NR667 - FNP Capstone Week 1 Full Length Practice Exam/150 Questions and Answers 100% Correct

This NR667 – FNP Capstone Week 1 Full-Length Practice Exam contains 150 expertly crafted questions with verified correct answers, covering the full spectrum of advanced family practice nursing. Content areas include cardiology, endocrine disorders, diabetes management, geriatrics, women’s health, GI disorders, respiratory care, emergency scenarios, and primary-care decision-making. Ideal for FNP students preparing for end-of-program exams, boards, or clinical competency assessments, this comprehensive set tests real-world judgment using scenario-based questions, evidence-based guidelines, and updated management standards. Perfect for fast revision, self-evaluation, and boosting exam confidence. Week 1 Full Length Practice Exam Due Sep 8 at 11:59pm Points 150 Questions 150 Available Sep 2 at 12am - Sep 8 at 11:59pm Time Limit 180 Minutes Attempt History Attempt Time Score LATEST Attempt 1 171 minutes 144 out of 150 Score for this quiz: 144 out of 150 Submitted Sep 8 at 8:23pm This attempt took 171 minutes.  Question 1 1 / 1 pts Effective long-term treatment of systolic heart failure with reduced ejection fraction should include which of the following? Correct! Prescribing valsartan/sacubitril (Entresto) unless contraindicated on discharge Angiotensin Receptor and Neprilysin Inhibition is considered goal-directed therapy for patients with reduced systolic heart function as evidence by the PARAGON-HF Trial. Auscultation is an assessment item, not a treatment. Midazolam does not have any long term benefit for heart failure. Fluid bolus in a patient with likely fluid overload from systolic heart failure only worsen their presenting symptoms. Prescribing 500 ml fluid bolus for hypotension Auscultating lung sounds for rhonchi Prescribing midazolam to aid with air hunger  Question 2 1 / 1 pts A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and shortness of breath. His ECG shows ST-segment elevation. What is the initial management response? Administer nitroglycerin sublingually Start intravenous heparin Perform immediate coronary angiography Correct! Administer aspirin and call for emergency medical services  Question 3 0 / 1 pts An 80-year-old man with a history of atrial fibrillation presents with sudden-onset unilateral leg pain and pallor. What is the most likely diagnosis? You Answered Deep vein thrombosis Correct Answer Acute arterial occlusion Cellulitis Peripheral artery disease  Question 4 1 / 1 pts An older adult female presents for her annual examination. She has been on antihypertensive medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse practitioner is concerned about the patient’s cardiac health risks, due her to weight and her waist circumference. According to the AHA guidelines, which of the following goals is expected for this patient? Physical activity for 60 minutes daily, 7 days a week Correct! Physical activity for 30 minutes daily, for a minimum of 5 days a week Physical activity for 30 minutes daily, 7 days a week Physical activity for 60 minutes daily, for a minimum of 6 days a week  Question 5 1 / 1 pts Recommendation for lipid check in adolescent with type 1 DM? 10 years 5 years 2 years Correct! 1 year Remember than with pediatric patients with diabetes, the easiest way to remember the evaluation schedule is to perform lipid checks is with annual physicals.  Question 6 1 / 1 pts An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0. The patient goes to a clinic for INR determination, and the result is 1.4. Which of the following would be likely to decrease the effects of warfarin (Coumadin)? Red Wine Red meat Correct! Broccoli Grapefruit It’s important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist, and therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K. Leafy green vegetables such as broccoli and spinach are notorious for increasing vitamin K levels, and therefore inhibiting the anticoagulation effect of warfarin. It’s also important to remember that with the direct oral anticoagulants category, vitamin K is not affected, and therefore no dietary restrictions are required for this class of medications such as apixaban, rivaroxaban, and edoxaban, which is a distinct benefit over warfarin as noted above. Also, with warfarin it is important to remember that the effects are based on the free drug, not the protein bound drug level, so patients who have considerable protein stores will require more warfarin than those who are emaciated or have low protein levels chronically. With respect to this particular question, red wine and grapefruit do not have an effect of lowering the INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically causes warfarin levels to rise through the CYP 450 system, and red wine causes the INR to increase by thinning the blood and and red meat is not likely to have a considerable impact, although it might have some impact if the protein stores are otherwise low prior to initiating the red meat in the diet. Broccoli is the only option that has vitamin K and should be an obvious choice for this question.  Question 7 1 / 1 pts A patient has been complaining of palpitations for the past week and presents to you at an urgent care clinic for evaluation. You perform a 12 lead EKG and identify atrial fibrillation with a hear rate of 122 beats per minute. What is your next order? Administer 5mg of warfarin Correct! Order a stat transthoracic (2D) echocardiogram and prepare the patient for transport to the closest appropriate hospital for inpatient evaluation A wearable monitor does not provide you with actionable information until it is read, and the patient is already identified as being in atrial fibrillation. Warfarin without bridging will take several days to achieve a therapeutic INR and without bridging (as it is not mentioned) would potentially increase prothrombotic state for first few days due to inhibition of protein C and S. Amiodarone is a rhythm conversion medication and should not be given unless first identifying any evidence of clot burden with an echocardiogram. Apply a Holter monitor Administer 150mg of amiodarone IV bolus  Question 8 1 / 1 pts As the nurse practitioner working in a primary care clinic, you have been notified from a hospitalist that your long-term patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection fraction of 40% two years ago who is also not on optimal medical therapy has been diagnosed with a myocardial infarction this admission and received emergent placement of a drug-eluting stent to the left anterior descending artery. As the patient’s medical home who will manage this patient after discharge, which of the following would you expect to be a priority in the patient’s care for their heart failure after an acute MI? Ordering a Holter monitor for 7 days post-discharge Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than 45% Ordering aspirin and clopidogrel for 3 months at discharge Correct! Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than 35% Dual anti-platelet therapy is required for 12 months minimum post-MI. A Holter monitor does not provide any conceivable benefit for this patient as presented. The patient should have a protective mechanism such as an implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due to the increased risk of sudden cardiac death with low EF states. Since most patients are not eligible for 90 days for an AICD in this state, optimizing their medication regimen and repeating an echo in 2-3 months to re-evaluate for improvement in their EF is required by most insurance companies. A baseline echo is needed at discharge to provide a baseline for improvement vs their repeat echo in 2-3 months.  Question 9 1 / 1 pts An older adult with diabetes mellitus presents with leg cramps. She states that the cramps as worst when walking to the supermarket. If she stops to rest, the pain subsides. The nurse practitioner knows that this patient needs a workup for: Deep vein thrombosis Benign nocturnal leg cramps Correct! Intermittent claudication Popliteal aneurism  Question 10 1 / 1 pts A 65-year-old woman presents for a follow-up examination. She is a smoker, and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse practitioner should start the patient on: Correct! a statin drug. a cholesterol absorption inhibitor. low-dose aspirin. bile acid sequestrant. Bile acid sequestrants and cholesterol absorption inhibitors may be useful in reducing ASVD risk, but for a patient who is an active smoker with premature coronary disease history (less than age 65 for women), has hypertension and is far from an LDL goal, this patient is most certainly a candidate for statin therapy, which represents the most aggressive therapy option of these four listed.  Question 11 1 / 1 pts Which of the following is at highest risk for type II diabetes? A 51-year-old black female with a BMI of 22 who walks daily at least 30 minutes Correct! An adult woman with a BMI of 34 who just delivered a baby weighing 10 lbs A 77-year-old Caucasian male with a BMI of 27 who is sedentary A 63-year-old Hispanic male with a BMI of 23 who works as a carpenter Of these options, an adult woman with a BMI of 34 who just delivered a baby weighing 10 lbs is the most likely due to their increased BMI and the large size of the baby. giving birth to a large baby, also known as a large-for-gestational-age (LGA) baby, can increase the risk of developing type 2 diabetes later in life. Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14 years after pregnancy compared to women who give birth to babies of average gestational age (AGA). This increased risk is even after adjusting for other risk factors, such as age, obesity, high blood pressure, and family history of diabetes.  Question 12 1 / 1 pts A 50-year-old woman with hypertension and diabetes comes in for a routine check-up. What screening test should be regularly performed to monitor for early signs of diabetic nephropathy? Renal biopsy Serum electrolyte panel Correct! Urine dipstick for protein Abdominal CT scan The most sensitive indicator of diabetic nephropathy would be the evidence of small proteins in the urine (proteinuria) as found on urinalysis. The other options might describe macro-organ function (such as BUN/Creat from a BMP, a renal biopsy which is not indicated for routine diabetic nephropathy testing, and a Abd CT, which is more akin to evaluation of less subtle findings), but at the functional level of the nephron, namely the glomerulus, evidence of glucose-related damage is easily identified with proteinuria from a UA.  Question 13 1 / 1 pts All the following are factors associated with a development of type II diabetes EXCEPT: weight greater than 20% of ideal body weight Correct! peripheral vascular disease positive family history delivering an infant greater than 9 lbs. Having peripheral vascular disease does not have correlation to development of DM2, whereas all the other options do.  Question 14 1 / 1 pts A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine Correct! 25 mcg 100 mcg 75 mcg 125 mcg The widely considered best practice for treatment of hypothyroidism in the elderly is to "go slow and start low". 25 mcg is the most appropriate low dose to start with of these options. It is possible that over time the dose will be increased until therapeutic levels are obtained, but the risk of over-dosing the patient outweighs the desire to quickly achieve this state.  Question 15 1 / 1 pts Patients on levothyroxine should be monitored for signs of: Correct! Angina pectoris and dysrhythmias Increased nausea and constipation Ankle edema and discomfort Memory deficits and hyperreflexia The risk of any supplementation is OVER-supplementation and of the potential options, angina pectoris and dysrhythmias are clinical symptoms associated with hyperthyroidism, or in this case over-treated hypothyroidism causing extrinsic hyperthyroid symptoms.  Question 16 1 / 1 pts A patient is evaluated in the urgent care for complications of Type 2 diabetes due to an episode of recent life stressors. All the following are consistent with HHS except: Correct! Markedly positive serum ketones Urine osmolality 380 mOsm/mL BS= 850 mg/dL Arterial pH 7.6 HHS presents with severe hyperglycemia with BS >600 and pts are more dehydrated. Ketosis is more common in DKA. Hyperosmolality is the hallmark of HHS, and the urine osmolality is typically 350-380 mOsm/mL and in DKA typically have elevated plasma osmolality. Arterial pH is suppressed in DKA <7.3 and is >7.3 in HHS  Question 17 1 / 1 pts A 40-year-old female presents with abnormal thyroid labs. Her labs show: TSH 0.25 (0.4-5.69), Free T4 1.5 (0.5-1.1), TSI antibody positive. You counsel her that: Plan to monitor her for S&S and repeat labs in 6-8 weeks She likely has autoimmune hypothyroidism and will need thyroid hormone replacement Correct! She likely has autoimmune hyperthyroidism, and a thyroid uptake scan and US may be helpful She likely has a multinodular toxic goiter Positive TSI and TRAB antibodies are consistent with Graves/hyperthyroidism. Positive TPO antibodies are consistent with Hashimoto’s/hypothyroidism.  Question 18 1 / 1 pts An adult male is seen for an initial visit. He denies tobacco, drug, or alcohol use. He has a sedentary lifestyle and no family history of diabetes. BP = 120/80, P = 76, and BMI = 31. Which of the following diabetes screening tests should the nurse practitioner order? No screening is indicated until age 45 Correct! Fasting plasma glucose Urine for glycosuria Basic metabolic panel With a sedentary lifestyle, a BMI of 31, on an initial visit establish a baseline, a fasting glucose is an appropriate response to specifically evaluate the diabetes screening for this patient.  Question 19 1 / 1 pts A 55-year-old woman presents with fatigue, hair loss, and cold intolerance. Her thyroid function tests reveal high TSH and low free T4. What is the most appropriate treatment? Radioactive iodine Beta-blockers Methimazole Correct! Levothyroxine All of these are clinical features of hypothyrodism. The only appropriate answer to augment thyroid levels is levothyroxine. Methimazole and radioactive iodine both directly antagonize thyroid levels and are used in the treatment of hyperthyroidism. Beta blockers, namely propranalol is used for the symptom management of hyperthyroidism (tremors, tachycardia, anxiety).  Question 20 1 / 1 pts A 33-year-old woman presents with irregular menstrual cycles, hirsutism, and obesity. Laboratory tests reveal elevated serum testosterone and LH ratio > 2:1. What is the most appropriate initial treatment? Correct! Oral contraceptives Spironolactone Metformin Clomiphene These are classic symptoms of polycystic ovarian syndrome and the patient should be treated with oral contraceptives to help stabilize their estrogen and progesterone. Additionally, they may be managed on metformin and/or spironolactone for their PCOS. Oral contraceptive pills (OCPs) are often the first pharmacological treatment for polycystic ovary syndrome (PCOS) because they help manage in several ways: Menstrual irregularities: OCPs can help regulate menstrual cycles, making periods lighter and more regular. This is important because irregular ovulation can lead to endometrial hyperplasia, which is a buildup of uterine tissue that can increase the risk of uterine cancer. Androgen excess: OCPs can reduce androgen production and increase sex hormone-binding globulin (SHBG), which binds androgens. This can help reduce symptoms like acne, hirsutism (unwanted body and facial hair), and androgenic alopecia (male pattern baldness). Endometrium protection: OCPs can protect the endometrium by ensuring regular ovulation  Question 21 1 / 1 pts A 90-year-old female is brought to the clinic by her neighbor. She states that everything is fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk. The neighbor is concerned that the patient often has no money to buy food, despite income from social security and a coal miner’s pension. The nurse practitioner suspects abuse. Which of the following is the nurse practitioner obligated to do next? Document the data and report the information to risk management. Call the patient’s family and inquire about the concerns. Tell the neighbor to check on the woman daily and report back. Correct! Report the case to the proper authorities. Remember, that suspected abuse is always a reportable event and therefore should be the right answer you gravitate toward on any question that suggest that there is any type of actual or suspected elder abuse.  Question 22 1 / 1 pts The management of COPD in the elderly is best guided by: radiologic imaging. spirometry. Correct! symptomatology. arterial blood gases. Symptomatology is what guides COPD management since the severity and frequency of symptoms will warrant changes and additions to medications as exacerbations present. Although very useful tool for chronic management and baseline status, spirometry does not typically dictate therapy, rather diagnose the disease state itself. Our blood gases may be used for clinically correlate severity during an exacerbation, and radiologic imaging may showcase severity of stable chronic finding such as somatic, lung tissue or bullae.  Question 23 1 / 1 pts A 92-year-old presents with a decline in personal care and increasing forgetfulness. They had a CVA a three years ago with mild cognitive changes then which has slowly progressed. The more likely diagnosis in this case is? Lewy-body dementia Alzheimer’s dementia Mini-strokes Correct! Progressive vascular dementia  Question 24 1 / 1 pts Which is best performed to assess the risk for fall in an 88-year old adult? Clock-drawing test PHQ-2 questionnaire Global screening assessment Correct! Get up and go test This question is asking you if you understand the different screening to available for Mobility and fall risk. The global screening assessment, PHQ-2 questionnaire, and clock drawing test have no clinical significance to mobility. The “get up and go” test is the only option that is a mobility test of these four.  Question 25 1 / 1 pts A frail elderly patient presents with constipation. Which of the following normal physiologic changes seen with aging is the most likely cause? Increased bile secretion Decreased pancreatic secretions Correct! Decreased bowel muscle tone Increased absorption of calcium The frail, elderly patient will typically have their GI track decrease bile secretion and decrease absorption of calcium. A decrease in pancreas secretions is not related to presence of constipation, however, decreased bowel muscle tone certainly does reduce the GI motility and increase the transit time, thereby increasing the drying of stool in the large intestine which leads to constipation  Question 26 1 / 1 pts A 28-year-old woman presents with abdominal pain, diarrhea, and weight loss. She also reports occasional bloody stools. Colonoscopy reveals continuous inflammation from the rectum extending proximally. What is the most likely diagnosis? Crohn's disease Celiac disease Diverticulitis Correct! Ulcerative colitis The presence of inflammatory bowel disease which is present in the patient with bloody stool suggests ulcerative colitis. This patient should be acutely managed with steroids and chronically with auto-immune therapy such as biologics and/or DMARDs.  Question 27 1 / 1 pts The most specific indicator of the presence of ascites is: A liver scratch test A positive Murphy test Costovertebral angle tenderness Correct! A prominent fluid wave During assessment for ascites, a fluid wave test should produce a prominent fluid wave if the patient is experiencing ascites.  Question 28 1 / 1 pts An adolescent with asthma presents for follow-up evaluation. After several changes in medications and doses, the parents report that the adolescent continues to experience difficulty with coughing, especially at night. Which of the following conditions is most likely cause of the continued cough? Vocal cord dysfunction Correct! Gastroesophageal reflux Cystic fibrosis Allergic rhinitis Many times with GERD, the coughing is actually worse at night due to the postural changes of lying down, and as such, vocal cord dysfunction being a more constant issue than intermittent is easily ruled out. Cystic fibrosis does tend to have more coughing with postural change during chest physiotherapy, but this option is a sophisticated detractor. Allergic rhinitis may induce more post nasal drip more when supine from position changes, but most commonly this patient should be evaluated for GERD first, as aspiration to the airway would very easily trigger it an asthma attack due to both the bronchoconstriction and inflammatory mechanisms.  Question 29 1 / 1 pts Your patient is suspected to have colon cancer. Which labs/marker are important to be performed on this patient? AFP BRCA 1 and 2 Correct! CEA CA-125 CEA is a complex glycoprotein and is produced by 90% of colorectal cancers. It is also helpful in post treatment (surgery) follow up/management  Question 30 1 / 1 pts A geriatric female presents with complaints of dyspnea and fatigue. All blood work is normal except for Hgb of 9.0 g/dL, Hct of 33%, and guaiac positive stool. The patient also reports a bowel pattern of alternating constipation and diarrhea, and frequent laxative use. Which diagnostic tests should be ordered? Upper GI series CT scan of abdomen Correct! Colonoscopy MRI scan of abdomen This patient is in need of a colonoscopy to evaluate for the cause of occult bleeding.  Question 31 1 / 1 pts An older adult patient with new onset GERD, cough, heartburn. Initial tx Sucralfate Correct! Antacid and lifestyle modification/weight loss H2 receptor antagonist PPI Before initiating a PPI or H2RA, it would always be wise to initiate diet/exercise and symptom management when present with an antacid. Loss of weight/dieting is most likely to deal with obesity as the most common underlying cause of GERD.  Question 32 1 / 1 pts A 43-year-old male with past medical history significant for GERD, smoking, and obesity presents to your clinic for worsening GERD symptoms, he has been taking Protonix 40mg daily with no improvement. He had an EGD done with biopsy. Which findings would diagnose the patient with Barret's esophagus? Intestinal dysplasia with goblet cells Smooth muscularis mucosae Erosion of esophagus, and inflammatory findings on biopsy Correct! Intestinal metaplasia with goblet cells Histologic examination of biopsy specimens from that columnar epithelium must reveal intestinal metaplasia characterized with goblet cells. This would be significant of change to diagnose a patient with Barrett's esophagus  Question 33 1 / 1 pts Oral clindamycin is contraindicated in which of the following conditions? Hypothyroidism Latex allergy Correct! Irritable bowel disease Rheumatoid arthritis Use of oral clindamycin should be avoided in any patient with a GI history due to the risk of C Diff colitis.  Question 34 1 / 1 pts A 63-year-old male presents with a suspected lower GI bleed. He reports passing frank small amounts of blood several times today. He denies any use of NSAID’s or blood thinners. What must be taken into consideration before performing a colonoscopy on this patient? Is patient hemodynamically stable and would tolerate procedure Correct! All are reasonable options What are the risks vs benefits for this patient Is there a potential for an upper GI bleed All the above, this patient has had blood loss and should first be hemodynamically stable, and fluid/blood product resuscitated. In all cases of GI bleed risk factors for an upper GI bleed must be taken into consideration first, we must always discuss with the patient all risks and benefits associated with the procedure to provide an informed consent.  Question 35 1 / 1 pts A 43-year-old male with past medical history significant for GERD, smoking, and obesity presents to your clinic for worsening GERD symptoms, he has been taking protonix 40mg daily with no improvement. What imagining/diagnostic would be warranted for this patient. Correct! EGD Barium x-ray MRI ERCP Due to this patient’s underlying history of GERD, and risk factors of obesity and smoking he should be screened for Barrett's esophagus. This would be done by performing an EGD  Question 36 1 / 1 pts In a mass casualty situation with presumed anthrax exposure, the drug of choice for prophylaxis is: tetracycline (Achromycin). chloramphenicol (Chloromycetin). Correct! doxycycline (Doryx). amoxicillin (Amoxil). When dealing with prophylactic exposure, the most appropriate medication for anthrax would be doxycycline per the CDC guidelines.  Question 37 1 / 1 pts Which of the following refers to the primary access point of medical care patients are encouraged to use to aid in providing continuity and reduction of cost per the Affordable Care Act? Urgent Care Consulting Healthcare Providers The Emergency Department Correct! The Medical Home The medical home reduces cost by providing continuity of care, reducing overtesting, duplicate testing, and aids with longitudinal management of the patient. The other options all increase these cost- burdening elements and should be avoided unless care through the medical home is not a reasonable or appropriate option.  Question 38 1 / 1 pts The nurse practitioner is caring for an acutely-ill 92 year old ICU intubated patient not responding to the best available care after a perforated gastric ulcer who underwent surgical exploration and washout two weeks ago. They have gone into ventricular tachycardia twice this morning and resuscitated with the use of DC cardioversion and IV amiodarone. Subsequent labs reveal profound lactic acidosis and they are not expected to survive the day due to a presumed diagnosis of mesenteric infarct. Before the first surgery, the patient told you and the family they did not want to undergo extreme measures to sustain their life and would like to “go out with some dignity”. Which of the following would NOT be an appropriate consult to make at this time? All options are appropriate Correct! Surgical consult for emergent abdominal re-exploration Chaplain services to address any spiritual preferences or needs Palliative care to establish goals of care In a state of futile/end of life care, it is appropriate to consult palliative medicine to evaluate the goals of care with the patient and their family. Also, chaplain services are a great resource for making sure the family and patient have an advocate not involved in medical decision making. An emergent surgery for this patient is both not an appropriate option and also does not advocate for the patient’s clearly- stated wishes.  Question 39 1 / 1 pts Which of the following is an example of implied consent? The patient has a scheduled surgery next week and discussed risks and benefits with the surgeon in a pre-operative visit. The patient with altered mental status has acute respiratory distress and two providers agree they need to be intubated in the absence of a healthcare surrogate or power of attorney present. Correct! The patient collapses while having a myocardial infarction in the hospital cafeteria. Bystanders witnessed the patient clutch his chest, say “my chest”, then collapse. They start CPR and initiate the emergency care system to transport the patient for care in the emergency department. The patient has an emergency department visit for a pneumothorax and discusses the risks and benefits before receiving a chest tube thoracostomy. Surgical consent is by definition “informed” when the risks and benefits are discussed as with the patients undergoing surgery and a chest tube, and 2 person emergency consent is described with the patient with altered mental status. The collapsed patient reflects a clear inability to care for oneself and care is being performed under the assumption of what is implied as what any reasonable person would want.  Question 40 1 / 1 pts Evidence based health screening is utilized with an understanding of the limits of interpreting the results. In this context, the term sensitivity refers to the ability of a test to: Provide reproducible results Detect the prevalence of a given condition Correct! Detect an abnormal condition when it exists Identify the specific condition Detecting an abnormal condition when it DOES exists is by definition sensitivity. Specificity refers to the ability to rule out those who do NOT have that abnormal condition.  Question 41 1 / 1 pts Which of the following is not a common symptom of Meniere’s disease? Tinnitus Vertigo Correct! Photophobia The classic triad of Meniere’s disease is vertigo, tinnitus, and hearing loss. Hearing loss  Question 42 1 / 1 pts Your patient has a Le Fort III fracture and is admitted for close monitoring. Which of the following represent a potential complication of this type of fracture? Correct! Cerebrospinal fluid leak Due to the complexity of these fractures, CSF leaks are most common among Le Fort III fractures than other types. None of the other listed options are specifically complications of any type of Le Fort fracture. Tetany Loss of bowel tone Sternocleidomastoid impingement  Question 43 1 / 1 pts The patient describes a sudden flashing like lightning in their left eye with a subsequent grayish coloration noted over the lateral half of their view. What diagnosis best describes these symptoms? Acute angle closure glaucoma Scotoma Correct! Detached retina Retinal detachment commonly has these symptoms verbatim. Scotoma is an optical migraine which tends to have features of blurry peripheral vision and a vibrating halo of vision that is temporary. Hyphema is the accumulation of red blood cells in the anterior portion of the eye. Acute angle glaucoma usually has unilateral erythema with a bulging, painful eye. Overall visual acuity suffers with glaucoma, not a distinct partial field of gaze like the detached retina. Hyphema  Question 44 1 / 1 pts A young adult presents with a sore throat, nasal congestion, postnasal drip, no temperature elevation, and no lower respiratory involvement. The most appropriate initial intervention is to: Obtain a Monospot test Obtain a nasopharyngeal culture and sensitivity Correct! Recommend gargling with warm salt water Prescribe a prophylactic course of oral penicillin Non infectious rhinosinusitis is best treated without antibiotics unless symptoms persist for over 10 days and there is systemic response such as fever, chills, malaise, productive cough, etc. Gargling with warm salt water will help the patient to reduce swelling and the presentation should self-limit.  Question 45 1 / 1 pts An older adult female reports nasal congestion, clear nasal secretions, and a post-nasal drip since going through menopause. After a thorough examination reveals no significant abnormalities, the nurse practitioner diagnoses the patient with: Viral rhinitis Allergic sinusitis Correct! Vasomotor rhinitis Allergic rhinitis Hormones can affect how the body reacts to environmental changes, like humidity and temperature. Menopause can trigger vasomotor rhinitis (VMR), also known as non-allergic rhinitis.  Question 46 1 / 1 pts An elderly patient has throbbing pain in the left eye, blurred vision, marked photophobia, and redness around the iris. What is the nurse practitioner’s initial diagnosis? Glaucoma Sjogren’s syndrome Conjunctivitis Correct! Iritis Redness around the iris is a classic descriptor of iritis, whereas conjunctival erythema and injection is suggestive of conjunctivitis. Sjogren syndrome is characterized by dry eyes, and glaucoma typically shares the symptoms noted above but does not have circular redness around the iris.  Question 47 1 / 1 pts An adult male presents with a 1-week history of headache and nasal congestion; assessment reveals T=103 degrees F (39.4 degrees C), periorbital swelling, and proptosis. Which is the most appropriate action? Obtain an X-ray of the sinuses Prescribe oral broad-spectrum antibiotic therapy Correct! Refer for hospital admission Prescribe beciomethasone (Beconase) This is suspicious for orbital cellulitis and this requires hospitalization and IV antibiotic therapy.  Question 48 1 / 1 pts Which antibiotic is appropriate for initial treatment of sinusitis? azithromycin (Zpack) Correct! amoxicillin/clavulanic acid (Augmentin) penicillin (PCN) Cefdinir Due to the mixed gram positive and gram negative flora that are present in the oropharynx, it would be wise to consider broad spectrum coverage with a beta lactamase inhibitor. Amoxicillin/clavulanic acid (Augmentin) does exactly this and is considered the recommendation for bacterial rhinosinusitis.  Question 49 1 / 1 pts An adult patient presents with complaints of acute-onset unilateral right eye pain, visual changes, seeing halos around lights, abdominal pain, and intermittent nausea. Physical findings include an erythematous right eye without discharge, a cloudy cornea, and a moderately dilated right pupil that is non-reactive to light. The nurse practitioner should immediately: Correct! refer the patient to the emergency department obtain a specimen for culture and sensitivity of the inflamed eye apply mydriatic drops for a funduscopic examination apply fluorescein stain and access for injury or foreign body These findings are suggestive of acute angle closure glaucoma and should be evaluated in an emergency department immediately.  Question 50 1 / 1 pts Your 25-year-old male patient presents to the primary care office with a complaint of sore throat, difficulty swallowing, and flu-like symptoms. Which of the following potentially life-threatening illnesses should you rule out in your evaluation? Tonsillitis Lichens planus Leukoplakia Correct! Retropharyngeal abscess Retropharyngeal abscess is particularly at risk for dissection to the mediastinum and causing airway impedance and mediastinitis. The rest are localized oral pathology and are not considered life- threatening.  Question 51 1 / 1 pts A 49 y.o. M patient, who works in an automotive battery factory, presents to urgent care with three-day onset of abdominal pain, constipation, anorexia, muscle aches, headache, and excessive fatigue. Considering the patient’s occupation, the provider should include which of the following labs in his work- up? Vitamin B12/Folate C. difficile stool culture Hemoglobin A1C Correct! Blood lead level Factories which produce batteries have a higher risk of workplace exposure to lead. This patient’s symptoms are consistent with an elevated blood lead level and, potentially, lead poisoning.  Question 52 1 / 1 pts Which of the following is appropriate long-term treatment for B12 deficiency in a patient with a history of gastric bypass? Parenteral vitamin B6 Inhaled B12 Correct! Parenteral vitamin B12 Oral vitamin B12 Treatment for B12 deficiency includes replacement of B12 stores. Parenteral administration of B12 is preferred for patients with altered GI anatomy. Absence of intrinsic factor makes oral absorption unlikely for patients who have undergone gastric bypass and parenteral routes are necessary.  Question 53 1 / 1 pts Progression to Acute Myelogenous Leukemia (AML) is a risk for untreated or poorly responsive: Macrocytic anemia Correct! Myelodysplastic syndrome Pancytopenia Aplastic anemia Long-term treatment goals include supportive care, prevent disease progression and/or development of AML.  Question 54 1 / 1 pts A 35-year-old man presents with recurrent episodes of severe pain in his back, chest, and extremities. He has a history of sickle cell disease. What is the most appropriate initial management during a pain crisis? Correct! Hospitalization for intravenous fluids and opioids Blood transfusion Hydroxyurea Nonsteroidal anti-inflammatory drugs (NSAIDs) Patients experiencing acute sickle cell crisis should be transported to the hospital for IV hydration therapy and pain management.  Question 55 1 / 1 pts Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following? Thrombocytopenia Correct! Disseminated intravascular coagulation Aplastic anemia Myelodysplastic syndrome DIC is a systemic process that has potential to result in thrombosis and hemorrhage often due to overactivation of coagulation and fibrinolysis.  Question 56 1 / 1 pts A patient with rheumatoid arthritis is admitted to the rehab unit you oversee for management of pain due to pelvic fracture after motor vehicle collision. Admission labs show ANC of 1.4. The patient is asymptomatic and denies history of repeated infection. What is the most appropriate level of intervention for this patient? Additional work-up/prep for allogenic stem cell transplant consideration Prophylactic Ciprofloxacin 500 mg PO three times weekly Correct! Observation until patient becomes symptomatic Neupogen 5mg/kg/day SQ Treatment of neutropenia in asymptomatic patients is observation.  Question 57 1 / 1 pts All the following thrombocytopenic emergencies require immediate action except: Pregnancy with severe thrombocytopenia Suspected acute leukemia, aplastic anemia, or other bone marrow failure syndrome Bleeding in the setting of severe thrombocytopenia Correct! Scheduled surgical procedure with mild thrombocytopenia Mild thrombocytopenia is not an emergency, but should involve evaluation by a hematologist or oncologist if no etiology is known prior to surgical stress.  Question 58 1 / 1 pts A geriatric patient with anemia, back pain, osteoporosis, and elevated erythrocyte sedimentation rate should be evaluated for: Paget's disease. Correct! multiple myeloma. renal dystrophy. cauda equina syndrome. Multiple myeloma is a type of cancer that affects plasma cells in the bone marrow. Symptoms can include: Bone pain: Often in the back, hips, or ribs Weakness or fatigue: May be caused by anemia Infections: People with multiple myeloma are more likely to get infections like pneumonia, bronchitis, sinusitis, and urinary tract infections Kidney problems: Myeloma protein can damage the kidneys, which may lead to kidney failure Bruising or bleeding: High levels of protein in the blood can make it easier to bruise and cause nosebleeds Other symptoms: Confusion, dizziness, stroke-like symptoms, loss of appetite, weight loss, nausea, vomiting, constipation, frequent urination, and shortness of breath (  Question 59 1 / 1 pts In which of the following patients is PRBC transfusion recommended? 64 y.o. M with anemia of unknown origin, SOB, fatigue, and Hgb 9.2 Correct! 73 y.o. M with acute GI bleed and Hgb 6.2 52 y.o. F with chronic lower GI bleed, asymptomatic, and Hgb 8.9 26 y.o. F s/p ORIF, Hgb 10.1 PRBC is indicated to provide enough RBCs to maximize clinical outcomes while avoiding unnecessary transfusions. For most hemodynamically stable medical and surgical patients, transfusion is recommended/considered at a hemoglobin of 7 to 8 g/dL.  Question 60 1 / 1 pts A 14-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up examination after a recent hospitalization. It is most important to continue monitoring growth, development, and: white blood cell levels. urine dipsticks. fecal occult blood test. Correct! hemoglobin levels. Chronic monitoring for patients with sickle cell disease includes monitoring of hemoglobin and hematocrit.  Question 61 1 / 1 pts Long-term immunoglobulin that is carried from generation to generation is likely which type of immunoglobulin? Correct! IgG IgG is passed from maternal circulation to fetal circulation to protect for the first several months to years of life. IgE IgM IgA  Question 62 1 / 1 pts What is the first-line treatment for mild systemic lupus erythematosus (SLE)? Corticosteroids Hydroxychloroquine (Plaquenil) acetaminophen (Tylenol) Correct! Ibuprofen (Advil) While more severe SLE will require steroids for acute management and monoclonal antibody therapy or biologics (DMARDS) for chronic therapy, mild SLE can be managed with non-steroidal anti-inflammatory agents. Acetaminophen is not an NSAID and is not indicated for SLE.  Question 63 1 / 1 pts The patient with anaphylaxis is experiencing which type of hypersensitivity response? Correct! Type I IgE mediated reactions are type 1 hypersensitivity reactions. Type IV Type II Type III  Question 64 1 / 1 pts 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? Examine the patient Consult pulmonology Correct! Order a core needle biopsy This question is asking for an intervention. Although examining the patient is useful, it is an evaluation tool, as is ordering routine lab work. Pulmonology is not an appropriate consultation for this patient; rather, hematology or oncology would be best suited to evaluate and work up this patient. A diagnostic needle biopsy is the most definitive intervention to gain a diagnosis for a suspected lymphoma. Order a CBC and TSH  Question 65 1 / 1 pts Patients with a new diagnosis of primary progressive multiple sclerosis are most likely to benefit from treatment with which of the following agents? Chronic high dose corticosteroids Correct! Rituximab Monoclonal antibody therapy is commonly used for multiple sclerosis treatment with good effect. Chronic opioids would be a high-risk of abuse and dependency. Corticosteroid therapy is used during acute attacks. Sulfamethoxazole is not indicated for this. Sulfamethoxazole Chronic opioids  Question 66 1 / 1 pts Your patient has been noticing bilateral joint pain in the knees and feet for about 6 months and has been started on methotrexate. Which of the following diagnoses correlate to this treatment plan? Correct! Rheumatoid arthritis This is a classic diagnosis and treatment of RA. OA is the same as DJD, and PMR is typically located in the upper chest and shoulder girdle. Degenerative joint disease Osteoarthritis Polymyalgia rheumatica  Question 67 1 / 1 pts Your patient presents with 2-month progressive weakness in legs, loss of coordination, and loss of bladder tone. Which of the following diseases should be investigated? Descending Guillain-Barre Multiple myeloma Correct! Multiple sclerosis Multiple sclerosis (MS) is commonly associated with progressive loss of muscular function due to demyelination of the nervous system. Embolic stroke is acute, not slow in nature. Descending GB would have symptoms starting in the upper extremities and working down the body, not up the body as described herein. Multiple myeloma tends to have symptoms of bone pain and are more nonspecific. Embolic stroke  Question 68 1 / 1 pts Which of the following categories of medication are not likely to be included in the medication regimen for a patient with HIV? NNRTIs Protease inhibitors NRTIs Correct! Protease antagonists NRTIs, NNRTIs, and protease inhibitors represent the three-drug regimen for HAART therapy.  Question 69 1 / 1 pts Your patient has been started on sulfamethoxazole for a urinary tract infection and two days later states she feels painful blistering on her skin. Which of the following life-threatening disease states are you most concerned about? Scleroderma Correct! Stevens-Johnson Syndrome This patient needs to be hospitalized and evaluated closely for progression and urgent management to avoid possible life-threatening end-organ dysfunction from SJS. The remaining options do not have any association to the administration of antibiotics such as sulfamethoxazole. Erythema multiforme Vasculitis  Question 70 1 / 1 pts Patients who have been identified as having angioedema due to bradykinin-mediated allergy should be notified to not take any further dosing of which of the following medication? Naproxen sodium Correct! Enalapril Bradykinin-mediated angioedema is usually caused by ACE Inhibitors, not NSAIDS such as ibuprofen, aspirin, and naproxen. Aspirin Ibuprofen  Question 71 1 / 1 pts A 27-year-old male patient, who works as a janitor, presents with a 6-month history of an intermittent rash on his hands. History reveals itching and occasional burning. Examination reveals irregularly- distributed scaly maculopapular erythematous patches extending from the dorsum of the hand several inches up the forearms, and dry palms with no nail involvement. The most likely diagnosis is: psoriasis. eczema. scabies infestation. Correct! contact dermatitis. Contact dermatitis is a type of skin inflammation that occurs when the skin comes into direct contact with an irritating substance (irritant contact dermatitis) or an allergen (allergic contact dermatitis). It is a common skin condition characterized by red, itchy, and sometimes painful rash that develops at the site of contact with the triggering substance.  Question 72 1 / 1 pts What is the etiology of actinic keratosis? Chronic UV-A exposure to the skin Correct! Chronic UV-B exposure to the skin Human Papilloma Virus infection in the skin Group B Strep infection in the skin HPV infection is the cause of verruca. Chronic UV exposure is a cause of actinic keratosis, solar lentigo, and squamous cell carcinoma.  Question 73 1 / 1 pts Your patient is being treated with disease modifying anti-rheumatic drugs for a plaque-like skin condition located on the extensor surfaces of joints. Which condition is this likely describing? Eczema Osteoarthritis Contact dermatitis Correct! Plaque psoriasis Plaque psoriasis is trademarked by these findings. Eczema tends to be on the flexor surfaces and is not treated with DMARDs. Contact dermatitis is due to exposure to an irritant and is typically self-limiting without the use of DMARDs.  Question 74 1 / 1 pts All the following are thought to cause acne except increase in androgens genetics bacterial contamination of the skin Correct! ingestion of soda and chocolate It's important to note that acne is influenced by multiple factors, including genetics, hormonal changes, skincare routines, and lifestyle habits. While diet can play a role for some individuals, it's not the primary cause of acne.  Question 75 1 / 1 pts Using the rule of palms, a patient with burn surface equivalent to 20 of the patient’s palms would be how many percent body surface area? 10 percent Correct! 20 percent 15 percent 40 percent each palm is equivalent to 1% of the patient’s body surface area  Question 76 1 / 1 pts Your patient has been noticing cracking and peeling on their hands and having some vesicular rash component. Which of the following is not likely the diagnosis? Dyshidrotic eczema Correct! Psoriasis Palmoplantar eczema Pompholyx Pompholyx and dishidrotic eczema are all synonyms for palmoplantar eczema which this describes precisely. Psoriasis tends to be on the extensor surfaces, not the flexor surfaces such as the palm.  Question 77 1 / 1 pts What is the most common form of skin cancer? Malignant melanoma Correct! Basal cell carcinoma Squamous cell carcinoma Keratoacanthoma Basal cell carcinoma is the most common type of skin cancer and with squamous cell carcinoma as the second most type.  Question 78 1 / 1 pts Your patient is being educated about the management of the new diagnosis of melanoma. Which of the following techniques is the most likely approach to be used in removal of the melanoma? Correct! Local wide excision Cryotherapy Shave biopsy Punch biopsy Due to the expansive nature and skin depth of melanoma, a local wide excision is used to aid in full removal. By the time it appears on the skin, it is usually already deeper also. The remaining options are all too superficial.  Question 79 1 / 1 pts The 61-year-old female patient with lichen sclerosis has been prescribed clobetasol propionate 0.05% ointment. Which of the following statements made by the patient demonstrates good understand of her new prescription? Correct! I will not use this anywhere other than where it is prescribed since it has a high risk of damaging my skin If I don’t see results from this, I can switch to a higher potency steroid than an ointment. I can add additional medications at the same site if they are put on top of the steroid I like this drug since I can take this for months and stop it abruptly without any side effects This is a super high potency steroid and must be only used where directed. Stopping any superpotency steroid may manifest symptoms of HPA axis suppression. Steroids should be used without any medications on them as it may potentiate the effects of the steroid. If this does not work, there is no more potent vehicle than an ointment and this is the most aggressive steroid routinely available for this disease process.  Question 80 0 / 1 pts Which dermatologic procedure is the safest way to address lesions on patients who have bleeding disorders or are anticoagulated? You Answered Shave biopsy Correct Answer Cryotherapy Elliptical excision Punch biopsy Cryotherapy is a beneficial technique for patients with bleeding disorders or are on anti-platelet or anticoagulation as it does not require incision to the tissue.  Question 81 1 / 1 pts Your patient has presented with an acute GI bleed. In working up potential causes, which of the following scenarios is most probable as a reason for the bleed? Tapered dose of prednisone for a contact dermatitis Correct! Four days of high dose of naproxen sodium for joint pain after a long hike Acute high dose use of NSAID is a risk of developing a stomach ulcer and subsequent GI bleeding. Topical use of NSAID is not associated with systemic absorption over 1-2% and accordingly does not carry the prostaglandin inhibition risks to the gut lining. Use of prednisone does not predispose to bleeding, nor does acetaminophen use. Chronic low-dose acetaminophen for rheumatoid arthritis pain Chronic topical use of diclofenac gel over a knee with arthritic pain  Question 82 1 / 1 pts The most specific test for gout is: Serum purine level Correct! Synovial fluid with monosodium urate crystals Hyperuricemia greater than 7mg/dL Normalized uric acid level after a trial of allopurinol (Zyloprim) Gout is diagnosed definitively by identifying monosodium urate crystals in synovial fluid aspirated from an affected joint. These crystals appear as needle-shaped, negatively birefringent crystals under a microscope.  Question 83 1 / 1 pts A 65-year-old woman with osteoporosis presents with acute onset of severe back pain after lifting a heavy object. What is the most likely diagnosis? Herniated disc Degenerative disc disease Correct! Vertebral compression fracture Lumbar strain A vertebral compression fracture can occur after lifting a heavy object. Symptoms of a vertebral compression fracture may include sudden onset of back pain, which can be severe and worsen with movement or weight-bearing. There may also be limited spinal mobility and height loss.  Question 84 1 / 1 pts A patient has moderate osteoarthritis. Which of the following dietary supplements could be recommended to reduce pain and joint space narrowing? garlic cinnamon red yeast rice Correct! glucosamine Glucosamine is a building block for cartilage, the flexible tissue that cushions the joints. Taking glucosamine supplements may help maintain or improve cartilage structure and function.  Question 85 1 / 1 pts A 75-year-old presents with depression. The patient also has osteoarthritis of both knees that interferes with mobility. Which antidepressant may also benefit osteoarthritis? Sertraline (Zoloft) Mirtazapine (Remeron) Correct! Duloxetine (Cymbalta) Paroxetine (Paxil) For individuals with both osteoarthritis and depression, duloxetine offers the advantage of addressing both conditions simultaneously, potentially improving overall quality of life. Its dual action can also be beneficial in managing chronic pain and associated emotional distress often experienced by patients with osteoarthritis.  Question 86 1 / 1 pts Which of the following treatments is most successful for patients with chronic fatigue syndrome? Correct! Graded exercise program CNS stimulants Antiviral therapy High carbohydrate diet A graded exercise program (GEP) for chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a structured approach to physical activity aimed at gradually increasing exercise tolerance and improving overall function. Here are key components and considerations for implementing a GEP: 1. Individualized Assessment: Before starting a GEP, it's crucial to conduct a thorough assessment of the individual's current physical capabilities, symptom severity, and any specific limitations or concerns related to CFS. 2. Goal Setting: Establish clear and realistic goals with the patient, focusing on improving function, reducing symptom severity, and enhancing quality of life rather than aiming for rapid fitness gains. 3. Structured Program: Develop a structured exercise plan tailored to the individual's baseline fitness level and tolerance. The program typically involves incremental increases in exercise intensity, duration, or frequency over time. 4. Pacing: Emphasize the importance of pacing activities to avoid overexertion and exacerbation of symptoms. Encourage regular breaks during activity and gradual progression based on symptom response.  Question 87 1 / 1 pts Patients who present with decreased joint space of a lumbar vertebrae on x-ray are likely diagnosed with which of the following chronic disease states? Spondylolisthesis Lumbosacral strain Ankylosing Spondylitis Correct! Osteoarthritis Joint space loss suggests cartilage breakdown, which is by definition osteoarthritis.  Question 88 1 / 1 pts Which of the following are not items assessed for compartment syndrome? Skin color Pain Sensation Correct! Guarding The 5 Ps of compartment syndrome are pain, pallor (skin color), paresthesia (sensation), pulselessness or deficit, and paralysis. Guarding is not associated with compartment syndrome.  Question 89 1 / 1 pts An 86-year-old patient is experiencing radiculopathy-associated lower back pain that has not improved over the past 4 weeks. The medical history includes a lumbar discectomy. The best type of imaging study for evaluating this patient would be a/an: myelography. nuclear bone scan. spinal X-ray. Correct! MRI MRI s the imaging modality of choice for evaluating the spine post-lumbar discectomy. It can help visualize the anatomy of the spine, including any residual or recurrent disc herniation, scar tissue formation, spinal stenosis, or other structural abnormalities affecting nerve roots.  Question 90 1 / 1 pts A 50-year-old man with a history of osteoarthritis presents with knee pain that is interfering with his daily activities. What is the most appropriate initial non-pharmacological management? Total knee replacement Correct! Physical therapy and weight loss Arthroscopic surgery Corticosteroid injections For a patient with osteoarthritis experiencing knee pain that interferes with daily activities, the most appropriate initial non-pharmacological management involves educating them about osteoarthritis, recommending exercises to improve joint flexibility and strength, emphasizing weight management if overweight.  Question 91 1 / 1 pts A 45-year-old man with a history of benign prostatic hyperplasia (BPH) presents with worsening urinary symptoms, including nocturia and weak stream. What is the most appropriate initial pharmacological treatment? Anticholinergics Antibiotics 5-alpha-reductase inhibitors Correct! Alpha-blockers Alpha-blockers are effective in managing the symptoms of BPH by improving urinary flow and reducing discomfort associated with urinary obstruction.  Question 92 1 / 1 pts Which nationality is four times as likely as Caucasians to be diagnosed with kidney disease? Eastern Europeans Native Alaskans Correct! African Americans African Americans are four times as likely as Caucasians to have a diagnosis of hypertension. Pacific Islanders  Question 93 1 / 1 pts A young male presents with dysuria. Dipstick urinalysis is positive for WBCs, shows a pH of 7.0, a specific gravity of 1.015, and is otherwise negative. The nurse practitioner should: Correct! Obtain a urine sample for a nucleic acid test (NAT) for chlamydia Initiate trimethoprim-sulfamethoxazole (Bactrim) pending culture results Start pyridoxine to decrease symptoms pending culture results Order a voiding cystourethrogram and an ultrasound of the kidneys Symptoms of chlamydia in men may include painful urination (dysuria), discharge from the penis, and, rarely, pain or swelling in the testicles.  Question 94 1 / 1 pts A 25-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows pyuria and bacteriuria. What is the most likely diagnosis? Kidney Stones Vaginitis Pyelonephritis Correct! Cystitis Symptoms of cystitis include frequent urges to urinate, which may be accompanied by pain or burning during urination. The urine may appear bloody or cloudy, and there can be discomfort or pressure in the lower abdomen or pelvic area. Additionally, individuals may feel generally unwell, fatigued, or experience a mild fever.  Question 95 1 / 1 pts A 24-year-old female reports urinary urgency with suprapubic tenderness relieved by bladder emptying. The patient has been evaluated by urology and urogynecology. Review of laboratory reports reveal negative urinalysis and cultures, negative results for sexually transmitted infections, and an unremarkable cystoscopy. Which of the following is an appropriate plan of care? Correct! Amitriptyline (Elavil) 25 mg oral once daily Referral to psychiatry Propranolol (Inderal) 10 mg oral once daily Nitrofurantoin (Macrodantin) 100 mg oral once daily Amitriptyline (Elavil) is a tricyclic antidepressant medication that is sometimes used off-label for various conditions, including the management of urinary urgency and overactive bladder symptoms.  Question 96 1 / 1 pts Your patient has presented with flank pain, CVA tenderness, frequency. Which diagnostic finding would be useful to differentiate between cystitis and pyelonephritis? UC positive for proteus mirabilis Presence of hematuria Correct! UA with presence of WBC casts UA with WBC casts suggests pyelonephritis. UA with RBC suggests glomerulonephritis. Presence of hematuria is non-specific and a UC positive for proteus is not specific to either, as both cystitis and pyelonephritis could have proteus as the bacterial agent. UA with presence of RBC casts  Question 97 1 / 1 pts Which of the following states represents an example of postrenal failure? Overuse of furosemide Contrast induced nephropathy after an angiogram Correct! Blood clot obstructing a foley catheter after a transurethral prostatectomy Obstruction to flow is an example of post-renal failure. CIN and furosemide use are examples of intrarenal failure, and hypotension represents prerenal failure. Hypotension after overdosing on lisinopril  Question 98 1 / 1 pts Which of the following suggest a diagnosis of glomerulonephritis? WBC casts in urine Correct! CD4 count of 50 with hematuria HIV is a common cause of glomerulonephritis. CD4 count of 50 suggests poor HIV control and hematuria is a common finding of glomerulonephritis. Absence of albuminuria Elevated WBCs on urinalysis  Question 99 0 / 1 pts Patients with uncontrolled hypertension should be started on antihypertensive agents in addition to diet and exercise. Which medication should not be considered for a hypertensive patient with acute kidney injury with a creatinine of 3.1? Amlodipine You Answered Hydralazine Although ACE inhibitors are recommended for patients with chronic kidney disease, they are contraindicated in acute kidney injury states as they can exacerbate worsening renal function. They should be added when the renal function has stabilized. Isosorbide mononitrate Correct Answer Lisinopril  Question 100 1 / 1 pts Patients with an elevated creatinine after receiving contrast from an angiogram are exhibiting which classification of renal dysfunction? Correct! Intrarenal This is a classic example of intrarenal failure due to contrast induced nephropathy (CIN). In the case of otherwise healthy kindeys, CIN is a transient finding and resolves without intervention other than time and hydration. If the kidney is in a chronically damaged state, CIN can exacerbate permanent damage. Postrenal Chronic kidney disease Prerenal  Question 101 1 / 1 pts An adolescent male college freshman presents to the student health office with concerns about succeeding in school. He is in his second semester and is on academic probation because of poor grades. He states that he has always struggled in school but managed to graduate from high school with a 3.5 grade point average because his parents monitored and controlled his studying. He wonders if he has a learning disability or other disorder. The nurse practitioner should respond by: Correct! acknowledging that he might have an attention disorder or learning disability, and then refer him for an evaluation calling his parents after he leaves the office to report his school problems and recommending tutoring services informing him that he might have an attention disorder or learning disability, but is too old for any diagnosis or treatment explaining that his high school grades prove that he does not have a learning disorder, he just needs to work harder While specific prevalence rates among college students may vary, learning disorders can indeed affect academic performance and overall well-being. Early identification, appropriate accommodations, and supportive interventions can help college students with learning disorders navigate their academic careers successfully.  Question 102 1 / 1 pts Patients who present with SAIDH should be treated with which of the following regimens? Sodium restriction Fluid promotion and general diet IV vasopressin Correct! Free water restriction SAIDH will have an increased expression of antidiuretic hormone (ADH) and as such free water should be restricted to help normalize the sodium balance. In some cases, loop diuretics are used to help promote elimination of free water.  Question 103 1 / 1 pts An adult patient reports increasingly frequent migraines, especially upon rising in the mornin