,AANP AGPCNP Test 1
1. An 88-year-old patient is evaluated after being found on the bathroom floor
following a fall. The patient has right-sided weakness and was unable to rise
without assistance, and the medical history includes aphasia and poor adherence
to prescribed antihypertensive medications. Based on the pattern of neurological
deficits and vascular risk factors, the nurse practitioner suspects an acute
cerebrovascular event. Which diagnosis most likely explains the patient’s right-
sided weakness?
A. Right-sided CVA
B. Left-sided CVA
C. Bilateral CVA
D. Cerebellar CVA
Correct Answer: B. Left-sided CVA
Rationale: A left-sided cerebrovascular accident commonly produces motor
deficits on the right side of the body because the major motor pathways cross before
reaching their target muscles. Aphasia also strongly supports involvement of the
dominant cerebral hemisphere, which is most commonly the left hemisphere. The
patient's hypertension and medication noncompliance further increase the risk for
ischemic or hemorrhagic stroke. Therefore, a left-sided CVA best explains the
combination of right-sided weakness and aphasia.
2. A patient reports persistent headaches that have progressively become more
concerning and are accompanied by neurological changes. The clinician is
evaluating whether the headache pattern could indicate an intracranial space-
occupying lesion rather than a primary headache disorder. Which combination of
findings is most commonly associated with headaches caused by an intracranial
tumor?
,A. Pain worse when lying down and focal neurological signs
B. Hyperreflexia and personality change without headache
C. Acute headache onset occurring over only several hours to days
D. Pupillary constriction accompanied by stupor
Correct Answer: A. Pain worse when lying down and focal neurological signs
Rationale: Headaches associated with intracranial tumors may worsen when the
patient lies down because changes in intracranial pressure can become more
pronounced in that position. Focal neurological deficits may occur when a tumor
compresses or disrupts specific areas of the brain. The symptoms are often
progressive rather than having a sudden onset over several hours. Therefore,
positional worsening of headache combined with focal neurological findings is the
most characteristic choice.
3. A patient presents to the clinic with a painful corneal abrasion following a minor
eye injury. The clinician wants to prevent secondary bacterial infection while the
corneal epithelium heals. Which pharmacotherapeutic treatment would be most
important to administer for this patient?
A. Timolol
B. Gentamicin ophthalmic (Genoptic)
C. Cromolyn ophthalmic
D. Olopatadine
Correct Answer: B. Gentamicin ophthalmic (Genoptic)
Rationale: Gentamicin ophthalmic is an antibacterial medication that can be used
to reduce the risk of bacterial infection associated with a corneal abrasion. A
damaged corneal surface provides an opportunity for microorganisms to invade the
tissue and cause keratitis or other complications. Timolol is primarily used to reduce
intraocular pressure, while cromolyn and olopatadine are used for allergic ocular
, conditions. Therefore, gentamicin ophthalmic is the appropriate
pharmacotherapeutic choice among the options provided.
4. A 25-year-old patient presents with decreased mobility and pain of the right
shoulder that becomes worse with movement. The patient reports participating in
extensive house painting approximately 24 hours before the pain began but denies
any direct trauma, and passive range of motion remains intact. There is no redness
or ecchymosis around the shoulder. What should the clinician do next to help
establish the diagnosis?
A. Obtain an X-ray of the shoulder
B. Palpate the structures around the shoulder
C. Obtain an MRI of the shoulder
D. Perform an EMG
Correct Answer: B. Palpate the structures around the shoulder
Rationale: Palpation is an important component of the initial musculoskeletal
examination because it can identify localized tenderness, inflammation, muscle
involvement, or abnormalities of specific shoulder structures. The history of
repetitive activity without trauma and preserved passive range of motion suggests an
overuse-related musculoskeletal problem. Advanced imaging such as MRI is generally
reserved for situations in which the physical examination and clinical history suggest
a structural lesion requiring further evaluation. Therefore, palpating the structures
around the shoulder is the appropriate next diagnostic step.
5. A 16-year-old female begins taking Ortho-Novum 7/7/7 and develops mild
midcycle spotting during the first month of therapy. She reports taking every
prescribed dose without missing any tablets and denies using other medications
that could interfere with contraceptive effectiveness. Which intervention is most
appropriate at this time?
1. An 88-year-old patient is evaluated after being found on the bathroom floor
following a fall. The patient has right-sided weakness and was unable to rise
without assistance, and the medical history includes aphasia and poor adherence
to prescribed antihypertensive medications. Based on the pattern of neurological
deficits and vascular risk factors, the nurse practitioner suspects an acute
cerebrovascular event. Which diagnosis most likely explains the patient’s right-
sided weakness?
A. Right-sided CVA
B. Left-sided CVA
C. Bilateral CVA
D. Cerebellar CVA
Correct Answer: B. Left-sided CVA
Rationale: A left-sided cerebrovascular accident commonly produces motor
deficits on the right side of the body because the major motor pathways cross before
reaching their target muscles. Aphasia also strongly supports involvement of the
dominant cerebral hemisphere, which is most commonly the left hemisphere. The
patient's hypertension and medication noncompliance further increase the risk for
ischemic or hemorrhagic stroke. Therefore, a left-sided CVA best explains the
combination of right-sided weakness and aphasia.
2. A patient reports persistent headaches that have progressively become more
concerning and are accompanied by neurological changes. The clinician is
evaluating whether the headache pattern could indicate an intracranial space-
occupying lesion rather than a primary headache disorder. Which combination of
findings is most commonly associated with headaches caused by an intracranial
tumor?
,A. Pain worse when lying down and focal neurological signs
B. Hyperreflexia and personality change without headache
C. Acute headache onset occurring over only several hours to days
D. Pupillary constriction accompanied by stupor
Correct Answer: A. Pain worse when lying down and focal neurological signs
Rationale: Headaches associated with intracranial tumors may worsen when the
patient lies down because changes in intracranial pressure can become more
pronounced in that position. Focal neurological deficits may occur when a tumor
compresses or disrupts specific areas of the brain. The symptoms are often
progressive rather than having a sudden onset over several hours. Therefore,
positional worsening of headache combined with focal neurological findings is the
most characteristic choice.
3. A patient presents to the clinic with a painful corneal abrasion following a minor
eye injury. The clinician wants to prevent secondary bacterial infection while the
corneal epithelium heals. Which pharmacotherapeutic treatment would be most
important to administer for this patient?
A. Timolol
B. Gentamicin ophthalmic (Genoptic)
C. Cromolyn ophthalmic
D. Olopatadine
Correct Answer: B. Gentamicin ophthalmic (Genoptic)
Rationale: Gentamicin ophthalmic is an antibacterial medication that can be used
to reduce the risk of bacterial infection associated with a corneal abrasion. A
damaged corneal surface provides an opportunity for microorganisms to invade the
tissue and cause keratitis or other complications. Timolol is primarily used to reduce
intraocular pressure, while cromolyn and olopatadine are used for allergic ocular
, conditions. Therefore, gentamicin ophthalmic is the appropriate
pharmacotherapeutic choice among the options provided.
4. A 25-year-old patient presents with decreased mobility and pain of the right
shoulder that becomes worse with movement. The patient reports participating in
extensive house painting approximately 24 hours before the pain began but denies
any direct trauma, and passive range of motion remains intact. There is no redness
or ecchymosis around the shoulder. What should the clinician do next to help
establish the diagnosis?
A. Obtain an X-ray of the shoulder
B. Palpate the structures around the shoulder
C. Obtain an MRI of the shoulder
D. Perform an EMG
Correct Answer: B. Palpate the structures around the shoulder
Rationale: Palpation is an important component of the initial musculoskeletal
examination because it can identify localized tenderness, inflammation, muscle
involvement, or abnormalities of specific shoulder structures. The history of
repetitive activity without trauma and preserved passive range of motion suggests an
overuse-related musculoskeletal problem. Advanced imaging such as MRI is generally
reserved for situations in which the physical examination and clinical history suggest
a structural lesion requiring further evaluation. Therefore, palpating the structures
around the shoulder is the appropriate next diagnostic step.
5. A 16-year-old female begins taking Ortho-Novum 7/7/7 and develops mild
midcycle spotting during the first month of therapy. She reports taking every
prescribed dose without missing any tablets and denies using other medications
that could interfere with contraceptive effectiveness. Which intervention is most
appropriate at this time?
