APEA PREDICTOR TESTED QUESTIONS AND CORRECT ANSWERS
✔✔A patient has been diagnosed with hypothyroidism and thyroid hormone
replacement therapy is prescribed. When should the nurse practitioner check the
patient's TSH? - ✔✔6 weeks.
The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days.
The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the
NP should wait a minimum of 4-6 weeks before checking the patient's TSH.
✔✔A 15 yo malue has a history of cryptorchidism which was surgically repaired.
Because of this information, it is essential for the nurse practitioner to teach him about: -
✔✔testicular self-examination.
Cryptorchidism, even with surgical repair, is associated with increased risk for testicular
cancer.
✔✔The treatment of choice for chronic bacterial prostatitis (CBP) is: - ✔✔a
flouroquinolone twice daily for 3 weeks to 4 months.
The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The
cure rate with Bactrim-DS is only about 30-40%.
✔✔A 25 yo female has a history of frequent candidal vaginal infections in the past year.
She is in a monogamous sexual relationship and uses and IUD for contraception. Of the
following, which is the most likely underlying conidition predisposing her to recurring
candidal vaginitis? - ✔✔Diabetes.
A common underlying cause of frequent infections is diabetes mellitus. Pregnancy
increases the incidence of candidiasis, but is unlikely a factor with this patient.
✔✔Which of the following is NOT a characteristic of the S3 heart sound? - ✔✔The
sound is high-pitched and occurs just prior to the S1 heart sound.
The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is
produced by rapid ventricular filling and is best auscultated in the mitral area. It is a
common finding with right-sided heart failure, rapid growth, and the last trimester of
pregnancy.
✔✔Following the finding of prostate gland abnormalities on DRE, the NP orders the
appropriate labs. Whem preparing to review lab reports with the patient, the nurse
practitioner knows all of the following are true EXCEPT: - ✔✔normal PSA is 10ng/ml or
less.
Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated
with BPH. A 10 or greater PSA level suggests prostate cancer. Positive serum acid
phosphatase is associated with malignancy of the prostate gland with bone metasasis.
,✔✔A 66 yo female presents to your clinic. She states that yesterday evening she had
chest pain for 20-30 minutes. Which finding most strongly correlates with myocardial
infarction? - ✔✔Elevated Troponin I levels
An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK
may be elevated from an IM injection, surgery, ot any type of extensive skeletal muscle
trauma or prolonged, strenuous physical exertion. ST segment depression on EKG
usually indicates an ischemic myocardium, but, not necessarily, one post-MI. Elevated
ST seghments reflect mycardial damage. MB bands are specific for myocardial smooth
muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most
accurate marker of cardiac damage, because it is more specific and sensitive than CK
MB, is a troponin measurement.
✔✔What is a secondary cause of hyperlipidemia? - ✔✔hypothyroidism
Hypothyroidism is a common secondary cause of hyperlipidemia. In the evaluation of a
patient with hyperlipidemia, a TSH should always be checked and corrected before
attempting treatment for hyperlipidemia. Other possible causes of seconday
hyperlipidemia include pregnancy, excessive weight gain, excessive alcohol intake,
insulin resistance or deficiency, obstructive liver disease, and uremia. Some
medications can produce secondary hypothyroidism too: thiazide diuretics, some beta-
blockers, oral contraceptives, and corticosteroids.
✔✔A 35-yo male presents with a complaint of low pelvic pain, dysuria, hesitancy,
urgency, and reduced for of stream. The nurse practitioner suspects acute bacterial
prostatitis. The NP would appropriately collect all of the following specimens EXCEPT a:
sterile in-and-out catheter urine specimen. - ✔✔A sterile in-and-out catheter specimen
would identify only organisms in the bladder and would not differentiate between
bladder, kidney, or prostate site infection. The sequence for obtaining specimens when
prostat infection is suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder
urine, and 3. voided post-prostate massage urine.
✔✔A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should
the nurse practitioner advise her to do to minimize her risk of pregnancy? - ✔✔Double
today's dose and tomorrow's dose and use a barrier method for the rest of the month.
If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled
and a barrier method recommended for the remainder of the cycle.
✔✔A 50yo, non-smoker, with no co-morbidity presents to the clinica and is diagnosed
with pna. His vital signs are normal except for temperature of 101.6 degrees. A sputum
specimen is collected and sent for culture and sensitivity. What action should the nurse
practitioner take today? - ✔✔Start Clarithromycin (Biaxin) 500mg 2 times a day for 10 to
14 days.
Most treatment guidelines for outpatient pna in non-smokers without co-morbidity and
60 years of age or younger, recommend erythromycin or another macrolide like Biaxin.
Pcn s indicated for patient swith pneumococcal pna and ciprofloxacin is recommended
for Legionella species.
,✔✔A 38 year old patient is being treated the by the NP for heavy vaginal bleeding
secondary to multiple uterine leiomyomas. Her uterus is greater than 12 weeks
gestational size, her hematocrit is 28%, and she has not responded to hormonal
therapy. Which of the following would be the most appropriate intervention at this time?
- ✔✔Obtain a gynecological consultation
Gynecological consultation is recommended for a patient with a uterus greater that 12
weeks gestational size, significant anemia (hct <30),. o a normal endometrial biopsy
with failure to respond to hormonal therapy.
✔✔What maternal situation is considered an absolute contraindication to
breastfeeding? - ✔✔Early HIV detection
There are few absolute contraindications to breastfeeding. HIV infection and IV drug
abuse are 2 contraindications.
✔✔A 21 yo college student presents to the sudent health center with copious, markedly
purulent discharge from her left eye. The nurse practitioner should suspect: -
✔✔gonococcal conjunctivitis.
A purulent and copious discharge should alert the nurse practitioner to the likely
possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic
treatment and immediate referral to an opthalmologist for evaluation.
✔✔Babies should begin oral iron supplementation: - ✔✔4-6 months of age.
Generally, full term infants who are breadt-fed have sufficient stores of iron to last
through the first 4-6 months of life. Earlier supplementation may be m=necessary for
premature infants, infants who are breastyfed exclusively beyond the first 6 months of
age, and infants who begin drinking cow's milk prior to 1 year of age.
✔✔Which item is NOT implicated in erectile dysfunction (ED)? - ✔✔Urinary tract
infection (UTI)
Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can
result in ED> Many medications can cause ED, particularly the antihypertensives
(Vasotec) and the antidepressants (Paxil). Other activities like heavy smoking, drug
abuse, and alcoholism can also lead to ED.
✔✔Expected spriometry readings when the patient has chronic emphysema include: -
✔✔Increased total lung capacity (TLC).
Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and
total lung capacity is increased with emphysema. RV, VC, and FEV-1 spirometry
readings are the same whether COPD is due to chronic emphysema or chronic
bronchitis, however, TLC is normal or only slightly increased with chronic bronchitis.
✔✔Physical exam findings consistent with emphysema include all of the following
EXCEPT: - ✔✔pallor and cyanosis of the mucosa and nailbeds.
, Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_.
Emphysema (Type A COPD, the "pink puffer") is not associated with pallor or cyanosis.
Increased AP dianeter produces a "barrel chest". The normal chest is elliptical whereas
the barrel chest is round. The muscles of the thorax appear thin and wasted while the
accessory muscles of respiration are hypertrophied. Breath sounds are minished and
cough is weak and ineffective.
✔✔Which laboratory test is useful in the diagnosis of spontaneous abortion? - ✔✔Serial
quantitative beta-huma chorionic gonadotropin levels.
Serial quantitative beta-human chorionic gonadotropin levels are the most useful for
diagnosing spontaneous abortion. The levels progressively decline.
✔✔The most acceoted recommendation regarding skin cancer prevention is: -
✔✔avoidance of excessive sun exposure.
Avoidance of excessive sun exposure is the most accepted recommendation for
prevention of skin cancer. All the other items are recommended by particular groups,
but are not as widely accepted. Clinicians should remain alert for suspicious lesions in
fair-skinned men and women >65 years, those with atypical moles, those with > 50
moles. These groups have a substantially increased risk for melanoma.
✔✔What prophylaxis medication is recommended for the patient under 35 years of age
with a positive ppd? - ✔✔isoniazid (INH)
The CDC recommends administration of isoniazid to persons under 35 years of age
with a positive PPD. The goal of this treatment is to prevent progression from latent
infection to active infection. The other medications are used to treat active TB, but not
for prophylaxis.
✔✔The diagnosis of Meniere's disease is based on: - ✔✔The exclusion of other
pathologies.
Most cases of Meniere's disease are idiopathic and the diagnosis is based on the
exclusion of other pathologies. Central vertigo is present with many vestibular problems.
Low frequency hearing loss is more commonly associated with Meniere's disease. MRI
is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease.
✔✔The reason beta-adrenergic blockers should be avoided in patients with diabetes is
because they may: - ✔✔Mask symptoms of hypoglycemia.
Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and
tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on
betablockers should be taught to look for this specific symptom as a possible indication
of hypoglycemia.
✔✔An adult female patient is seeking information about her ideal weight. She is 5 feet 7
inches tall. Using the "height-weight formula" what is her ideal body weight? - ✔✔135
lbs
✔✔A patient has been diagnosed with hypothyroidism and thyroid hormone
replacement therapy is prescribed. When should the nurse practitioner check the
patient's TSH? - ✔✔6 weeks.
The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days.
The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the
NP should wait a minimum of 4-6 weeks before checking the patient's TSH.
✔✔A 15 yo malue has a history of cryptorchidism which was surgically repaired.
Because of this information, it is essential for the nurse practitioner to teach him about: -
✔✔testicular self-examination.
Cryptorchidism, even with surgical repair, is associated with increased risk for testicular
cancer.
✔✔The treatment of choice for chronic bacterial prostatitis (CBP) is: - ✔✔a
flouroquinolone twice daily for 3 weeks to 4 months.
The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The
cure rate with Bactrim-DS is only about 30-40%.
✔✔A 25 yo female has a history of frequent candidal vaginal infections in the past year.
She is in a monogamous sexual relationship and uses and IUD for contraception. Of the
following, which is the most likely underlying conidition predisposing her to recurring
candidal vaginitis? - ✔✔Diabetes.
A common underlying cause of frequent infections is diabetes mellitus. Pregnancy
increases the incidence of candidiasis, but is unlikely a factor with this patient.
✔✔Which of the following is NOT a characteristic of the S3 heart sound? - ✔✔The
sound is high-pitched and occurs just prior to the S1 heart sound.
The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is
produced by rapid ventricular filling and is best auscultated in the mitral area. It is a
common finding with right-sided heart failure, rapid growth, and the last trimester of
pregnancy.
✔✔Following the finding of prostate gland abnormalities on DRE, the NP orders the
appropriate labs. Whem preparing to review lab reports with the patient, the nurse
practitioner knows all of the following are true EXCEPT: - ✔✔normal PSA is 10ng/ml or
less.
Normal PSA is 4ng/ml or less. PSA levels greater the 4 and less than 10 are associated
with BPH. A 10 or greater PSA level suggests prostate cancer. Positive serum acid
phosphatase is associated with malignancy of the prostate gland with bone metasasis.
,✔✔A 66 yo female presents to your clinic. She states that yesterday evening she had
chest pain for 20-30 minutes. Which finding most strongly correlates with myocardial
infarction? - ✔✔Elevated Troponin I levels
An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK
may be elevated from an IM injection, surgery, ot any type of extensive skeletal muscle
trauma or prolonged, strenuous physical exertion. ST segment depression on EKG
usually indicates an ischemic myocardium, but, not necessarily, one post-MI. Elevated
ST seghments reflect mycardial damage. MB bands are specific for myocardial smooth
muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most
accurate marker of cardiac damage, because it is more specific and sensitive than CK
MB, is a troponin measurement.
✔✔What is a secondary cause of hyperlipidemia? - ✔✔hypothyroidism
Hypothyroidism is a common secondary cause of hyperlipidemia. In the evaluation of a
patient with hyperlipidemia, a TSH should always be checked and corrected before
attempting treatment for hyperlipidemia. Other possible causes of seconday
hyperlipidemia include pregnancy, excessive weight gain, excessive alcohol intake,
insulin resistance or deficiency, obstructive liver disease, and uremia. Some
medications can produce secondary hypothyroidism too: thiazide diuretics, some beta-
blockers, oral contraceptives, and corticosteroids.
✔✔A 35-yo male presents with a complaint of low pelvic pain, dysuria, hesitancy,
urgency, and reduced for of stream. The nurse practitioner suspects acute bacterial
prostatitis. The NP would appropriately collect all of the following specimens EXCEPT a:
sterile in-and-out catheter urine specimen. - ✔✔A sterile in-and-out catheter specimen
would identify only organisms in the bladder and would not differentiate between
bladder, kidney, or prostate site infection. The sequence for obtaining specimens when
prostat infection is suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder
urine, and 3. voided post-prostate massage urine.
✔✔A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should
the nurse practitioner advise her to do to minimize her risk of pregnancy? - ✔✔Double
today's dose and tomorrow's dose and use a barrier method for the rest of the month.
If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled
and a barrier method recommended for the remainder of the cycle.
✔✔A 50yo, non-smoker, with no co-morbidity presents to the clinica and is diagnosed
with pna. His vital signs are normal except for temperature of 101.6 degrees. A sputum
specimen is collected and sent for culture and sensitivity. What action should the nurse
practitioner take today? - ✔✔Start Clarithromycin (Biaxin) 500mg 2 times a day for 10 to
14 days.
Most treatment guidelines for outpatient pna in non-smokers without co-morbidity and
60 years of age or younger, recommend erythromycin or another macrolide like Biaxin.
Pcn s indicated for patient swith pneumococcal pna and ciprofloxacin is recommended
for Legionella species.
,✔✔A 38 year old patient is being treated the by the NP for heavy vaginal bleeding
secondary to multiple uterine leiomyomas. Her uterus is greater than 12 weeks
gestational size, her hematocrit is 28%, and she has not responded to hormonal
therapy. Which of the following would be the most appropriate intervention at this time?
- ✔✔Obtain a gynecological consultation
Gynecological consultation is recommended for a patient with a uterus greater that 12
weeks gestational size, significant anemia (hct <30),. o a normal endometrial biopsy
with failure to respond to hormonal therapy.
✔✔What maternal situation is considered an absolute contraindication to
breastfeeding? - ✔✔Early HIV detection
There are few absolute contraindications to breastfeeding. HIV infection and IV drug
abuse are 2 contraindications.
✔✔A 21 yo college student presents to the sudent health center with copious, markedly
purulent discharge from her left eye. The nurse practitioner should suspect: -
✔✔gonococcal conjunctivitis.
A purulent and copious discharge should alert the nurse practitioner to the likely
possibility of gonococcal or chlamydial conjunctivitis. Noth require systemic anitbiotic
treatment and immediate referral to an opthalmologist for evaluation.
✔✔Babies should begin oral iron supplementation: - ✔✔4-6 months of age.
Generally, full term infants who are breadt-fed have sufficient stores of iron to last
through the first 4-6 months of life. Earlier supplementation may be m=necessary for
premature infants, infants who are breastyfed exclusively beyond the first 6 months of
age, and infants who begin drinking cow's milk prior to 1 year of age.
✔✔Which item is NOT implicated in erectile dysfunction (ED)? - ✔✔Urinary tract
infection (UTI)
Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can
result in ED> Many medications can cause ED, particularly the antihypertensives
(Vasotec) and the antidepressants (Paxil). Other activities like heavy smoking, drug
abuse, and alcoholism can also lead to ED.
✔✔Expected spriometry readings when the patient has chronic emphysema include: -
✔✔Increased total lung capacity (TLC).
Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and
total lung capacity is increased with emphysema. RV, VC, and FEV-1 spirometry
readings are the same whether COPD is due to chronic emphysema or chronic
bronchitis, however, TLC is normal or only slightly increased with chronic bronchitis.
✔✔Physical exam findings consistent with emphysema include all of the following
EXCEPT: - ✔✔pallor and cyanosis of the mucosa and nailbeds.
, Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_.
Emphysema (Type A COPD, the "pink puffer") is not associated with pallor or cyanosis.
Increased AP dianeter produces a "barrel chest". The normal chest is elliptical whereas
the barrel chest is round. The muscles of the thorax appear thin and wasted while the
accessory muscles of respiration are hypertrophied. Breath sounds are minished and
cough is weak and ineffective.
✔✔Which laboratory test is useful in the diagnosis of spontaneous abortion? - ✔✔Serial
quantitative beta-huma chorionic gonadotropin levels.
Serial quantitative beta-human chorionic gonadotropin levels are the most useful for
diagnosing spontaneous abortion. The levels progressively decline.
✔✔The most acceoted recommendation regarding skin cancer prevention is: -
✔✔avoidance of excessive sun exposure.
Avoidance of excessive sun exposure is the most accepted recommendation for
prevention of skin cancer. All the other items are recommended by particular groups,
but are not as widely accepted. Clinicians should remain alert for suspicious lesions in
fair-skinned men and women >65 years, those with atypical moles, those with > 50
moles. These groups have a substantially increased risk for melanoma.
✔✔What prophylaxis medication is recommended for the patient under 35 years of age
with a positive ppd? - ✔✔isoniazid (INH)
The CDC recommends administration of isoniazid to persons under 35 years of age
with a positive PPD. The goal of this treatment is to prevent progression from latent
infection to active infection. The other medications are used to treat active TB, but not
for prophylaxis.
✔✔The diagnosis of Meniere's disease is based on: - ✔✔The exclusion of other
pathologies.
Most cases of Meniere's disease are idiopathic and the diagnosis is based on the
exclusion of other pathologies. Central vertigo is present with many vestibular problems.
Low frequency hearing loss is more commonly associated with Meniere's disease. MRI
is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease.
✔✔The reason beta-adrenergic blockers should be avoided in patients with diabetes is
because they may: - ✔✔Mask symptoms of hypoglycemia.
Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and
tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on
betablockers should be taught to look for this specific symptom as a possible indication
of hypoglycemia.
✔✔An adult female patient is seeking information about her ideal weight. She is 5 feet 7
inches tall. Using the "height-weight formula" what is her ideal body weight? - ✔✔135
lbs
