And Answers. Updated 2026/2027
An adult female presents with a 1-week history of left lower quadrant abdominal
pain. T=101.2 degrees F. (38.4 degrees C) and an elevated WBC count. This is the
patient's first episode of severe abdominal pain. The nurse practitioner suspects
diverticulitis. Which of the following diagnostic tests would confirm the diagnosis?
- ANSWER -CT scan of the abdomen
Rationale: For patients with acute diverticulitis, CT of the abdomen will provide
evidence of the pathophysiology. Evidence of diverticula will be present on a flat
plate KUB x-ray, but there is not enough specificity to show that it is inflamed as
with a CT scan.
A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue.
The patient reports a 2-week history of blackened stools, which the patient
attributes to drinking berry juice. Assessment reveals vital signs of BP = 110/60, P
= 100, R = 24; Hgb = 4.5 g/dL; Hct = 16%. What is the most appropriate
immediate intervention? - ANSWER -Send to the emergency room.
Rationale: This patient is experiencing a GI bleed and is in need of emergency
treatment due to their considerably low hemoglobin.
An older adult has a follow-up fasting lipid panel 6 months after making
therapeutic lifestyle changes. LDL=205mg/dL (Normal=<100mg/dL),
HDL=44mg/dL, and triglycerides=180mg/dL (Normal-<150mg/dL). The patient is
placed on statin therapy. Two months later, the patient presents for follow-up and
complains of body aches. In addition to creatine phosphokinase (CPK), which of
the following tests should the nurse practitioner order? - ANSWER -Liver
transaminase (AST and ALT) levels
Rationale: Due to the potential liver function test elevation found with statin use,
LFTs of AST/ALT should be checked routinely after initiation of therapy
A 56-year-old male on your service has been diagnosed with colon cancer which
is localized. What is the primary management that you should expect to prepare
your patient for? - ANSWER -Surgery
Rationale: Surgery is the only curative modality for localized colon cancers.
Patients with progressive/metastatic disease may require chemotherapy/radiation.
, A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss.
She also reports occasional bloody stools. Colonoscopy reveals continuous
inflammation from the rectum extending proximally. What is the most likely
diagnosis? - ANSWER -Ulcerative colitis
Rationale: The presence of inflammatory bowel disease which is present in the
patient with bloody stool suggests ulcerative colitis. This patient should be acutely
managed with steroids and chronically with auto-immune therapy such as biologics
and/or DMARDs.
A 63-year-old male presents with a suspected lower GI bleed. He reports passing
frank small amounts of blood several times today. He denies use of NSAID's or
blood thinners. What questions would be important to ask to further differentiate
your diagnosis? - ANSWER -All these questions would help determine if this
bleed was associated with a potential diverticular bleed (typically painless), painful
bowel movement associated with IBD (UC/Crohn's), and changes in bowel
habit/colonoscopy risk for malignancy.
Which is best performed to assess the risk for fall in an 88-year old adult? -
ANSWER -Get up and go test
Rationale: This question is asking you if you understand the different screening to
available for Mobility and fall risk. The global screening assessment, PHQ-2
questionnaire, and clock drawing test have no clinical significance to mobility. The
"get up and go" test is the only option that is a mobility test of these four.
A frail elderly patient presents with constipation. Which of the following normal
physiologic changes seen with aging is the most likely cause? - ANSWER -
Decreased bowel muscle tone
Rationale: The frail, elderly patient will typically have their GI track decrease bile
secretion and decrease absorption of calcium. A decrease in pancreas secretions is
not related to presence of constipation, however, decreased bowel muscle tone
certainly does reduce the GI motility and increase the transit time, thereby
increasing the drying of stool in the large intestine which leads to constipation
An elderly patient diagnosed with end-stage lung cancer has been refusing meals,
opting instead for ice cream only. The family is concerned about the patient not
getting enough nutrition. The NP: - ANSWER -explains loss of appetite is
common at the end of life
Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual
re-orientation to the terminal state of a patient's condition may be appropriate when
unrealistic expectations for their longevity have been voiced. The reasonable
,choice in this case is to describe the normalcy of what the patient is experiencing
with their loss of appetite and their terminal state. Testing the patient for
depression has really no clinical bearing on this particular time nor does
prescribing methylphenidate. Ordering a UA and CBC would suggest a concern of
a urinary tract infection, and that is not a likely scenario to describe the patient's
existing condition. Support the patient as his advocate by helping the man enjoy
the ice cream he requested.
An elderly patient is being admitted to the skilled nursing facility and is being
screened for the risk of falling. Which of the following information would trigger a
complete falls assessment? - ANSWER -A history of two or more falls in the prior
year
Rationale: Of these options, the only two that have any clinical bearing on falls are
a patient who has a demonstrated incident of two or more falls in a year and a
patient who has a altered cognition, such as the patient who is living alone and has
mild dementia. Of the two options, the clear winner is the patient who has already
demonstrated to fall in the last year and they should certainly be a valuated more
thoroughly with a complete fall assessment.
The management of COPD in the elderly is best guided by: - ANSWER -
symptomatology.
Rationale: Symptomatology is what guides COPD management since the severity
and frequency of symptoms will warrant changes and additions to medications as
exacerbations present.
Although very useful tool for chronic management and baseline status, spirometry
does not typically dictate therapy, rather diagnose the disease state itself. Our
blood gases may be used for clinically correlate severity during an exacerbation,
and radiologic imaging may showcase severity of stable chronic finding such as
somatic, lung tissue or bullae.
Which of the following is an example of implied consent? - ANSWER -The
patient collapses while having a myocardial infarction in the hospital cafeteria.
Bystanders witnessed the patient clutch his chest, say "my chest", then collapse.
They start CPR and initiate the emergency care system to transport the patient for
care in the emergency department.
Rationale: Surgical consent is by definition "informed" when the risks and benefits
are discussed as with the patients undergoing surgery and a chest tube, and 2
person emergency consent is described with the patient with altered mental status.
The collapsed patient reflects a clear inability to care for oneself and care is being
, performed under the assumption of what is implied as what any reasonable person
would want.
Which of the following refers to the primary access point of medical care patients
are encouraged to use to aid in providing continuity and reduction of cost per the
Affordable Care Act? - ANSWER -The Medical Home
Rationale: The medical home reduces cost by providing continuity of care,
reducing overtesting, duplicate testing, and aids with longitudinal management of
the patient. The other options all increase these cost-burdening elements and
should be avoided unless care through the medical home is not a reasonable or
appropriate option.
A patient states they do not want to have any further medical care and wishes to
leave against medical advice. Unknown to you, the healthcare tech then held their
arm down to get an IV catheter placed against their will. The healthcare tech is at
risk of being charged with which of the following: - ANSWER -Battery
Rationale: Assault refers to the risk of a harm to others, whereas battery refers to
the actual act of that harm.
Which act formed in 1996 was created to protect patient health information from
being disclosed without the patient's consent or knowledge? - ANSWER -Health
Insurance Portability and Acountability Act (HIPAA)
Rationale: The Health Insurance Portability and Accountability Act of 1996
(HIPAA) is a federal law that required the creation of national standards to protect
sensitive patient health information from being disclosed without the patient's
consent or knowledge. FERPA was aimed at educational protections similar to
HIPAA but for education. COBRA is for continuing insurance benefits after
separation from employment. EMTALA is to guarantee provision of emergency
treatment for stabilization or for those in active labor.
An 87-year-old female has a history of ovarian cancer. She recently completed the
tenth of 26 chemotherapy treatments. She informs the nurse practitioner that she
plans to stop chemotherapy; she has lived a good life and is ready to die. She is
alert and very active, and lives with her son. The family is determined that the
patient will complete the chemotherapy. The nurse practitioner's most appropriate
action is to: - ANSWER -support the patient's decision.
Rationale: Good nursing practice supports advocacy at all times for the patient,
even when the patient's family disagrees. Supporting their decision to self-direct
their care is your primary obligation.