NUR 604 Board Vitals Questions & Answers_2025.

NUR 604 Board Vitals Questions & Answers_2025. A 17-year-old male student presents for a pre-sports physical examination. When taking his history, you discover that his uncle and older brother both died suddenly while playing sports. The patient has a holosystolic murmur at the apex of the heart that radiates to the axilla. What is the most likely cause? A. Aortic stenosis B. Brain aneurysm C. Hypertrophic obstructive cardiomyopathy (HOCM) D. Ventricular septal defect (VSD) 16 year-old female is evaluated for the first time by a nurse practitioner. She reports no significant past medical history, chronic medical conditions, does not take medication, and denies drug or alcohol use. Her last menstrual cycle was 18 months ago. Today, she weighs 90 kg and she is 155 cm tall. She has had a weight increase of more than 10 kg by her recollection. Her blood pressure is 142/88 mm Hg. Examination reveals chin hair and some dark hair on the upper lip. Which of the following is the best intervention by the nurse practitioner? A. Begin weight loss supplements B. Refer the patient to a nutritionist to provide a very low-calorie diet C. Evaluate the patient for secondary causes of obesity D. Advise the patient to exercise daily A child presents with concerns about their school performance from their caregiver. The child is sleeping poorly, their grades are deteriorating, and their teachers have observed a decrease in their attention span. On physical examination, the patient exhibits lid lag, tremors, and an increased heart rate. Which of the following additional findings supports the suspected diagnosis of Graves' disease? A. Diffuse goiter B. Precocious puberty C. Pretibial myxedema D. Weight gain An NP is managing a child with classic congenital adrenal hyperplasia (CAH). Which of the following therapies is essential in the management of this condition? A. Corticotropin-releasing factor type 1 receptor antagonists B. Glucocorticoid and mineralocorticoid replacement C. Growth hormone therapy and testosterone replacement D. Referral for surgical adrenalectomy An NP is managing a child with type 1 diabetes mellitus (T1DM). Routine screening is recommended for which of the following most common comorbid autoimmune conditions in children? A. Autoimmune thyroiditis. B. Crohn's disease C. Psoriatic arthritis D. Rheumatoid arthritis An infant presents for a well-child visit after a home birth six weeks ago and no prior history of any medical care. On physical examination, the infant has hypotonia, dry skin, umbilical hernia, large fontanels, and jaundice. Which of the following differential diagnoses must be considered in this scenario? A. Benign neonatal hyperbilirubinemia B. Congenital hypothyroidism C. Fragile X syndrome D. Phenylketonuria A 4-year-old girl has been diagnosed recently with type 1 diabetes after a 2- week history of thirst and secondary enuresis. She presents at her first endocrinology appointment after hospital discharge. The mother is 6 months pregnant and has many questions regarding her daughter's health and the health of her baby. What is true regarding the unborn child? A. Prenatal testing is available. B. Siblings of children with diabetes need frequent blood-sugar monitoring. C. Keeping the child at a healthy weight can prevent the development of type 1 diabetes. D. The baby is at increased risk of diabetes, but screening in the absence of symptoms is not recommended. A child with a history of Down syndrome (trisomy 21) presents for their annual physical exam. Other than the history of a ventricular septal defect (VSD) repaired at the age of 7 months, they have not had any significant health problems. On the specialized growth chart for children with Down syndrome, the NP notes increased weight and a deceleration in linear growth. Which of the following endocrine disorders is most likely to be responsible for these findings? A. Hypothyroidism B. Addison’s disease C. Diabetes D. Primary hypogonadism A previously healthy child presents for a well-child examination. Over the past few years, the NP notes declining height velocity. The child’s caregiver reports having noticed declining school performance, constipation, and fatigue. On physical examination, the child's skin is dry, their face appears puffy, their BMI is elevated, and their deep tendon reflexes are delayed. Which of the following laboratory tests should be measured to evaluate this child’s most likely diagnosis? A. Adrenocorticotropic hormone stimulation test B. Complete blood count and iron studies C. Hemoglobin A1c D. Thyroid-stimulating hormone and free thyroxine A 16-year-old male is diagnosed with celiac disease during a workup for chronic diarrhea. After being told about the diagnosis, the patient reads about the disease and associated conditions. He has multiple questions regarding his new diagnosis. Which of the following is true? A. Patients with untreated celiac disease are at increased risk for lymphoma B. Patients with type 2 diabetes are considered to be at increased risk for celiac disease C. The most commonly associated skin condition is epidermolysis bullosa D. Patients with latent celiac disease (positive IgA endomysial antibody, but normal small bowel biopsy) should be on a gluten-free diet E. Patients without symptoms should be tested for thiamine deficiency The nurse practitioner knows that the correct auscultatory site for the aortic area is the: A. Midclavicular line, fifth interspace, left side B. Left fourth intercostal close to the sternum C. Right second interspace close to the sternum D. Midclavicular line, second interspace, left side An 8-year old female in previously good health presents to clinic with her mother who states she has been losing weight despite an increased appetite. She has also been very thirsty, according to her mother. The patient’s mother states the symptoms became pronounced a few days ago when the child was suffering from cold-like symptoms that have since resolved. On examination, you note the child is afebrile with normal vital signs except for a mild tachycardia and tachypnea. Her weight has dropped 4 pounds since her last visit, which was for a routine physical examination 3 months ago. She has a fruity odor on her breath. Exam is otherwise unremarkable. Which of the following is the next step in evaluation of the patient? A. Urinary ketones B. CBC C. Liver function tests D. Electrolyte panel During developmental surveillance of milestones in a toddler, the NP recognizes that the child has not met expected milestones in several areas of functioning. Which of the following conditions is most likely to be associated with global developmental delays? A. Asthma B.Scoliosis C. Lead poisoning D. Varicella-zoster virus A 17-year-old female presents to the clinic for a pre-college physical. Her vitals are notable for a BMI of 22 kg/m2, blood pressure of 110/60 mm Hg sitting and 83/45 standing, and heart rate of 45 beats/minute. Physical exam is notable for calluses on the back of their hands, parotid gland swelling, and erosion of the dental enamel. You suspect bulimia nervosa after a conversation with the patient. Which of the following is the next step in the management of this patient? A. Start amitriptyline B. Refer to an outpatient dietitian C. Admit to the hospital. D. Refer for cognitive-behavioral therapy An adolescent presents for their yearly physical examination. The patient’s caregiver has noticed a decline in the patient's school performance, and the patient has been getting into trouble for falling asleep in class. The patient reports chronically feeling fatigued and difficulty concentrating despite sleeping at least 9 hr a night. What additional findings would suggest a diagnosis of primary hypothyroidism? A. Weight loss, high thyroid-stimulating hormone (TSH), and high free thyroxine (T4). B. Weight loss, low thyroid-stimulating hormone (TSH), and high free thyroxine (T4). C. Weight gain, low thyroid-stimulating hormone (TSH), and low free thyroxine (T4). D. Weight gain, high thyroid-stimulating hormone (TSH), and low free thyroxine (T4). An active 8-year-old male with type 1 diabetes presents for a wellness visit. The child plays soccer and swims on a selective team. How should the NP counsel the patient and his parents? A. Hyperglycemia may occur on weekends. B. Type 1 diabetics should avoid high impact and strenuous exercise. C. Hypoglycemia in the evening may occur on the days he is more active with sports. D. Insulin dosing and eating patterns should not be changed during periods of exercise. A 16-year-old female has a history of an upper respiratory infection 3 weeks ago. She is currently complaining of a sharp pain in the mid-chest that increases in intensity when she is supine. On examination, she has a temperature of 99 degrees Fahrenheit. The nurse practitioner hears a precordial rub and soft S4. Which of the following is the most likely diagnosis? A. Mycoplasma pneumoniae B. Acute pericarditis C. Pulmonary embolism D. Bacterial endocarditis An NP is caring for a pediatric patient with Down syndrome (DS). Which of the following comorbidities is this patient at greatest risk for? A. Thyroid disease B. Parkinson's disease C. Bipolar disorder D. Urinary tract infections A 30-year-old female with a 12-year history of type 1 diabetes mellitus has maintained strict glycemic control and has experienced no significant diabetic complications. At a routine office visit, her blood pressure is 127/80 mmHg. A funduscopic exam reveals no abnormalities. Laboratory tests show that all blood chemistries are within normal limits. What is the next step in patient management for the secondary prevention of diabetic nephropathy? A. Renal biopsy B. ACE inhibitor therapy C. Random urine dipstick test for proteinuria D. Urine albumin concentration from an early morning sample. An adolescent presents to the clinic with concerns about darkening armpits. They first noted dark spots bilaterally about 9 months ago. These enlarged and became rough and raised. The patient's BMI is in the 98th percentile. On physical examination, both axillae have thickened, fissured, hyperpigmented plaques with a velvety texture. What is the most likely diagnosis? A. Café-au-lait spots B. Linear epidermal nevus C. Acanthosis nigricans D. Lichen planus pigmentosus Which of the following disorders is not associated with acanthosis nigricans? A. Obesity B. Tinea versicolor C. Diabetes D. gastrointestinal cancer A young adult presents to the clinic with concerns about dark spots on their axillae and neck that have persisted for several months. These spots enlarged and became rough and raised. On physical examination, the bilateral axillae and the neck have hyperpigmented plaques with a velvety texture. What is the most likely medical condition associated with this finding? A. Addison’s disease B. Hyperlipidemia C. Hypothyroidism D. Elevated BMI An adolescent presents with secondary amenorrhea, acne, hirsutism, and weight gain. They currently take no regular prescribed medications. Which of the following laboratory findings support the diagnosis of polycystic ovary syndrome? A. Elevated free testosterone B. Elevated follicle-stimulating hormone C. Elevated prolactin D. elevated thyroid-stimulating hormone Which of the following is a characteristic of a diastolic murmur? A. Onset with the S1 heart sound B. Onset with S2 heart sound C. Usually a benign functional murmur D. Accompanied by an S3 heart sound A 2-year-old male with congenital heart disease presents to a nurse practitioner for evaluation of shortness of breath and lower-extremity swelling. The child has not been eating well, according to his father. A chest radiograph is consistent with congestive heart failure. Which of the following will the NP be most likely to find on physical examination of this patient? A. S1, S2, JVD B. S3 and bibasilar crackles. C. Opening snap and rumbling diastolic murmur D. Split S2