in a given situation with established standards of practice, is: 311) A patient taking levothyroxine is being over-replaced. What condition is he at risk for: 312) What prophylaxis medication is recommended for the patient under 35-years-of-age with…. 313) The infant 1 to 6 months-of-age with a diagnosis of developmental hip dysplasia is correctly treated with: 314) A 25-year-old hypertensive patient has a BMI of 16. His BP is 165/110. There is an audible bruit in his left upper abdomen quadrant. He probably has: narrowing of the artery which may cause secondary HTN as a result. 315) A female patient believes that she was exposed to HIV through sexual intercourse several months ago. She asks for “the test for AIDS”. Which statement is NOT correct? 316) The most appropriate first-line drug treatment for African American patients diagnosed with HTN is: 317) The NP knows that the frail elderly is at high risk for malnutrition. Indicators of malnutrition in this population include all of the following EXCEPT: 318) Which drugs below would be expected to produce the least amount of hypokalemia? 319) A 25-years-old overweight patient presents with a complaint of dull achiness in his groin and history of palpable lump that “comes and goes”. On physical examination, the NP does not detect a scrotal mass. The scrotum does not transluminate. Considering these finding what is the most likely diagnosis? 320) Acute idiopathic thrombocytopenia purpura (ITP) is most commonly seen in childhood following: 321) Which of the following drug classes may potentiate hyperkalemia in a patient taking a potassium-sparing diuretic or potassium supplement? 322) The major health risk(s) associated with oral contraceptive therapy is (are): : 323) A 35-year-old women with prior history of extreme nervousness has been treated with diazepam (Valium) for 4 weeks. She shows improvement. Today her pulse is 112 bpm and BP is 130/92 mmHg. She is 5’4”and weight 105 pounds. What is the diagnosis? 324) Of the following characteristics, which are most closely associated with risk for becoming an abusive parent? 325) A 55-year-old male patient presents with dysuria, urgency, perineal pain, and temperature of 101 degrees. What is most likely diagnosis? 326) Licensure is: 327) A patient with no significant medical history has varicose veins. She complains of “aching legs.” The intervention that will provide greatest relief for 328) an 8-year-old presents to the health clinic with history of acute onset severe sore throat and respiratory rale. The child’s history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis? 329) A mother who has diabetes mellitus wants to breast-feed her infant. The NP should: 330) The treatment of choice for recurrent herpes simplex II infection is: 331) A NP is examining a 2-month-old infant. What question is most important to ask: 332) Which of the following liver enzyme values indicative of alcohol-related hepatitis? a) ALT:AST ratio >2.0 333) Which of the following is TRUE concerning sensitivity and specificity? 334) Which antibiotic is demonstrated to be the most effective treatment for community acquired pneumonia (CAP) in young adults with co-morbid conditions? 335) Infants with celiac disease (gluten enteropathy) are at risk for multiple complications. The most urgent complication of this disease is: 336) Prescriptive authority for APRN is: [Show More]

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