1. 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:
A. bile acid sequestrant
B. a statin drug
C. a cholesterol absorption inhibitor
D. low-dose aspirin
Answer: B. a statin drug
Rationale: Very high LDL (≥190) requires statin therapy regardless of other factors to reduce
cardiovascular risk.
2. The most commonly prescribed medication for mild systemic lupus erythematosus (SLE) is:
A. azathioprine (AZA)
B. belimumab (Benlysta)
C. ibuprofen (Advil)
D. cyclophosphamide (Cytoxan)
Answer: C. ibuprofen (Advil)
Rationale: NSAIDs are first-line for mild SLE symptoms such as joint pain and inflammation.
,3. The most common sign of cervical cancer is:
A. postcoital bleeding
B. strong odor from vaginal discharge
C. itching in the vaginal area
D. molluscum contagiosum
Answer: A. postcoital bleeding
Rationale: Postcoital bleeding is a classic early symptom of cervical cancer.
4. 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:
A. discontinue amitriptyline and begin ibuprofen (Motrin)
B. refer to physical therapy
C. start methocarbamol (Robaxin)
D. discontinue amitriptyline and begin gabapentin (Neurontin)
Answer: D. discontinue amitriptyline and begin gabapentin (Neurontin)
Rationale: Anticholinergic side effects require stopping amitriptyline; gabapentin is a safer
alternative.
5. A 17-year-old male with rheumatoid arthritis is being treated with an NSAID and omeprazole
(Prilosec). The patient complains of headache, abdominal pain, and gas. These symptoms are
most likely:
,A. associated with the omeprazole
B. related to the underlying condition
C. the result of the NSAID
D. caused by viral gastroenteritis
Answer: A. associated with the omeprazole
Rationale: Omeprazole commonly causes headache and gastrointestinal discomfort.
6. The medication of choice for the initial treatment of juvenile rheumatoid arthritis is:
A. acetaminophen
B. prednisone
C. aspirin
D. ibuprofen
Answer: D. ibuprofen
Rationale: NSAIDs like ibuprofen are first-line therapy for juvenile rheumatoid arthritis.
7. A 12-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents
for a follow-up examination after a recent hospitalization. It is most important to continue
monitoring growth, development, and:
A. white blood cell levels
B. fecal occult blood test
C. hemoglobin levels
D. urine dipsticks
Answer: C. hemoglobin levels
Rationale: Hemoglobin levels reflect anemia severity and recovery after crisis.
, 8. 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?
A. report the case to the proper authorities
B. tell the neighbor to check on the woman daily and report back
C. document the data and report the information to risk management
D. call the patient's family and inquire about the concerns
Answer: A. report the case to the proper authorities
Rationale: Suspected elder abuse must be reported immediately as a legal obligation.
9. In most cases, the first manifestation of Alzheimer's disease is:
A. impaired judgment
B. decrease in short-term memory
C. disorientation in time and place
D. decrease in long-term memory
Answer: B. decrease in short-term memory
Rationale: Early Alzheimer’s disease primarily affects recent (short-term) memory.
10. The optimal treatment for latent tuberculosis is:
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:
A. bile acid sequestrant
B. a statin drug
C. a cholesterol absorption inhibitor
D. low-dose aspirin
Answer: B. a statin drug
Rationale: Very high LDL (≥190) requires statin therapy regardless of other factors to reduce
cardiovascular risk.
2. The most commonly prescribed medication for mild systemic lupus erythematosus (SLE) is:
A. azathioprine (AZA)
B. belimumab (Benlysta)
C. ibuprofen (Advil)
D. cyclophosphamide (Cytoxan)
Answer: C. ibuprofen (Advil)
Rationale: NSAIDs are first-line for mild SLE symptoms such as joint pain and inflammation.
,3. The most common sign of cervical cancer is:
A. postcoital bleeding
B. strong odor from vaginal discharge
C. itching in the vaginal area
D. molluscum contagiosum
Answer: A. postcoital bleeding
Rationale: Postcoital bleeding is a classic early symptom of cervical cancer.
4. 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:
A. discontinue amitriptyline and begin ibuprofen (Motrin)
B. refer to physical therapy
C. start methocarbamol (Robaxin)
D. discontinue amitriptyline and begin gabapentin (Neurontin)
Answer: D. discontinue amitriptyline and begin gabapentin (Neurontin)
Rationale: Anticholinergic side effects require stopping amitriptyline; gabapentin is a safer
alternative.
5. A 17-year-old male with rheumatoid arthritis is being treated with an NSAID and omeprazole
(Prilosec). The patient complains of headache, abdominal pain, and gas. These symptoms are
most likely:
,A. associated with the omeprazole
B. related to the underlying condition
C. the result of the NSAID
D. caused by viral gastroenteritis
Answer: A. associated with the omeprazole
Rationale: Omeprazole commonly causes headache and gastrointestinal discomfort.
6. The medication of choice for the initial treatment of juvenile rheumatoid arthritis is:
A. acetaminophen
B. prednisone
C. aspirin
D. ibuprofen
Answer: D. ibuprofen
Rationale: NSAIDs like ibuprofen are first-line therapy for juvenile rheumatoid arthritis.
7. A 12-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents
for a follow-up examination after a recent hospitalization. It is most important to continue
monitoring growth, development, and:
A. white blood cell levels
B. fecal occult blood test
C. hemoglobin levels
D. urine dipsticks
Answer: C. hemoglobin levels
Rationale: Hemoglobin levels reflect anemia severity and recovery after crisis.
, 8. 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?
A. report the case to the proper authorities
B. tell the neighbor to check on the woman daily and report back
C. document the data and report the information to risk management
D. call the patient's family and inquire about the concerns
Answer: A. report the case to the proper authorities
Rationale: Suspected elder abuse must be reported immediately as a legal obligation.
9. In most cases, the first manifestation of Alzheimer's disease is:
A. impaired judgment
B. decrease in short-term memory
C. disorientation in time and place
D. decrease in long-term memory
Answer: B. decrease in short-term memory
Rationale: Early Alzheimer’s disease primarily affects recent (short-term) memory.
10. The optimal treatment for latent tuberculosis is:
