with Rationales | Comprehensive Study Guide PDF
Question 1
A 68-year-old patient arrives in the emergency department after ingesting an unknown quantity
of prescription medication approximately 30 minutes ago. The healthcare provider orders the
insertion of a nasogastric tube to cleanse the stomach of the toxic substance. Which procedure is
being performed?
A. Gavage
B. Emesis
C. Lavage
D. Stomach pumping
Correct Answer: C. Lavage
Expert Rationale:
Gastric lavage is the process of cleansing the stomach using fluid administered and removed
through a nasogastric tube. Although commonly referred to as "stomach pumping," the medical
term is lavage. It may be considered in selected poisoning or overdose cases when performed
shortly after ingestion and under appropriate clinical circumstances. Gavage refers to feeding
through a tube, while emesis is the act of vomiting.
Question 2
A 72-year-old woman recently started hemodialysis for end-stage renal disease. During
discharge teaching, her daughter asks which foods are appropriate for her mother's diet. Which of
the following foods does NOT need to be avoided?
A. Avocado
B. Lean red meat
C. Dried fruit
D. Bananas
Correct Answer: B. Lean red meat
Expert Rationale:
Patients receiving dialysis require high-quality protein to replace protein lost during dialysis
and promote tissue repair. Lean red meat is an excellent protein source and is encouraged in
appropriate portions. Foods such as bananas, avocados, and dried fruits are high in potassium
and should generally be limited because impaired kidney function reduces potassium excretion,
increasing the risk of life-threatening cardiac dysrhythmias.
,Question 3
An 89-year-old patient presents with epigastric pain, nausea, and dyspepsia. Diagnostic testing
confirms Peptic Ulcer Disease (PUD). Which of the following would be the LEAST likely
differential diagnosis?
A. Cholecystitis
B. Migraines
C. Gastric carcinoma
D. Cardiovascular disease
Correct Answer: B. Migraines
Expert Rationale:
Peptic Ulcer Disease commonly presents with upper gastrointestinal symptoms. Differential
diagnoses include gastric carcinoma, cholecystitis, pancreatitis, biliary tract disease, and
even atypical cardiac ischemia, particularly in older adults. Migraines are neurologic disorders
and are not considered a typical differential diagnosis for gastrointestinal ulcer disease.
Question 4
A 70-year-old man with a 45-pack-year smoking history presents for his annual wellness visit.
As part of preventive care, the nurse practitioner provides smoking cessation counseling. Which
sequence represents the evidence-based components of a brief tobacco cessation intervention?
A. Counsel, Document, Caution, Describe, Demonstrate
B. Advise, Confer, Describe, Document, Prescribe
C. Advise, Counsel, Intervene, Prescribe, Follow-up
D. Ask, Advise, Assess, Assist, Arrange
Correct Answer: D. Ask, Advise, Assess, Assist, Arrange
Expert Rationale:
The 5 A's model is the recommended evidence-based approach to tobacco cessation counseling:
• Ask about tobacco use.
• Advise every tobacco user to quit.
• Assess readiness to quit.
• Assist with counseling and pharmacologic therapy.
• Arrange follow-up to support long-term abstinence.
This structured intervention significantly improves smoking cessation success rates.
, Question 5
A 50-year-old woman presents with a raised, itchy lesion on her forearm after being bitten by a
mosquito while gardening. On examination, the lesion is erythematous, slightly elevated, and
transient. Which primary skin lesion best describes this finding?
A. Cyst
B. Bulla
C. Wheal
D. Plaque
Correct Answer: C. Wheal
Expert Rationale:
A wheal is a transient, elevated, irregular lesion caused by localized dermal edema, commonly
resulting from insect bites or allergic reactions. A cyst is a fluid-filled encapsulated lesion, a
bulla is a large fluid-filled blister greater than 5 mm, and a plaque is an elevated, broad lesion
typically formed by the coalescence of papules.
Question 6
A 68-year-old man with a 40-year smoking history presents for a preventive health examination.
Based on current screening recommendations, which patient should undergo one-time screening
for an abdominal aortic aneurysm (AAA)?
A. Males aged 65–75 who have ever smoked
B. Females aged 65–75 with hypertension
C. Males and females older than 75 years
D. Females older than 75 years
Correct Answer: A. Males aged 65–75 who have ever smoked
Expert Rationale:
Current screening recommendations advise a one-time abdominal ultrasound for men aged 65
to 75 years who have ever smoked, as smoking is the strongest modifiable risk factor for AAA.
Routine screening is not recommended for women unless additional high-risk factors are present.
Question 7