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A 65-year-old woman presents for a follow-up examination after a new patient visit. She has not seen a healthcare provider for several years. She is a smoker and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the nurse practitioner should start the patient on: 1.bile acid sequestrant.
- a statin drug.
- a cholesterol absorption inhibitor.
- low-dose aspirin. - CORRECT ANSWER ✔✔A statin drug The most commonly prescribed medication for mild systemic lupus erythematosus (SLE) is:
- azathioprine (AZA).
- belimumab (Benlysta).
- ibuprofen (Advil).
- cyclophosphamide (Cytoxan). - CORRECT ANSWER ✔✔ibuprofen (advil)
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The most common sign of cervical cancer is:
- postcoital bleeding.
- strong odor from vaginal discharge.
- itching in the vaginal area.
- molluscum contagiosum. - CORRECT ANSWER ✔✔postcoital bleeding The nurse practitioner prescribes amitriptyline (Elavil) for a patient with neuropathic pain secondary to diabetes mellitus. On follow-up, the patient complains of urine retention and dry mouth. The practitioner would:
- discontinue amitriptyline and begin ibuprofen (Motrin).
- refer to physical therapy.
- start methocarbamol (Robaxin).
- discontinue amitriptyline and begin gabapentin (Neurontin). - CORRECT ANSWER ✔✔discontinue amitriptyline and begin gabapentin (neurontin)
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hospitalization. It is most important to continue monitoring growth, development, and:
- white blood cell levels.
- fecal occult blood test.
- hemoglobin levels.
- urine dipsticks. - CORRECT ANSWER ✔✔hemoglobin levels A 90-year-old female is brought to the clinic by her neighbor. She states that everything is fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk. The neighbor is concerned that the patient often has no money to buy food, despite income from social security and a coal miner's pension. The nurse practitioner suspects abuse. Which of the following is the nurse practitioner obligated to do next?
- Report the case to the proper authorities.
- Tell the neighbor to check on the woman daily and report back.
- Document the data and report the information to risk management.
- Call the patient's family and inquire about the concerns. - CORRECT ANSWER ✔✔report the case to proper authorities In most cases, the first manifestation of Alzheimer's disease is:
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- impaired judgment.
- decrease in short-term memory.
- disorientation in time and place.
- decrease in long-term memory. - CORRECT ANSWER ✔✔decrease in short-term memory The optimal treatment for latent tuberculosis is:
- rifampin (Rifadin) for 5 months.
- isoniazid (Nydrazid) for 9 months.
- pyrazinamide for 6 months.
- ethambutol for 6 months. - CORRECT ANSWER ✔✔osioniazid (nydrazid) for 9 months Unilateral spontaneous serous or serosanguineous discharge from a single duct of a breast is most often caused by:
- intraductal papilloma.
- mucinous breast lesions.
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- if premature rupture of membranes occurs.
- if maternal viral loads are greater than 10,000. - CORRECT ANSWER ✔✔after 14 weeks gestation T-wave inversion with a normal ST segment on a 12-lead EKG may represent:
- acute coronary ischemia.
- right ventricular hypertrophy.
- atrial hypertrophy.
- hyperkalemia. - CORRECT ANSWER ✔✔acute coronary ischemia The 16-year-old mother of a 2-month-old presents the infant, reporting that the child is very irritable and does not feed well. During physical examination, the child's head drops back and the child exhibits sudden flexing of the extremities. As the flexing stops, the child cries uncontrollably. Funduscopic examination reveals retinal hemorrhages. Which of the following diagnostic tests should be ordered?
- Skull X-rays
- MRI
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- CT scan
- Pet scan - CORRECT ANSWER ✔✔CT scan The most important diagnostic factor in evaluating angina pectoris is the patient's:
- King of Heart's monitor.
- physical examination.
- history.
- echocardiogram. - CORRECT ANSWER ✔✔history There are three reasons for latex allergies. Which of the following does NOT cause the problem?
- Immediate hypersensitivity
- Irritant contact of dermatitis
- Cytotoxic hypersensitivity
- Immune complex reaction - CORRECT ANSWER ✔✔cytotoxic hypersensitivity
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A 3-year-old presents with a 2-day history of acute diarrhea with a total of 8 watery stools without blood or mucus, and 2 episodes of vomiting in the past 48 hours. Assessment reveals no current antibiotic therapy, dehydration <5%, soft abdomen with hyperactive bowel sounds, no masses or organomegaly; other physical findings are normal. Which of the following is the most appropriate management plan?
- Stool culture; Immodium AD liquid.
- No laboratory workup; instruct parents on signs and symptoms of dehydration; diet of clear liquids, advancing to bananas, rice cereal, Jell- O, and soup.
- Start diet of clear liquids, advancing to bananas, rice cereal, Jell-O, and soup over next 72 hours; Imodium AD liquid, 1 mg/sml
- Stool for ova and parasites; advise parents of likely sources of Giardia; prescribe furazolidone (Furoxone) - CORRECT ANSWER ✔✔No laboratory workup; instruct parents on signs and symptoms of dehydration; diet of clear liquids, advancing to bananas, rice cereal, Jell- O, and soup. A mother presents her 12-month-old child with concern because the child does not yet say "mama" or "dada." The mother reports that in the first months of life, the child loved listening to music and being talked to. The past medical history is negative for ear infections. The nurse practitioner should:
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- evaluate for hearing loss.
- refer to speech therapy.
- re-evaluate in 3 months.
- check for cerumen impaction. - CORRECT ANSWER ✔✔evaluate for hearing loss The most common side effect of the oral ribavirin used in the treatment of hepatitis C is:
- hemolytic anemia.
- weight loss.
- depression.
- hypothyroidism. - CORRECT ANSWER ✔✔hemolytic anemia An 86-year-old patient presents with pinguecula, a yellow triangular degenerative tissue thickening of the bulbar conjunctiva. This condition is:
- cured by eye drops.
- a genetic process.
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- Increased sphincter tone
- Increased peristalsis
- Decreased secretions - CORRECT ANSWER ✔✔increased peristalsis Type 2 diabetes mellitus is characterized by which of the following?
- Decreased production of exogenous glucagon-like peptide
- Autoimmune beta-cell destruction
- Relative deficiency of dipeptidyl peptidase-
- Decreased reabsorption of sodium-glucose transporters - CORRECT ANSWER ✔✔decreased reabsorption of sodium-glucose transporters In pulmonary function testing, forced vital capacity represents the:
- maximum volume of air that can be forcefully exhaled after maximum inspiration.
- total volume of air that is exhaled after normal inspiration.
- total volume of air that the lungs can hold, minus the expiratory reserve volume.
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- volume of air that can be forcefully exhaled in 1 second. - CORRECT ANSWER ✔✔maximum volume of air that can be forcefully exhaled after maximum inspiration An adult male presents as first patient of the day after awaking about 5:00 AM with indigestion and chest pressure. On checking his pulse, he found no change from previous measurements. He states that, while waiting for the nurse practitioner to arrive, he began to feel a little clammy. A 12-lead EKG records the following patterns. On the basis of these EKG readings, the diagnosis is:
- anterior-septal acute myocardial infarction.
- lateral acute myocardial infarction.
- inferior acute myocardial infarction.
- anterior acute myocardial infarction. - CORRECT ANSWER ✔✔inferior acute myocardial infarction During the past 24 hours, a 62-year-old has experienced abdominal pain that radiates to the back. The patient also reports several episodes of nausea and vomiting, a low-grade temperature, and a history of excessive drinking. Physical examination reveals a distended abdomen. Laboratory serum values indicate elevated alkaline phosphatase, amylase, and serum lipase. The most likely diagnosis is:
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restaurant. For which contact(s) would chemoprophylaxis with rifampin be recommended?
- Preschool contacts in the past 7 days
- A friend of the patient's sister who visited after school yesterday
- The checkout employee at the grocery store yesterday
- Diners at the restaurant during lunch the day the patient ate there - CORRECT ANSWER ✔✔preschool contacts in past 7 days Congenital dysplasia of the hip:
- more commonly affects both hips.
- occurs more commonly in females.
- is correctable at any age.
- typically self-corrects by 12 weeks of age. - CORRECT ANSWER ✔✔more commonly affects both hips Anticholinergic agents such as ipratropium (Atrovent) and tiotropium (Spiriva) are used in COPD primarily to:
- induce bronchodilation.
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- decrease airway inflammation.
- expand the lung fields.
- treat hypoxemia. - CORRECT ANSWER ✔✔induce bronchodilation The clinical presentation of placenta previa that develops during the third trimester includes:
- intermittent dark-red spotting.
- occult bleeding with abdominal or back pain.
- sudden onset of painless and profuse bleeding.
- painless occult bleeding that becomes visible upon onset of labor. - CORRECT ANSWER ✔✔sudden onset of painless and profuse bleeding A 27-year-old male patient, who works as a janitor, presents with a 6- month history of an intermittent rash on his hands. History reveals itching and occasional burning. Examination reveals irregularly- distributed scaly maculopapular erythematous patches extending from the dorsum of the hand several inches up the forearms, and dry palms with no nail involvement. The most likely diagnosis is:
- contact dermatitis.
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A patient reports to your office, having been struck on the right cheek with a baseball bat. On examination, you notice tenderness and swelling over the cheek. The patient is unable to gaze laterally with his left eye, and he complains of double vision when he attempts to do so. This is most likely associated with:
- retinal hemorrhage.
- orbital rim fracture.
- subarachnoid hemorrhage.
- periorbital cellulitis. - CORRECT ANSWER ✔✔orbital rim fractures A 7-year-old child presents with group A streptococcal infection confirmed by throat culture. Past history includes treatment for positive streptococcal infection with erythromycin (EryPed oral suspension) 3 weeks ago. What is the most appropriate next intervention?
- Treat with amoxicillin for 10 days.
- Obtain culture for all household members.
- Treat with azithromycin (Zithromax) for 10 days.
- Intramuscular Penicillin. - CORRECT ANSWER ✔✔treat with amoxicillin for 10 days
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A 16-year-old female adolescent is brought to the nurse practitioner's office by her mother, who is concerned about her daughter's recent weight loss. History reveals that the daughter was consistently in the 50th percentile for weight, but is now in the 10th percentile. The mother states that she is concerned that her daughter is purging herself after meals since she often goes to the restroom after eating and remains there for a long period of time. The daughter denies any self- induced vomiting, starvation or excessive activity. She does state that she jogs five miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment?
- Electrolytes, fasting blood sugar
- Creatine phosphokinase, follicle-stimulating hormone (FSH)
- Electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis
- Electrolyt - CORRECT ANSWER ✔✔electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis An adult female who is homeless presents for an initial obstetric visit at 34 weeks of pregnancy. She is diagnosed with Chlamydia trachomatis infection. What complication will her newborn be most at risk?
- Conjunctivitis
