NORAC LATEST COMPREHENSIVE TEST
PAPER 2026 COMPLETE ANSWERS
ACCURATE
⫸ When providing culturally competent health care services to an
American Indian elder, the nurse practitioner understands which is
traditionally true? Answer: The "Medicine Wheel" is used by many for
the purpose of health and healing
The "Medicine Wheel" is traditionally used and contains four directions;
north, south, east, and west. Traditionally each tribe has different
meanings for each direction and they may represent the season of the
year or stage of life. It is aimed at providing a holistic view of life.
________________________________________
An understanding of different cultural preferences leads to cultural
competence in healthcare. Some patients may value traditional culture
and preferences as it relates to healthcare. These individual preferences
should be included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to
health care integrating the person, lifestyle, environment, family, and
religion. Patients adhering to these traditional cultural practices often
feel that illness is due to a lack of harmony with the physical body,
mind, spirit, and emotions. Patients may seek care from western
medicine for specific ailments while also consulting with traditional
healers for spiritual guidance.
,Healthcare providers should seek to understand relevant cultural factors
and assess each individual's healthcare literacy in order to provide
culturally competent care.
⫸ The nurse practitioner sees an older adult patient in the clinic with the
primary report of hearing loss and a sensation of fullness in the right ear.
The nurse practitioner suspects conductive hearing loss. Which could
contribute to this? Answer: Cerumen, commonly called earwax, is a
combination of secretions and sloughed epithelial cells that protects the
ears from infection, water, and insects. It is normally expelled from the
ear canal through natural jaw movement. When this self-cleaning
process fails, cerumen can become impacted. Cerumen impaction
occludes the ear canal and can press against the tympanic membrane,
resulting in conductive hearing loss.
_________________________________________
Conductive hearing is the transition of sound from the external and
middle ear to the inner ear. Conductive hearing loss is caused by
problems in the external and middle ear that interfere with the
transmission of sound and its conversion to mechanical vibration.
Causes of conductive hearing loss include obstruction of the external
auditory canal by cerumen, foreign bodies, debris from otitis externa,
and large exocytosis and osteomas.
Sensorineural hearing loss involves difficulty converting mechanical
vibrations to electrical potential in the cochlea or in auditory nerve
transmission to the brain. It is mostly caused by permanent damage in
the organ of Corti. It can be caused by age-related hearing loss, noise
,trauma, medications, autoimmune diseases, mechanical trauma, Meniere
disease, infection, and neoplasm (acoustic neuroma).
Approximately one-third of older adults between the ages of 61 and 70
years have hearing loss. More than 90% of adults older than 85 years of
age have hearing loss. The most common type of hearing loss is age-
related and sensorineural. All adults older than 60 years of age should be
screened for hearing loss at periodic health examinations.
⫸ An otherwise healthy adult patient presents to the clinic with a
diagnosis of community-acquired pneumonia and no recent antibiotic
therapy. Which is the best option for treatment? Answer: Amoxicillin
High-dose amoxicillin (Amoxil) or doxycycline are recommended as
first-line therapy for adults without comorbidities.
_____________________________________________
Community-acquired pneumonia (CAP) is pneumonia not acquired in a
hospital or long-term care facility. Patients with suspected CAP should
receive a chest X-ray for diagnosis. The Pneumonia Severity Index
should be used to assist in decisions regarding the need for
hospitalization in patients with CAP.
According to the American Thoracic Society (ATS) and the Infectious
Diseases Society of America (IDSA) 2019 guidelines, the initial
treatment of CAP for most patients is amoxicillin or doxycycline.
Macrolides are an option for treatment, but are no longer recommended
routinely as first-line treatment, given increased macrolide resistance.
This is a change from the 2007 ATS/IDSA guidelines. Respiratory
fluoroquinolones and amoxicillin/clavulanate should be used in patients
who fail first-line medications, have significant comorbidities, have had
, recent antibiotic therapy, are allergic to alternative agents, or have a
documented infection with highly drug-resistant pneumococci.
⫸ A patient presents to the clinic for conception counseling. She
recently stopped taking oral contraceptives and would like to become
pregnant. Which statement about conception safety after stopping oral
contraceptives is correct? Answer:
⫸ You have a 35-year-old female patient who is complaining of wrist
pain. She is an administrative assistant who does a great deal of
computer work in her job. You will test her for carpal tunnel syndrome.
When you tap at the volar surface of the wrist you are performing which
of the following tests? Answer: Tinel's sign
⫸ A gastrinoma located on the pancreas or the stomach which secretes
gastrin, stimulating high levels of acid production in the stomach is
which of the following? Answer: Zollinger-Ellison syndrome
⫸ A 16-year-old male is in the office. He has a insect bite on his left
forearm and you suspect a brown recluse spider bite. What medical
management would you provide? Answer: ice pack and elevation of the
area
⫸ In addition to being overweight, the American Diabetes Association
recommends type 2 diabetes mellitus testing in adults who: Answer:
have an HDL level of < 35 mg/dL
PAPER 2026 COMPLETE ANSWERS
ACCURATE
⫸ When providing culturally competent health care services to an
American Indian elder, the nurse practitioner understands which is
traditionally true? Answer: The "Medicine Wheel" is used by many for
the purpose of health and healing
The "Medicine Wheel" is traditionally used and contains four directions;
north, south, east, and west. Traditionally each tribe has different
meanings for each direction and they may represent the season of the
year or stage of life. It is aimed at providing a holistic view of life.
________________________________________
An understanding of different cultural preferences leads to cultural
competence in healthcare. Some patients may value traditional culture
and preferences as it relates to healthcare. These individual preferences
should be included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to
health care integrating the person, lifestyle, environment, family, and
religion. Patients adhering to these traditional cultural practices often
feel that illness is due to a lack of harmony with the physical body,
mind, spirit, and emotions. Patients may seek care from western
medicine for specific ailments while also consulting with traditional
healers for spiritual guidance.
,Healthcare providers should seek to understand relevant cultural factors
and assess each individual's healthcare literacy in order to provide
culturally competent care.
⫸ The nurse practitioner sees an older adult patient in the clinic with the
primary report of hearing loss and a sensation of fullness in the right ear.
The nurse practitioner suspects conductive hearing loss. Which could
contribute to this? Answer: Cerumen, commonly called earwax, is a
combination of secretions and sloughed epithelial cells that protects the
ears from infection, water, and insects. It is normally expelled from the
ear canal through natural jaw movement. When this self-cleaning
process fails, cerumen can become impacted. Cerumen impaction
occludes the ear canal and can press against the tympanic membrane,
resulting in conductive hearing loss.
_________________________________________
Conductive hearing is the transition of sound from the external and
middle ear to the inner ear. Conductive hearing loss is caused by
problems in the external and middle ear that interfere with the
transmission of sound and its conversion to mechanical vibration.
Causes of conductive hearing loss include obstruction of the external
auditory canal by cerumen, foreign bodies, debris from otitis externa,
and large exocytosis and osteomas.
Sensorineural hearing loss involves difficulty converting mechanical
vibrations to electrical potential in the cochlea or in auditory nerve
transmission to the brain. It is mostly caused by permanent damage in
the organ of Corti. It can be caused by age-related hearing loss, noise
,trauma, medications, autoimmune diseases, mechanical trauma, Meniere
disease, infection, and neoplasm (acoustic neuroma).
Approximately one-third of older adults between the ages of 61 and 70
years have hearing loss. More than 90% of adults older than 85 years of
age have hearing loss. The most common type of hearing loss is age-
related and sensorineural. All adults older than 60 years of age should be
screened for hearing loss at periodic health examinations.
⫸ An otherwise healthy adult patient presents to the clinic with a
diagnosis of community-acquired pneumonia and no recent antibiotic
therapy. Which is the best option for treatment? Answer: Amoxicillin
High-dose amoxicillin (Amoxil) or doxycycline are recommended as
first-line therapy for adults without comorbidities.
_____________________________________________
Community-acquired pneumonia (CAP) is pneumonia not acquired in a
hospital or long-term care facility. Patients with suspected CAP should
receive a chest X-ray for diagnosis. The Pneumonia Severity Index
should be used to assist in decisions regarding the need for
hospitalization in patients with CAP.
According to the American Thoracic Society (ATS) and the Infectious
Diseases Society of America (IDSA) 2019 guidelines, the initial
treatment of CAP for most patients is amoxicillin or doxycycline.
Macrolides are an option for treatment, but are no longer recommended
routinely as first-line treatment, given increased macrolide resistance.
This is a change from the 2007 ATS/IDSA guidelines. Respiratory
fluoroquinolones and amoxicillin/clavulanate should be used in patients
who fail first-line medications, have significant comorbidities, have had
, recent antibiotic therapy, are allergic to alternative agents, or have a
documented infection with highly drug-resistant pneumococci.
⫸ A patient presents to the clinic for conception counseling. She
recently stopped taking oral contraceptives and would like to become
pregnant. Which statement about conception safety after stopping oral
contraceptives is correct? Answer:
⫸ You have a 35-year-old female patient who is complaining of wrist
pain. She is an administrative assistant who does a great deal of
computer work in her job. You will test her for carpal tunnel syndrome.
When you tap at the volar surface of the wrist you are performing which
of the following tests? Answer: Tinel's sign
⫸ A gastrinoma located on the pancreas or the stomach which secretes
gastrin, stimulating high levels of acid production in the stomach is
which of the following? Answer: Zollinger-Ellison syndrome
⫸ A 16-year-old male is in the office. He has a insect bite on his left
forearm and you suspect a brown recluse spider bite. What medical
management would you provide? Answer: ice pack and elevation of the
area
⫸ In addition to being overweight, the American Diabetes Association
recommends type 2 diabetes mellitus testing in adults who: Answer:
have an HDL level of < 35 mg/dL
