9|Page
inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency.
Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection.
25) The NP examines a 2-month-old with unequal gluteal and thigh skin folds. What should the
NP do next?
a. Send the infant for x-ray of the hips
b. Send the infant for ultrasound of the hips
c. Perform Ortolani and Barlow test
d. Examine the infant for unequal arm length
Explanation: Gluteal and thigh skin fold asymmetry may indicate congenital hip dysplasia. X-
ray studies are not useful before 3 months-of-age because the femoral head has not completely
ossified.
26) A very active 35 years old male has painful hemorrhoid, but he does not want hemorrhoidal
surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most
appropriate recommendation is for him to select food that are:
a. Low in fiber such as milk and other dairy products
b. High in simple carbohydrates such as white bread and mashed potatoes
c. High in fiber such as bran, complex carbohydrates and fresh fruit
d. High protein such a meat, poultry and fish
Explanation: Hemorrhoid disease is the most common reason patients seek evaluation by a
colon and rectal surgeon. The majority of hemorrhoids can be managed nonoperatively with
medical management or office-based procedures. Patients should benefit from minimizing
straining and avoiding constipation. Bulking of the stool facilitates this and can be accomplished
by increasing dietary fiber and fluid intake. Stool softeners may also be used.
27) Correct instructions to give new parent who are transporting their newborn infant is
a. A rear-facing infant car seat secured in the backseat is required until the infant weight 20
lbs.
b. The infant car set may be secured in the back or front seat, but must rear-facing
c. The infant car seat may be front facing when the infant is 1 year old
d. A rear or front-facing infant car seat must be secured in the back seat until the infant weight
20 lbs.
Explanation: The American Academy of Pediatrics (AAP) recommends that infants and
toddlers ride in a rear-facing seat until they are 2 years old or until they have reached the
maximum weight and height limits recommended by the manufacturer
28) A 13 y/o pt. complains that he fell while running during football practice. Now his knee
hurts and sometimes “lucks”. The NP conducts McMurrays test. Which of the following is
TRUE about this test?
a. An audible or palpated “click” is positive for a torn meniscus
b. A various stress is applied to the flexed knee
c. The straight leg is internally rotated with the patient supine and flat
d. The knee is grasped with the examiner’s fingers placed laterally.
Explanation: Mac Murray’s test is conducted while the patient is in the supine position. The NP
places the distal hand on the foot and raises the knee slowly, keeping the foot and knee externally
9
,10 | P a g e
rotated with the proximal hand resting on the join line. The knee is flexed and then quickly
straightened. If an audible or palpable click occurs during the this test, the outcome is positive
for medial meniscal injury.
29) A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels heavy but
denies pain. On examination, the NP notes transillumination of the scrotum. What is the most
likely diagnosis?
a. Hydrocele
b. Orchitis
c. Testicular torsion
d. Indirect inguinal hernia
Explanation: Hydrocele is common in newborns and usually disappears without treatment
within the first year. Older men can develop hydroceles, sometimes due to inflammation or
injury. Hydroceles are usually painless, but may become large and inconvenient. An ultrasound
may be needed to diagnose the condition.
30) A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of this
information, it is essential for the NP to teach him about
a. Testicular self-examination
b. Protection of the testes during sports activities
c. Risk of testicular torsion
d. Practicing safer sex
Explanation: Cryptorchidism, even with surgical repair, is associated with increased risk for
testicular cancer.
31) A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He is
instructed in lifestyle modification, and drug initialed. Two month later, he returns and report that
he still has symptoms. The next steps are to.
a) Refer for surgical interventions such as partial or complete fundoplication.
b) Refer for endoscopy, namometry, and/or PH testing
c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications.
d) Review proper proton pump inhibitor dosing time and adherence with the patient.
Explanation: poor adherence is an importance cause of inadequate acid suppression and
refractory GERD. Determining adherence to proton pump inhibitor (PPI) therapy and
superficially timing in relation to meals, should be sought first alarm features such as iron
deficiency anemia, unexplained weight loss, and persistent vomiting would precipitate the need
for further diagnostic testing. Diagnostic testing procedures should proceed any surgical
intervention like fundoplication.
32) A 51 –year- old post-menopausal female, request guidance regarding osteoporosis risk.
The NP would be correct to recommend all of the following EXCEPT
a. Moderate weight bearing exercise 3 times per week
b. 1200 – 1500 mg calcium daily
c. Avoidance of alcoholic beverages
d. Weight loss
10
,11 | P a g e
Explanation: the recommended calcium intake is 1,200 mg – 1500 mg a day. Regular weight-
bearing and muscle-strengthening exercise reduce the risk of falls and fractures. Moderate
alcohol intake has no known negative effect on bone and may even be associated with slightly
higher bone density and lower risk of fracture in postmenopausal women. However, alcohol
intake of more than two drinks per day for women or three drinks a day for men may be
detrimental to bone health, increases the risk of falling and requires further evaluation for
possible alcoholism. In addition, Risk factors for osteoporosis include age greater than 65, white
or Asian ethnicity, cigarette smoking, inactive lifestyle, low weight and postmenopausal estrogen
deficiency including premature menopause.
33) According to Erickson, the developmental task of the elderly adult is:
a. Intimacy VS isolation
b. Ego integrity VS despair
c. Industry VS self-doubt
d. Trust Vs mistrust
explanation:
34) Moderate weight loss, particularly of visceral adipose tissue in patients with type 2 diabetes
mellitus may have all of the following beneficial effects EXCEPT:
a. Improved insulin sensitivity
b. Increased glucose uptake and utilization by the cells
c. Increase lean muscle mass’
d. Improved lipid profile
Explanation: Regular, consistent exercise is an essential part of diabetes and prediabetes
management. The ADA recommends that people with diabetes perform at least 30 minutes, 5
11
, 12 | P a g e
days/wk of a moderate-intensity aerobic physical activity. The ADA also encourages people with
type 2 diabetes to perform resistance training 3Xwk in the absence of contraindications. Exercise
contributes to weight loss, which further decreases insulin resistance. The therapeutic benefits of
regular physical activity may result in a decreased need for diabetes medications to reach target
blood glucose goals. Regular exercise may also help reduce triglyceride and low-density
lipoprotein (LDL) cholesterol levels, increase high-density lipoprotein (HDL), reduce BP, and
improve circulation. Patients who use insulin, sulfonylureas, or meglitinides are at increased risk
for hypoglycemia when they increase physical activity.
35) A 12 y/o presents with eat pain or 36 hours duration. The NP diagnoses acute otitis media
because the
a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly
b. Tympanic membrane is retracted against boy landmarks
c. Bony landmarks are obscured, and the tympanic membrane is mildly erythematous, dulls
and immobile.
d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact
Explanation: Serous otitis media typically presents with a flat or bulging and tympanic
membrane with a fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may
be immobile and retracted against the bony landmarks when the eustachian tube is swollen or
congested as with the common cold or allergies. Narrowing of the external canal with erythema
and extreme tenderness of the canal wall is indicative of otitis externa.
36) The NP should instruct the mother of an infant with thrush to:
a. Take oral nystatin since she is breastfeeding
b. Stop breast feeding until the thrush has resolved
c. administer antifungal medication to the infant prior to feeding
d. sterilized pacifiers and bottle nipples
explanation: Most bouts of oral thrush occur for no apparent reason. However, regularly
sterilization of pacifiers, bottles-feed and other mouth toys used by the baby may help to prevent
some bouts.
37) A 26 y/o patient, 18 weeks pregnant with twins, has been healthy and has followed
recommendations of her nurse midwife. She is in the office to discuss results of her maternal
serum alpha-fetoprotein (MSAFP) test. which show elevation in this particular pregnancy?
a. Elevated MSAFPO is an indicator of Down Syndrome
b. Low MSAFP is expected at 18 weeks’ gestation
c. Neural tube defects are highly probable
d. Elevated MSAFP is an expected finding
Explanation: elevated maternal serum alfa Protein is expected when a woman is pregnant with
twins. An elevation can also be an indication of a miscalculated due date. Low levels can indicate
Down Syndrome
12
inflammation. Cancerous nodes frequently are larger, non-tender, and stone-like in consistency.
Nodes are pea-sized, non-tender, mobile, discrete and reflect pre-existent infection.
25) The NP examines a 2-month-old with unequal gluteal and thigh skin folds. What should the
NP do next?
a. Send the infant for x-ray of the hips
b. Send the infant for ultrasound of the hips
c. Perform Ortolani and Barlow test
d. Examine the infant for unequal arm length
Explanation: Gluteal and thigh skin fold asymmetry may indicate congenital hip dysplasia. X-
ray studies are not useful before 3 months-of-age because the femoral head has not completely
ossified.
26) A very active 35 years old male has painful hemorrhoid, but he does not want hemorrhoidal
surgery at this time. His diet has been indiscriminate as his job requires frequent travel. The most
appropriate recommendation is for him to select food that are:
a. Low in fiber such as milk and other dairy products
b. High in simple carbohydrates such as white bread and mashed potatoes
c. High in fiber such as bran, complex carbohydrates and fresh fruit
d. High protein such a meat, poultry and fish
Explanation: Hemorrhoid disease is the most common reason patients seek evaluation by a
colon and rectal surgeon. The majority of hemorrhoids can be managed nonoperatively with
medical management or office-based procedures. Patients should benefit from minimizing
straining and avoiding constipation. Bulking of the stool facilitates this and can be accomplished
by increasing dietary fiber and fluid intake. Stool softeners may also be used.
27) Correct instructions to give new parent who are transporting their newborn infant is
a. A rear-facing infant car seat secured in the backseat is required until the infant weight 20
lbs.
b. The infant car set may be secured in the back or front seat, but must rear-facing
c. The infant car seat may be front facing when the infant is 1 year old
d. A rear or front-facing infant car seat must be secured in the back seat until the infant weight
20 lbs.
Explanation: The American Academy of Pediatrics (AAP) recommends that infants and
toddlers ride in a rear-facing seat until they are 2 years old or until they have reached the
maximum weight and height limits recommended by the manufacturer
28) A 13 y/o pt. complains that he fell while running during football practice. Now his knee
hurts and sometimes “lucks”. The NP conducts McMurrays test. Which of the following is
TRUE about this test?
a. An audible or palpated “click” is positive for a torn meniscus
b. A various stress is applied to the flexed knee
c. The straight leg is internally rotated with the patient supine and flat
d. The knee is grasped with the examiner’s fingers placed laterally.
Explanation: Mac Murray’s test is conducted while the patient is in the supine position. The NP
places the distal hand on the foot and raises the knee slowly, keeping the foot and knee externally
9
,10 | P a g e
rotated with the proximal hand resting on the join line. The knee is flexed and then quickly
straightened. If an audible or palpable click occurs during the this test, the outcome is positive
for medial meniscal injury.
29) A 20 y/o male patient complains of “scrotal swelling”. He states his scrotum feels heavy but
denies pain. On examination, the NP notes transillumination of the scrotum. What is the most
likely diagnosis?
a. Hydrocele
b. Orchitis
c. Testicular torsion
d. Indirect inguinal hernia
Explanation: Hydrocele is common in newborns and usually disappears without treatment
within the first year. Older men can develop hydroceles, sometimes due to inflammation or
injury. Hydroceles are usually painless, but may become large and inconvenient. An ultrasound
may be needed to diagnose the condition.
30) A 15 y/o male has a hx of cryptorchidism which was surgically repaired. Because of this
information, it is essential for the NP to teach him about
a. Testicular self-examination
b. Protection of the testes during sports activities
c. Risk of testicular torsion
d. Practicing safer sex
Explanation: Cryptorchidism, even with surgical repair, is associated with increased risk for
testicular cancer.
31) A pt. present with classic symptoms of gastroesophageal reflux diseases’ (GERD). He is
instructed in lifestyle modification, and drug initialed. Two month later, he returns and report that
he still has symptoms. The next steps are to.
a) Refer for surgical interventions such as partial or complete fundoplication.
b) Refer for endoscopy, namometry, and/or PH testing
c) Repeat the 8*-week course of drug therapy while continuing lifestyles modifications.
d) Review proper proton pump inhibitor dosing time and adherence with the patient.
Explanation: poor adherence is an importance cause of inadequate acid suppression and
refractory GERD. Determining adherence to proton pump inhibitor (PPI) therapy and
superficially timing in relation to meals, should be sought first alarm features such as iron
deficiency anemia, unexplained weight loss, and persistent vomiting would precipitate the need
for further diagnostic testing. Diagnostic testing procedures should proceed any surgical
intervention like fundoplication.
32) A 51 –year- old post-menopausal female, request guidance regarding osteoporosis risk.
The NP would be correct to recommend all of the following EXCEPT
a. Moderate weight bearing exercise 3 times per week
b. 1200 – 1500 mg calcium daily
c. Avoidance of alcoholic beverages
d. Weight loss
10
,11 | P a g e
Explanation: the recommended calcium intake is 1,200 mg – 1500 mg a day. Regular weight-
bearing and muscle-strengthening exercise reduce the risk of falls and fractures. Moderate
alcohol intake has no known negative effect on bone and may even be associated with slightly
higher bone density and lower risk of fracture in postmenopausal women. However, alcohol
intake of more than two drinks per day for women or three drinks a day for men may be
detrimental to bone health, increases the risk of falling and requires further evaluation for
possible alcoholism. In addition, Risk factors for osteoporosis include age greater than 65, white
or Asian ethnicity, cigarette smoking, inactive lifestyle, low weight and postmenopausal estrogen
deficiency including premature menopause.
33) According to Erickson, the developmental task of the elderly adult is:
a. Intimacy VS isolation
b. Ego integrity VS despair
c. Industry VS self-doubt
d. Trust Vs mistrust
explanation:
34) Moderate weight loss, particularly of visceral adipose tissue in patients with type 2 diabetes
mellitus may have all of the following beneficial effects EXCEPT:
a. Improved insulin sensitivity
b. Increased glucose uptake and utilization by the cells
c. Increase lean muscle mass’
d. Improved lipid profile
Explanation: Regular, consistent exercise is an essential part of diabetes and prediabetes
management. The ADA recommends that people with diabetes perform at least 30 minutes, 5
11
, 12 | P a g e
days/wk of a moderate-intensity aerobic physical activity. The ADA also encourages people with
type 2 diabetes to perform resistance training 3Xwk in the absence of contraindications. Exercise
contributes to weight loss, which further decreases insulin resistance. The therapeutic benefits of
regular physical activity may result in a decreased need for diabetes medications to reach target
blood glucose goals. Regular exercise may also help reduce triglyceride and low-density
lipoprotein (LDL) cholesterol levels, increase high-density lipoprotein (HDL), reduce BP, and
improve circulation. Patients who use insulin, sulfonylureas, or meglitinides are at increased risk
for hypoglycemia when they increase physical activity.
35) A 12 y/o presents with eat pain or 36 hours duration. The NP diagnoses acute otitis media
because the
a. Tympanic membrane is bulging and glossy with tiny bubbles visible posteriorly
b. Tympanic membrane is retracted against boy landmarks
c. Bony landmarks are obscured, and the tympanic membrane is mildly erythematous, dulls
and immobile.
d. Canal is narrowed, erythematous, and exquisitely tender with speculum contact
Explanation: Serous otitis media typically presents with a flat or bulging and tympanic
membrane with a fluid line and/or tiny bubbles visible posteriorly. The tympanic membrane may
be immobile and retracted against the bony landmarks when the eustachian tube is swollen or
congested as with the common cold or allergies. Narrowing of the external canal with erythema
and extreme tenderness of the canal wall is indicative of otitis externa.
36) The NP should instruct the mother of an infant with thrush to:
a. Take oral nystatin since she is breastfeeding
b. Stop breast feeding until the thrush has resolved
c. administer antifungal medication to the infant prior to feeding
d. sterilized pacifiers and bottle nipples
explanation: Most bouts of oral thrush occur for no apparent reason. However, regularly
sterilization of pacifiers, bottles-feed and other mouth toys used by the baby may help to prevent
some bouts.
37) A 26 y/o patient, 18 weeks pregnant with twins, has been healthy and has followed
recommendations of her nurse midwife. She is in the office to discuss results of her maternal
serum alpha-fetoprotein (MSAFP) test. which show elevation in this particular pregnancy?
a. Elevated MSAFPO is an indicator of Down Syndrome
b. Low MSAFP is expected at 18 weeks’ gestation
c. Neural tube defects are highly probable
d. Elevated MSAFP is an expected finding
Explanation: elevated maternal serum alfa Protein is expected when a woman is pregnant with
twins. An elevation can also be an indication of a miscalculated due date. Low levels can indicate
Down Syndrome
12
