1. Question
A 65 year old female patient presents today to the clinic with worsening back pain over
the last week. She appears to be sweating and states that she is profusely dizzy. Which
of the following findings on her urinalysis would indicate the most immediate need for
referral to the emergency department ?
o Red blood cell (RBC) casts, as they are indicative of possible cytomegalovirus
o White blood cell (WBC) casts, as they are indicative of pyelonephritis
o Hyaline casts, as they are indicative of dehydration after exercise o Glucose, as it
confirms a new diagnosis of Diabetes
Correct
With the patient’s presenting symptoms, it appears that the likely diagnosis is
pyelonephritis. WBC casts in conjunction with the presenting symptoms would warrant
an immediate referral as it can be life threatening. Dehydration does not always warrant
an immediate referral, and glucose in the urine does not confirm a diagnosis of Diabetes.
RBC casts are not indicative of possible Cytomegalovirus (CMV).
2. 2. Question
A middle aged patient recently started taking Benadryl
(diphenhydramine) for issues with allergic rhinitis symptoms. Which of the following
signs or symptoms would be least likely for the patient to report after regularly taking
this medication?
o Blurred vision o Dry mouth o Diarrhea
o Urinary hesitancy
Correct
Benadryl (Diphenhydramine) is a second line treatment for allergic rhinitis. This drug
belongs to the antihistamine drug class which is notorious for anticholinergic side
effects. The typical anticholinergic side effects that can occur are constipation, vision
complaints, dry mouth, and urinary hesitancy.
3. 3. Question
A patient presented with suspected gallstones, and the ultrasound results indicate there
are no gallstones present. However, the patient continues to have symptoms of acute
cholecystitis. Which of the following would be the most appropriate next action for this
patient?
o Refer the patient for an MRI o Repeat the ultrasound as it can take weeks for
gallstones to appear
o Refer the patient for a HIDA scan
,o Refer to general surgery to have the gallbladder removed
, Correct
An ultrasound is the first line diagnostic test for cholecystitis. If the ultrasound is negative
for gallstones, the next appropriate step would be to refer the patient for a HIDA scan, which
is more sensitive. The patient does not necessarily need surgery right away, and an MRI is not
as sensitive as a HIDA scan is for cholecystitis. An ultrasound is used prior to a HIDA scan to
rule out gallstones due to safety concerns. 4. 4. Question
A 56-year-old male patient comes into the clinic after falling on ice. He states he was
carrying groceries in one arm and used the other to break his fall. He is now having pain
and tenderness in the hand which he fell on. Where would the nurse practitioner
palpate to examine this patient for a scaphoid fracture?
o The humeral tuberosity o The radial head
o The boxer’s anatomical position o The
anatomic snuffbox
Correct
The anatomical snuffbox is a triangle-shaped depression on the lateral aspect of the
back of the hand. It is best seen and palpated when the thumb is
extended. Tenderness in this area is indicative of a scaphoid fracture, also known as a
navicular fracture.
5. 5. Question
A patient is having excruciating pain in the side of their face and is placed on
carbamazepine (Tegretol) for this condition. The nurse practitioner understands which
cranial nerve is affected?
o CN IV o
CN VII o
CN VI o CN
V
Correct
Trigeminal neuralgia presents as severe, excruciating pain due to the trigeminal nerve
(CN V)
6. 6. Question
A middle aged patient presents to the clinic requesting hormone replacement therapy
for her menopausal symptoms. Which of the following in the patient’s history is not a
contraindication to starting hormone replacement therapy?
o 2 pack per day smoker o Deep vein thrombosis o New vaginal
spotting that began two weeks ago o Endometriosis
, Incorrect
The NAmerican NAcademy Nof NFamily NPhysicians Nnotes Nthat Nundiagnosed Nvaginal Nbleeding
Nis Nan Nabsolute Ncontraindication Nto Nhormone Nreplacement Ntherapy N(HRT). NEndometriosis
Nand Nprevious Nhistory Nof Nthromboembolism Nare Nrelative Ncontraindications. NAt Nthis
Ntime, Nsmoking Nis Nill Nadvised Nwhile Ntaking NHRT Nbut Nis Nnot Nconsidered Na
Ncontraindication.
7. 7. NQuestion
A N68-year-old Nmale Npresents Nwith Ncomplaints Nof Nswelling Nand Nredness Nin Nhis Nright Nlower
leg. NHe Nexplains Nthat Nhe Nhas Nalways Nhad Nveins Nthat N“stuck Nout” Nbut Nnow Nhis Nskin Nitches
Nand Nlooks N“leathery”. NDuring Nthe Nexam, Nthe Nnurse Npractitioner Nnotes Na Nreddish-
brown Ndiscoloration Nof Nthe Nlegs Nwith Nmild Nedema Npresent. NThere Nare Nalso Nseveral
Nvaricose Nveins Non Nthe Nright Nlower Nleg, Nsparing Nthe Nfoot. NWhat Nis Nthe Nmost Nlikely
Ndiagnosis?
o Deep NVein NThrombosis N(DVT) No NCellulitis
o Lymphedema
o Chronic NVenous NInsufficiency N(CVI) NCorrect
Chronic Nvenous Ninsufficiency N(CVI) Nis Ncharacterized Nby Nlower Nextremity Nedema,
Nvaricose Nveins, Npruritus Nof Nthe Nskin, Ndiscoloration Nof Nthe Nskin, Nand Npossible Nulcerations
Nor Nabrasions Nto Nthe Nskin. NIt Nis Ndue Nto Ninadequate Nvenous Ncirculation Ncaused Nby Na
Npartial Nvein Nblockage Nor Nleakage Nof Na Nvenous Nvalve Nthat Nincreases Npressure. NAlthough
NDVTs Ncan Nbe Ncaused Nby NCVI N– Nit Nis Nimportant Nto Nremember Nthat Nthis Ncan Nhappen
Nfrom Nother Nthings Nas Nwell Nsuch Nas Nsitting Nor Nstanding Ntoo Nlong, Nsmoking, Nobesity, Nor
Ntrauma Nto Nthe Nleg.
8. 8. NQuestion
An N82 Nyear Nold Npatient Npresents Nto Nthe Noffice Ntoday Nwith Ncomplaints Nof Nsevere Npain,
Nredness, Nwarmth, Nand Nswelling Nof Nthe Ndistal Ninterphalangeal Njoint Non Nher Nright Nhand.
NWhich Nof Nthe Nfollowing Ndiagnoses Nmay Nbe Nresponsible Nfor Nher Nacute Nsymptoms? NSelect
Nall Nthat Napply Nby Nchoosing Ntwo Nof Nthe Nfollowing Nanswer Nchoices.
o Carpal Ntunnel Nsyndrome No
Rheumatoid Narthritis No NGout
o Cellulitis No
Ganglion Ncyst
Incorrect
Based Non Nthe Npain, Nredness, Nwarmth, Nand Nswelling Nthis Npatient Nis Nexperiencing Nin Nher
Nfinger, Nboth Ngout Nand Ncellulitis Nshould Nbe Nconsidered. NGout, Nalthough Nmore Ncommon
Nin Nthe Ngreat Ntoes Nand Nknees, Ncan Noccur Nin Nthe Nfingers. NHerberden’s Nnodes Nare
Ntraditionally Nassociated Nwith Nosteoarthritis Nrather Nthan Nrheumatoid Narthritis. NFinally,
Na Nganglion Ncyst Nmay Npresent Nwith Npain Nand Nswelling, Nbut Nwill Nlikely Nnot Npresent Nwith
Nredness Nand Nwarmth.
9. 9. NQuestion
A N63 Nyear Nold Npatient Ndiagnosed Nwith NCOPD Nhas Na NCAT N(COPD NAssessment NTest) Nscore
Nof N6 Nand Nhas Nnot Nhad Nany Nsevere Nexacerbations Nin Nthe Nlast Nyear, Nplacing Nthem Nin
Ntreatment NGroup NA. NWhich Nmedications Nmight Nthis Npatient Nbe Non? NSelect Nall Nthat
Napply Nby Nchoosing Ntwo Nof Nthe Nfollowing Nanswer Nchoices.
A 65 year old female patient presents today to the clinic with worsening back pain over
the last week. She appears to be sweating and states that she is profusely dizzy. Which
of the following findings on her urinalysis would indicate the most immediate need for
referral to the emergency department ?
o Red blood cell (RBC) casts, as they are indicative of possible cytomegalovirus
o White blood cell (WBC) casts, as they are indicative of pyelonephritis
o Hyaline casts, as they are indicative of dehydration after exercise o Glucose, as it
confirms a new diagnosis of Diabetes
Correct
With the patient’s presenting symptoms, it appears that the likely diagnosis is
pyelonephritis. WBC casts in conjunction with the presenting symptoms would warrant
an immediate referral as it can be life threatening. Dehydration does not always warrant
an immediate referral, and glucose in the urine does not confirm a diagnosis of Diabetes.
RBC casts are not indicative of possible Cytomegalovirus (CMV).
2. 2. Question
A middle aged patient recently started taking Benadryl
(diphenhydramine) for issues with allergic rhinitis symptoms. Which of the following
signs or symptoms would be least likely for the patient to report after regularly taking
this medication?
o Blurred vision o Dry mouth o Diarrhea
o Urinary hesitancy
Correct
Benadryl (Diphenhydramine) is a second line treatment for allergic rhinitis. This drug
belongs to the antihistamine drug class which is notorious for anticholinergic side
effects. The typical anticholinergic side effects that can occur are constipation, vision
complaints, dry mouth, and urinary hesitancy.
3. 3. Question
A patient presented with suspected gallstones, and the ultrasound results indicate there
are no gallstones present. However, the patient continues to have symptoms of acute
cholecystitis. Which of the following would be the most appropriate next action for this
patient?
o Refer the patient for an MRI o Repeat the ultrasound as it can take weeks for
gallstones to appear
o Refer the patient for a HIDA scan
,o Refer to general surgery to have the gallbladder removed
, Correct
An ultrasound is the first line diagnostic test for cholecystitis. If the ultrasound is negative
for gallstones, the next appropriate step would be to refer the patient for a HIDA scan, which
is more sensitive. The patient does not necessarily need surgery right away, and an MRI is not
as sensitive as a HIDA scan is for cholecystitis. An ultrasound is used prior to a HIDA scan to
rule out gallstones due to safety concerns. 4. 4. Question
A 56-year-old male patient comes into the clinic after falling on ice. He states he was
carrying groceries in one arm and used the other to break his fall. He is now having pain
and tenderness in the hand which he fell on. Where would the nurse practitioner
palpate to examine this patient for a scaphoid fracture?
o The humeral tuberosity o The radial head
o The boxer’s anatomical position o The
anatomic snuffbox
Correct
The anatomical snuffbox is a triangle-shaped depression on the lateral aspect of the
back of the hand. It is best seen and palpated when the thumb is
extended. Tenderness in this area is indicative of a scaphoid fracture, also known as a
navicular fracture.
5. 5. Question
A patient is having excruciating pain in the side of their face and is placed on
carbamazepine (Tegretol) for this condition. The nurse practitioner understands which
cranial nerve is affected?
o CN IV o
CN VII o
CN VI o CN
V
Correct
Trigeminal neuralgia presents as severe, excruciating pain due to the trigeminal nerve
(CN V)
6. 6. Question
A middle aged patient presents to the clinic requesting hormone replacement therapy
for her menopausal symptoms. Which of the following in the patient’s history is not a
contraindication to starting hormone replacement therapy?
o 2 pack per day smoker o Deep vein thrombosis o New vaginal
spotting that began two weeks ago o Endometriosis
, Incorrect
The NAmerican NAcademy Nof NFamily NPhysicians Nnotes Nthat Nundiagnosed Nvaginal Nbleeding
Nis Nan Nabsolute Ncontraindication Nto Nhormone Nreplacement Ntherapy N(HRT). NEndometriosis
Nand Nprevious Nhistory Nof Nthromboembolism Nare Nrelative Ncontraindications. NAt Nthis
Ntime, Nsmoking Nis Nill Nadvised Nwhile Ntaking NHRT Nbut Nis Nnot Nconsidered Na
Ncontraindication.
7. 7. NQuestion
A N68-year-old Nmale Npresents Nwith Ncomplaints Nof Nswelling Nand Nredness Nin Nhis Nright Nlower
leg. NHe Nexplains Nthat Nhe Nhas Nalways Nhad Nveins Nthat N“stuck Nout” Nbut Nnow Nhis Nskin Nitches
Nand Nlooks N“leathery”. NDuring Nthe Nexam, Nthe Nnurse Npractitioner Nnotes Na Nreddish-
brown Ndiscoloration Nof Nthe Nlegs Nwith Nmild Nedema Npresent. NThere Nare Nalso Nseveral
Nvaricose Nveins Non Nthe Nright Nlower Nleg, Nsparing Nthe Nfoot. NWhat Nis Nthe Nmost Nlikely
Ndiagnosis?
o Deep NVein NThrombosis N(DVT) No NCellulitis
o Lymphedema
o Chronic NVenous NInsufficiency N(CVI) NCorrect
Chronic Nvenous Ninsufficiency N(CVI) Nis Ncharacterized Nby Nlower Nextremity Nedema,
Nvaricose Nveins, Npruritus Nof Nthe Nskin, Ndiscoloration Nof Nthe Nskin, Nand Npossible Nulcerations
Nor Nabrasions Nto Nthe Nskin. NIt Nis Ndue Nto Ninadequate Nvenous Ncirculation Ncaused Nby Na
Npartial Nvein Nblockage Nor Nleakage Nof Na Nvenous Nvalve Nthat Nincreases Npressure. NAlthough
NDVTs Ncan Nbe Ncaused Nby NCVI N– Nit Nis Nimportant Nto Nremember Nthat Nthis Ncan Nhappen
Nfrom Nother Nthings Nas Nwell Nsuch Nas Nsitting Nor Nstanding Ntoo Nlong, Nsmoking, Nobesity, Nor
Ntrauma Nto Nthe Nleg.
8. 8. NQuestion
An N82 Nyear Nold Npatient Npresents Nto Nthe Noffice Ntoday Nwith Ncomplaints Nof Nsevere Npain,
Nredness, Nwarmth, Nand Nswelling Nof Nthe Ndistal Ninterphalangeal Njoint Non Nher Nright Nhand.
NWhich Nof Nthe Nfollowing Ndiagnoses Nmay Nbe Nresponsible Nfor Nher Nacute Nsymptoms? NSelect
Nall Nthat Napply Nby Nchoosing Ntwo Nof Nthe Nfollowing Nanswer Nchoices.
o Carpal Ntunnel Nsyndrome No
Rheumatoid Narthritis No NGout
o Cellulitis No
Ganglion Ncyst
Incorrect
Based Non Nthe Npain, Nredness, Nwarmth, Nand Nswelling Nthis Npatient Nis Nexperiencing Nin Nher
Nfinger, Nboth Ngout Nand Ncellulitis Nshould Nbe Nconsidered. NGout, Nalthough Nmore Ncommon
Nin Nthe Ngreat Ntoes Nand Nknees, Ncan Noccur Nin Nthe Nfingers. NHerberden’s Nnodes Nare
Ntraditionally Nassociated Nwith Nosteoarthritis Nrather Nthan Nrheumatoid Narthritis. NFinally,
Na Nganglion Ncyst Nmay Npresent Nwith Npain Nand Nswelling, Nbut Nwill Nlikely Nnot Npresent Nwith
Nredness Nand Nwarmth.
9. 9. NQuestion
A N63 Nyear Nold Npatient Ndiagnosed Nwith NCOPD Nhas Na NCAT N(COPD NAssessment NTest) Nscore
Nof N6 Nand Nhas Nnot Nhad Nany Nsevere Nexacerbations Nin Nthe Nlast Nyear, Nplacing Nthem Nin
Ntreatment NGroup NA. NWhich Nmedications Nmight Nthis Npatient Nbe Non? NSelect Nall Nthat
Napply Nby Nchoosing Ntwo Nof Nthe Nfollowing Nanswer Nchoices.
