1. D: A patient currently undergoing concurrent chemotherapy/radiation treatment
for glottic squamous cell carcinoma is admitted to the rehab unit you oversee for
management of intractable nausea, vomiting, and dehydration. Admission CBC
showed WBC 1.3, Hgb 7.5, PLT 45, ANC 0.8. Which of the following conditions is
this patient at risk for?
A. Macrocytic anemia due to B12 deficiency
B. Iron deficiency anemia due to chronic blood loss
C. Microcytic anemia due to chronic kidney disease
D. Aplastic anemia due to bone marrow suppression
2. C: Your patient presents to the urgent care clinic with a swollen exudative pharynx,
profound fatigue, and a very tender left upper quadrant abdomen. What is the most
likely diagnosis?
A. Strep pharyngitis
B. Tonsillitis
C. Epstein Barr virus (EBV)
D. Pancreatitis
3. B: Which of the following best characterizes presbycusis in the older adult?
A. Bilateral low-frequency sensorineural hearing loss
B. Bilateral high-frequency sensorineural hearing loss
C. Unilateral high-frequency sensorineural hearing loss
D. Unilateral low-frequency sensorineural hearing loss
4. C: A 35-year-old woman presents with allergic rhinitis, experiencing significant
nasal congestion, sneezing, and itchy eyes. She has tried over-the-counter antihis-
tamines with limited relief. What is the most appropriate next step in management?
A. Oral decongestants
B. Nasal saline irrigation
C. Intranasal corticosteroids
D. Referral to an allergist for immunotherapy
5. D: A patient currently undergoing concurrent chemotherapy/radiation treatment
for glottic squamous cell carcinoma is admitted to the rehab unit you oversee for
management of intractable nausea, vomiting, and dehydration. Admission CBC
showed WBC 1.3, Hgb 7.5, PLT 45, ANC 0.8. Which of the following conditions is
this patient at risk for?
A. Iron deficiency anemia due to chronic blood loss
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B. Microcytic anemia due to chronic kidney disease
C. Macrocytic anemia due to B12 deficiency
D. Aplastic anemia due to bone marrow suppression
6. B: A 78 y.o. M patient reports chronic infections, bruising, fatigue, SOB, and fevers.
He has a history of rectal adenocarcinoma and completed concurrent chemother-
apy/radiation earlier this year. His CBC shows Hgb 7.5, PLT 88, WBC 1.2, ANC
0.8, and peripheral smear shows dysplasia. What additional work-up would you
anticipate for this patient?
A. Colonoscopy and fecal occult blood test
B. Bone marrow biopsy and flow cytometry
C. No additional work-up is required, these are expected sequela of his oncologic
treatment
D. Repeat CBC/CMP/peripheral smear in eight weeks
7. D: Progression to Acute Myelogenous Leukemia (AML) is a risk for untreated or
poorly responsive:
A. Pancytopenia
B. Aplastic anemia
C. Macrocytic anemia
D. Myelodysplastic syndrome
8. D: Treatment for symptomatic aplastic anemia includes all the following except:
A. Bone marrow transplant
B. PRBC/Platelet/WBC transfusions
C. Prophylactic antibiotics
D. Removal of bone marrow stimulants
9. A: A patient diagnosed with iron deficiency anemia requires iron supplementation.
Which of the following treatments would likely be ineffective?
A. Ferrous sulfate 325 mg PO BID for a 43 y.o. F s/p gastric bypass 2 years ago
B. Iron sucrose 200 mg IV infusion weekly x 8 weeks in a 26 y.o. F at 34 weeks of
pregnancy
C. Ferrous sulfate 325 mg PO TID for a 25 y.o. F with menorrhagia
D. Ferrous sulfate 325 mg PO BID for a 63 y.o. M with ulcerative colitis
10. C: Which of the following is not a common mechanism of neutrophil expenditure
and resultant neutropenia?
A. Decreased neutrophil production in the bone marrow
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B. Redistribution of neutrophils to the spleen or vascular endothelium
C. Loss of circulating neutrophils in acute blood loss
D. Immune destruction
11. C: Which of the following blood lead levels (BLL) would likely require chelation
therapy?
A. < 80 mcg/dL
B. 35 mcg/dL
C. >100 mcg/dL
D. 75 mcg/dL
12. D: A geriatric patient with anemia, back pain, osteoporosis, and elevated ery-
throcyte sedimentation rate should be evaluated for:
A. cauda equina syndrome.
B. renal dystrophy.
C. Paget's disease.
D. multiple myeloma.
13. D: Overactivation of coagulation and fibrinolysis resulting in thrombosis and
hemorrhage is a trademark of which of the following?
A. Thrombocytopenia
B. Aplastic anemia
C. Myelodysplastic syndrome
D. Disseminated intravascular coagulation
14. B: A patient on warfarin (Coumadin) therapy for recurrent deep vein thrombosis
(DVT) is about to have lumbar spinal fusion surgery. The patient's warfarin is put on
hold starting 5 days prior to the surgery and subcutaneous enoxaparin (Lovenox)
has been ordered for DVT prophylaxis until the resumption of the warfarin. The nurse
practitioner knows that the patient's postoperative warfarin dose should be restarted
based on the:
A. Value of her morning Prothrombin time
B. baseline PT and INR values
C. target INR of 2.5
D. Loading dose of 20 mg, plus the previous warfarin dose
15. B: Your patient presented yesterday to urgent care with symptoms of lower
extremity weakness and then went home for observation with family. They have
returned to urgent care, and it now appears to be affecting the patient's abdomen in
just the past few hours. What is your priority intervention?
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A. Order physical therapy evaluation and treatment
B. Immediate transportation to the hospital and monitor for airway involvement
C. Apply oxygen via nasal cannula
D. Assess muscular strength in bilateral lower extremities
16. A: Which of the following is a common symptom of Systemic Lupus Erythemato-
sus (SLE)?
A. Joint pain and swelling
B. Frequent urination and thirst
C. Sudden weight gain and high blood pressure
D. Persistent cough and shortness of breath
17. B: Patients with Stevens-Johnson syndrome should be managed by which of the
following mechanisms?
A. With negative pressure isolation due to contagious nature of SJS
B. Similarly to burn patients due to loss of fluid volume
C. Similarly to heart surgery patients due to risk of hypervolemia
D. With off floor privileges to encourage mobility and retaining muscle mass
18. B: Which of the following categories of medication are not likely to be included
in the medication regimen for a patient with HIV?
A. NRTIs
B. Protease antagonists
C. NNRTIs
D. Protease inhibitors
19. A: A patient who has active herpes zoster is at risk of shedding which contagious
virus?
A. Varicella zoster
B. Herpes simplex virus -2
C. Herpes simplex virus -1
D. Shingles
20. A: Your patient presents with painless lymph node swelling, weight loss, night
sweats, and asks what is wrong with him. Which of the following represents a most
appropriate intervention to confirm a diagnosis of lymphoma?
A. Order a core needle biopsy
B. Order a CBC and TSH