A 44-year-old woman has recently been diagnosed with advanced metastatic non-small-cell
lung cancer. Genetic testing is ordered to determine if the patient's tumor has any genomic
alterations and to guide treatment decisions. A few weeks later, the patient's test results
come back positive for a genetic mutation. The APN starts osimertinib (Tagrisso). Based on
this information, what type of genetic mutation does this patient have? - ANSWER EGFR
mutation
What is the gold standard for the suspected diagnosis of Celiac Disease? - ANSWER En-
doscopy with small intestine biopsy
A 20-year-old male meets with an advanced professional nurse (APN) to discuss symptoms
that have been slowly progressing over the past several years. He is mainly concerned be-
cause he has been falling frequently. Since childhood, his gait has consisted of walking on his
toes. During middle school, he was able to participate in sports but was unable to participate
in high school sports due to difficulty with running and jumping. Lately, he has noticed it
takes longer and is more difficult to change positions from sitting to standing than it used to
in the past. He has also been waking up with muscle and joint stiffness. The APRN notes that
his family history is not significant for any chronic or genetic diseases. Which condition is
likely to be the cause of these symptoms? - ANSWER Becker muscular dystrophy
--Becker muscular dystrophy (often called Becker MD or BMD) is a form of muscular dystro-
phy, a genetic disorder that gradually makes the body's muscles weaker and smaller. It
causes less severe problems than the most common type, Duchenne muscular dystrophy.
Which statement should the provider give the patient regarding the pathophysiology of SLE
and its relation to thrombocytopenia? - ANSWER SLE disrupts immune homeostasis and
promotes development of self-reactive antibodies.
A female patient presents to an office to establish care. Her previous primary care provider
told her to follow up regarding an elevated ferritin level. She has no previous medical history
and is currently asymptomatic. She is concerned about the elevated ferritin and would like
1
,to know if she should be worried. What should the provider do next for this patient? - AN-
SWER Order a liver function test
A 75-year-old female presents to the emergency department with an irregular heart rate of
130.What can be ascertained about this patient's findings given the limited information? -
ANSWER She is diagnosed with atrial fibrillation and needs her heart rate controlled with
metoprolol (Lopressor).
Which condition from this patient's medical history is contributing to the loss of contractil-
ity? - ANSWER Acute myocardial infarction
Which condition is this patient suffering from? - ANSWER Diabetic ketoacidosis
A 45-year-old female fears that she is having a stroke and takes herself to an emergency
room. After several diagnostic and laboratory tests, the patient is diagnosed with Cushing
disease. Which lab abnormality would be present in this patient? - ANSWER Increased
cortisol
SOB when lying down, and moving around --Based on the patient's presentation, which dis-
ease process is the patient likely exhibiting? - ANSWER Asthma
A two-year-old child presents with a clear runny nose and cough which has lasted 3 days.
The child's mother reports the cough sounds like a barking noise. The child is sleeping in the
mother's arms and appears to have stridor. The child's mother also reports an axillary tem-
perature of 101°F last night. Which management technique is appropriate for this child's
symptoms? - ANSWER Oral steroids and breathing treatments
An 18-year-old male is involved in a motorcycle crash while not wearing a helmet. He is
brought into an emergency room and is immediately taken for a CT scan. The provider tells
the patient's parents he has bleeding between the dura mater and the skull. What is this pa-
tient's condition called? - ANSWER Epidural hematoma
2
, Delerium, urinary incontinence, fever-- Which lab and diagnostic tests should be ordered as
part of the patient's assessment? - ANSWER Complete blood count, complete metabolic
profile, and urinalysis
-- What is the appropriate diagnosis for this patient? - ANSWER Crohn's disease
Which diagnostic test is appropriate to order for this patient? - ANSWER Ultrasound
A 45-year-old male is being seen in the clinic for a yearly check-up and lab work. His history
includes hypertension and hyperlipidemia for which he currently takes Norvasc 5 mg daily
and Lipitor 20 mg nightly. Patient has a family history of diabetes, hypertension, heart dis-
ease, and hyperlipidemia. After obtaining lab work, the provider notices the patient's
hgbA1c is elevated at 7.5. The patient is already on a DASH diet and watching the amount of
sweets and carbohydrates he eats daily. The patient is not overweight and participates in
moderate physical activity at least 4-5 days a week. He was started on Metformin three
months ago, and his hemoglobin A1c is now 6.9. The nurse expects to see a class of medica-
tion prescribed which is proven to reduce the risk of cardiovascular events. Considering the
treatment guidelines from the American College of Cardiology, which medication should be
recommended for this patien - ANSWER Invokana 100 mg daily
--Invokana is a medication used to treat type 2 diabetes. It is a third-line medication to met-
formin. It is used together with exercise and diet. It is not recommended in type 1 diabetes.
It is taken by mouth.
A 78-year-old female presents to the clinic for a checkup and refills on her medications. She
is currently taking lisinopril (Zestril), metformin (Glucophage), and levothyroxine (Synthroid).
The patient has a history of hypertension, type 2 diabetes, hypothyroidism, GERD, and gas-
tric ulcers. The patient is concerned about heart disease and wants to start taking a low-
dose aspirin. Which aspirin regimen recommendation should the advanced professional
nurse (APN) give to the patient? - ANSWER Low-dose enteric coated aspirin 81 mg daily
A 28-year-old married female presents to primary care accompanied by her husband with
complaints of weight gain, fatigue, muscle aches, bloating, constipation, and difficulty con-
centrating. The patient explains that she has been experiencing these symptoms with in-
creasing frequency over the last two months and reports feeling upset that she has gained
10 pounds over the past month despite no significant changes in dietary intake or activity
3
lung cancer. Genetic testing is ordered to determine if the patient's tumor has any genomic
alterations and to guide treatment decisions. A few weeks later, the patient's test results
come back positive for a genetic mutation. The APN starts osimertinib (Tagrisso). Based on
this information, what type of genetic mutation does this patient have? - ANSWER EGFR
mutation
What is the gold standard for the suspected diagnosis of Celiac Disease? - ANSWER En-
doscopy with small intestine biopsy
A 20-year-old male meets with an advanced professional nurse (APN) to discuss symptoms
that have been slowly progressing over the past several years. He is mainly concerned be-
cause he has been falling frequently. Since childhood, his gait has consisted of walking on his
toes. During middle school, he was able to participate in sports but was unable to participate
in high school sports due to difficulty with running and jumping. Lately, he has noticed it
takes longer and is more difficult to change positions from sitting to standing than it used to
in the past. He has also been waking up with muscle and joint stiffness. The APRN notes that
his family history is not significant for any chronic or genetic diseases. Which condition is
likely to be the cause of these symptoms? - ANSWER Becker muscular dystrophy
--Becker muscular dystrophy (often called Becker MD or BMD) is a form of muscular dystro-
phy, a genetic disorder that gradually makes the body's muscles weaker and smaller. It
causes less severe problems than the most common type, Duchenne muscular dystrophy.
Which statement should the provider give the patient regarding the pathophysiology of SLE
and its relation to thrombocytopenia? - ANSWER SLE disrupts immune homeostasis and
promotes development of self-reactive antibodies.
A female patient presents to an office to establish care. Her previous primary care provider
told her to follow up regarding an elevated ferritin level. She has no previous medical history
and is currently asymptomatic. She is concerned about the elevated ferritin and would like
1
,to know if she should be worried. What should the provider do next for this patient? - AN-
SWER Order a liver function test
A 75-year-old female presents to the emergency department with an irregular heart rate of
130.What can be ascertained about this patient's findings given the limited information? -
ANSWER She is diagnosed with atrial fibrillation and needs her heart rate controlled with
metoprolol (Lopressor).
Which condition from this patient's medical history is contributing to the loss of contractil-
ity? - ANSWER Acute myocardial infarction
Which condition is this patient suffering from? - ANSWER Diabetic ketoacidosis
A 45-year-old female fears that she is having a stroke and takes herself to an emergency
room. After several diagnostic and laboratory tests, the patient is diagnosed with Cushing
disease. Which lab abnormality would be present in this patient? - ANSWER Increased
cortisol
SOB when lying down, and moving around --Based on the patient's presentation, which dis-
ease process is the patient likely exhibiting? - ANSWER Asthma
A two-year-old child presents with a clear runny nose and cough which has lasted 3 days.
The child's mother reports the cough sounds like a barking noise. The child is sleeping in the
mother's arms and appears to have stridor. The child's mother also reports an axillary tem-
perature of 101°F last night. Which management technique is appropriate for this child's
symptoms? - ANSWER Oral steroids and breathing treatments
An 18-year-old male is involved in a motorcycle crash while not wearing a helmet. He is
brought into an emergency room and is immediately taken for a CT scan. The provider tells
the patient's parents he has bleeding between the dura mater and the skull. What is this pa-
tient's condition called? - ANSWER Epidural hematoma
2
, Delerium, urinary incontinence, fever-- Which lab and diagnostic tests should be ordered as
part of the patient's assessment? - ANSWER Complete blood count, complete metabolic
profile, and urinalysis
-- What is the appropriate diagnosis for this patient? - ANSWER Crohn's disease
Which diagnostic test is appropriate to order for this patient? - ANSWER Ultrasound
A 45-year-old male is being seen in the clinic for a yearly check-up and lab work. His history
includes hypertension and hyperlipidemia for which he currently takes Norvasc 5 mg daily
and Lipitor 20 mg nightly. Patient has a family history of diabetes, hypertension, heart dis-
ease, and hyperlipidemia. After obtaining lab work, the provider notices the patient's
hgbA1c is elevated at 7.5. The patient is already on a DASH diet and watching the amount of
sweets and carbohydrates he eats daily. The patient is not overweight and participates in
moderate physical activity at least 4-5 days a week. He was started on Metformin three
months ago, and his hemoglobin A1c is now 6.9. The nurse expects to see a class of medica-
tion prescribed which is proven to reduce the risk of cardiovascular events. Considering the
treatment guidelines from the American College of Cardiology, which medication should be
recommended for this patien - ANSWER Invokana 100 mg daily
--Invokana is a medication used to treat type 2 diabetes. It is a third-line medication to met-
formin. It is used together with exercise and diet. It is not recommended in type 1 diabetes.
It is taken by mouth.
A 78-year-old female presents to the clinic for a checkup and refills on her medications. She
is currently taking lisinopril (Zestril), metformin (Glucophage), and levothyroxine (Synthroid).
The patient has a history of hypertension, type 2 diabetes, hypothyroidism, GERD, and gas-
tric ulcers. The patient is concerned about heart disease and wants to start taking a low-
dose aspirin. Which aspirin regimen recommendation should the advanced professional
nurse (APN) give to the patient? - ANSWER Low-dose enteric coated aspirin 81 mg daily
A 28-year-old married female presents to primary care accompanied by her husband with
complaints of weight gain, fatigue, muscle aches, bloating, constipation, and difficulty con-
centrating. The patient explains that she has been experiencing these symptoms with in-
creasing frequency over the last two months and reports feeling upset that she has gained
10 pounds over the past month despite no significant changes in dietary intake or activity
3
