AANP AGPCNP PSI Test 1 & 2
1. An older adult presents with severe abdominal pain. The husband reports that
earlier in the afternoon, the patient's abdominal hernia had been firm and bulged out
4 inches (10.2 cm). The patient had him press on the hernia and immediately felt
burning pain throughout the abdomen. Which of the following is the nurse
practitioners' NEXT action?
1. Abdominal CT scan
2. Complete blood count with differential
3. Abdominal ultrasound
4. Referral to the ED - ------------ANS: 4. Referral to the ED
2. A young adult female presents with painful swelling of the right cheek anterior to
the TMJ. The diagnosis is sialadenitis. In addition to antibiotics, treatment for this
patient should include:
1. hot soaks and lemon drops.
2. alternating heat and cold.
3. cold compresses and massage.
4. hot soaks and mucolytics. - ------------ANS: 1. hot soaks and lemon drops.
3. Initial therapy for older adult patients with arthritic joints is:
1. naproxen, 1000 mg twice daily.
2. ibuprofen, 600 mg four times daily.
3. glucosamine, 750 mg twice daily.
4. acetaminophen, 1000 mg four times daily. - ------------ANS: 4. acetaminophen,
1000 mg four times daily.
4. Which of the following is an example of gross negligence?
1. Prescription of a drug that causes a fatal allergic reaction
2. Misdiagnosis of appendicitis, resulting in peritonitis and a prolonged hospital stay
3. Refusal to return the emergency phone call of a patient who has chest pain
evolving into an MI
4. Failure to diagnose a problem at an unrelated routine visit - ------------ANS: 3.
Refusal to return the emergency phone call of a patient who has chest pain evolving
into an MI
5. What is the correct order of pharmacokinetics of drugs in the body?
1. absorption, distribution, metabolism, excretion
,2. distribution, absorption, metabolism, excretion
3. absorption, metabolism, distribution, excretion
4. metabolism, distribution, absorption, excretion - ------------ANS: 1. absorption,
distribution, metabolism, excretion
6. An older adult female is brought in by her daughter, who has been visiting her. The
daughter reports that her mother seems confused and anxious, and is moving oddly
as if she is stiff. The daughter has brought along the mother's medications. She is
taking hydrochlorothiazide, levothyroxine (Synthroid), sertraline (Zoloft), baby aspirin,
a multivitamin, and St. John's wort. Which condition would the nurse practitioner
MOST urgently suspect?
1. Alzheimer's disease
2. Serotonin syndrome
3. Vascular dementia
4. Aspirin toxicity - ------------ANS: 2. Serotonin syndrome
7. An adolescent male presents with marked itching in the inguinal region but not on
the scrotum. Examination shows a peripherally-spreading, sharply-demarcated,
centrally-clearing, erythematous lesion. The MOST likely diagnosis is:
1. poor hygiene.
2. tinea versicolor.
3. pediculosis pubis.
4. tinea cruris. - ------------ANS: 4. tinea cruris.
8. A young adult presents with a 3-day history of a sore throat, fever [102°F
(38.9°C)], and malaise. Physical examination reveals posterior cervical
lymphadenopathy and splenomegaly. A complete blood count (CBC) reveals
lymphocytosis. Which of the following patient care instructions is MOST appropriate?
1. Avoid strenuous activity and contact sports until advised.
2. Restrict symptomatic antipyretic therapy to acetaminophen.
3. Restrict symptomatic antipyretic therapy to NSAIDs.
4. Avoid close contact with others for 2 weeks. - ------------ANS: 1. Avoid strenuous
activity and contact sports until advised.
9. A nurse practitioner is treating an adult with iron deficiency anemia. At what point
would the hematocrit level be expected to return to baseline?
1. 3 weeks
2. 2 months
3. 6 months
4. 1 year - ------------ANS: 2. 2 months
,10. An older adult complains of fatigue, stiffness in the shoulders and neck, recent
onset of temporal headache, and an episode of transient visual loss in one eye.
Erythrocyte sedimentation rate (ESR) is 72 mm/h [normal value = <15 mm/h]. These
findings are consistent with:
1. migraine headache.
2. glaucoma.
3. giant cell (temporal) arteritis.
4. Sjögren's syndrome. - ------------ANS: 3. giant cell (temporal) arteritis.
11. The triple approach for evaluation of a dominant breast mass in an adult female
includes a clinical breast examination, mammography, and:
1. bilateral ultrasound.
2. ductal lavage.
3. fine-needle aspiration.
4. MRI. - ------------ANS: 3. fine-needle aspiration.
12. A young adult female who is 34 weeks pregnant presents with the complaint of
urinary frequency every 1 to 2 hours. The patient has no fever and denies back pain.
A urine dipstick test is positive for leukocyte esterase and nitrites. Microscopic
analysis reveals 15-20 WBCs/hpf and a few bacteria. The BEST choice for treatment
of this patient's urinary tract infection would be:
1. trimethoprim-sulfamethoxazole (Bactrim), 160 mg/800 mg twice daily for 3 days.
2. cephalexin (Keflex), 500 mg four times daily for 7 days.
3. ciprofloxacin (Cipro), 500 mg twice daily for 7 days.
4. erythromycin, 250 mg three times daily for 5 days. - ------------ANS: 2. cephalexin
(Keflex), 500 mg four times daily for 7 days.
13. Which of the following drugs is the BEST choice for prevention of coronary artery
disease in elderly patients?
1. Enteric-coated ASA
2. Warfarin (Coumadin)
3. Dipyridamole-ASA (Aggrenox)
4. Clopidogrel (Plavix) - ------------ANS: 1. Enteric-coated ASA
14. An older adult presents with vague epigastric pain occurring at night, causing
early morning awakening, and decreased appetite with early satiety. Significant
history includes recent use of ibuprofen for headaches. Which is the MOST likely
diagnosis?
, 1. Gastroparesis
2. Reflux esophagitis
3. Duodenal ulcer
4. Crohn's disease - ------------ANS: 3. Duodenal ulcer
15. An older adult female is diagnosed with urge urinary incontinence. The patient is
alert and cognitively intact. The MOST appropriate management is:
1. urinating frequently to avoid urgency.
2. bladder retraining.
3. wearing protective garments, such as continence pads.
4. reducing fluid intake to four 8-oz glasses a day. - ------------ANS: 2. bladder
retraining.
16. Which of the following asymptomatic skin conditions can an older adult manage
at home?
1. Actinic keratosis
2. Basal cell lesions
3. Seborrheic keratosis
4. Squamous cell lesions - ------------ANS: 3. Seborrheic keratosis
17. The MOST common bacterial cause of cellulitis in patients with diabetes mellitus
is:
1. group A beta-hemolytic Streptococcus.
2. Vibrio vulnificus.
3. Pseudomonas aeruginosa.
4. Staphylococcus aureus. - ------------ANS: 4. Staphylococcus aureus.
18. An adult with coronary artery disease has had angioplasty twice, as well as a
two-vessel bypass graft. The patient presents with increasing shortness of breath,
dyspnea on exertion, paroxysmal and nocturnal dyspnea, and mild edema of the
lower extremities. Which of the following findings is MOST likely?
1. Diastolic murmur
2. Systolic ejection murmur
3. Pericardial friction rub
4. Third heart sound - ------------ANS: 4. Third heart sound
19. An elderly male farmer presents with an oval, pearly nodule, 0.6 inch (1.5 cm)
long, on the lower eyelid. The lesion has a rolled, translucent border and is
surrounded by multiple small telangiectasias. The MOST likely diagnosis is:
1. An older adult presents with severe abdominal pain. The husband reports that
earlier in the afternoon, the patient's abdominal hernia had been firm and bulged out
4 inches (10.2 cm). The patient had him press on the hernia and immediately felt
burning pain throughout the abdomen. Which of the following is the nurse
practitioners' NEXT action?
1. Abdominal CT scan
2. Complete blood count with differential
3. Abdominal ultrasound
4. Referral to the ED - ------------ANS: 4. Referral to the ED
2. A young adult female presents with painful swelling of the right cheek anterior to
the TMJ. The diagnosis is sialadenitis. In addition to antibiotics, treatment for this
patient should include:
1. hot soaks and lemon drops.
2. alternating heat and cold.
3. cold compresses and massage.
4. hot soaks and mucolytics. - ------------ANS: 1. hot soaks and lemon drops.
3. Initial therapy for older adult patients with arthritic joints is:
1. naproxen, 1000 mg twice daily.
2. ibuprofen, 600 mg four times daily.
3. glucosamine, 750 mg twice daily.
4. acetaminophen, 1000 mg four times daily. - ------------ANS: 4. acetaminophen,
1000 mg four times daily.
4. Which of the following is an example of gross negligence?
1. Prescription of a drug that causes a fatal allergic reaction
2. Misdiagnosis of appendicitis, resulting in peritonitis and a prolonged hospital stay
3. Refusal to return the emergency phone call of a patient who has chest pain
evolving into an MI
4. Failure to diagnose a problem at an unrelated routine visit - ------------ANS: 3.
Refusal to return the emergency phone call of a patient who has chest pain evolving
into an MI
5. What is the correct order of pharmacokinetics of drugs in the body?
1. absorption, distribution, metabolism, excretion
,2. distribution, absorption, metabolism, excretion
3. absorption, metabolism, distribution, excretion
4. metabolism, distribution, absorption, excretion - ------------ANS: 1. absorption,
distribution, metabolism, excretion
6. An older adult female is brought in by her daughter, who has been visiting her. The
daughter reports that her mother seems confused and anxious, and is moving oddly
as if she is stiff. The daughter has brought along the mother's medications. She is
taking hydrochlorothiazide, levothyroxine (Synthroid), sertraline (Zoloft), baby aspirin,
a multivitamin, and St. John's wort. Which condition would the nurse practitioner
MOST urgently suspect?
1. Alzheimer's disease
2. Serotonin syndrome
3. Vascular dementia
4. Aspirin toxicity - ------------ANS: 2. Serotonin syndrome
7. An adolescent male presents with marked itching in the inguinal region but not on
the scrotum. Examination shows a peripherally-spreading, sharply-demarcated,
centrally-clearing, erythematous lesion. The MOST likely diagnosis is:
1. poor hygiene.
2. tinea versicolor.
3. pediculosis pubis.
4. tinea cruris. - ------------ANS: 4. tinea cruris.
8. A young adult presents with a 3-day history of a sore throat, fever [102°F
(38.9°C)], and malaise. Physical examination reveals posterior cervical
lymphadenopathy and splenomegaly. A complete blood count (CBC) reveals
lymphocytosis. Which of the following patient care instructions is MOST appropriate?
1. Avoid strenuous activity and contact sports until advised.
2. Restrict symptomatic antipyretic therapy to acetaminophen.
3. Restrict symptomatic antipyretic therapy to NSAIDs.
4. Avoid close contact with others for 2 weeks. - ------------ANS: 1. Avoid strenuous
activity and contact sports until advised.
9. A nurse practitioner is treating an adult with iron deficiency anemia. At what point
would the hematocrit level be expected to return to baseline?
1. 3 weeks
2. 2 months
3. 6 months
4. 1 year - ------------ANS: 2. 2 months
,10. An older adult complains of fatigue, stiffness in the shoulders and neck, recent
onset of temporal headache, and an episode of transient visual loss in one eye.
Erythrocyte sedimentation rate (ESR) is 72 mm/h [normal value = <15 mm/h]. These
findings are consistent with:
1. migraine headache.
2. glaucoma.
3. giant cell (temporal) arteritis.
4. Sjögren's syndrome. - ------------ANS: 3. giant cell (temporal) arteritis.
11. The triple approach for evaluation of a dominant breast mass in an adult female
includes a clinical breast examination, mammography, and:
1. bilateral ultrasound.
2. ductal lavage.
3. fine-needle aspiration.
4. MRI. - ------------ANS: 3. fine-needle aspiration.
12. A young adult female who is 34 weeks pregnant presents with the complaint of
urinary frequency every 1 to 2 hours. The patient has no fever and denies back pain.
A urine dipstick test is positive for leukocyte esterase and nitrites. Microscopic
analysis reveals 15-20 WBCs/hpf and a few bacteria. The BEST choice for treatment
of this patient's urinary tract infection would be:
1. trimethoprim-sulfamethoxazole (Bactrim), 160 mg/800 mg twice daily for 3 days.
2. cephalexin (Keflex), 500 mg four times daily for 7 days.
3. ciprofloxacin (Cipro), 500 mg twice daily for 7 days.
4. erythromycin, 250 mg three times daily for 5 days. - ------------ANS: 2. cephalexin
(Keflex), 500 mg four times daily for 7 days.
13. Which of the following drugs is the BEST choice for prevention of coronary artery
disease in elderly patients?
1. Enteric-coated ASA
2. Warfarin (Coumadin)
3. Dipyridamole-ASA (Aggrenox)
4. Clopidogrel (Plavix) - ------------ANS: 1. Enteric-coated ASA
14. An older adult presents with vague epigastric pain occurring at night, causing
early morning awakening, and decreased appetite with early satiety. Significant
history includes recent use of ibuprofen for headaches. Which is the MOST likely
diagnosis?
, 1. Gastroparesis
2. Reflux esophagitis
3. Duodenal ulcer
4. Crohn's disease - ------------ANS: 3. Duodenal ulcer
15. An older adult female is diagnosed with urge urinary incontinence. The patient is
alert and cognitively intact. The MOST appropriate management is:
1. urinating frequently to avoid urgency.
2. bladder retraining.
3. wearing protective garments, such as continence pads.
4. reducing fluid intake to four 8-oz glasses a day. - ------------ANS: 2. bladder
retraining.
16. Which of the following asymptomatic skin conditions can an older adult manage
at home?
1. Actinic keratosis
2. Basal cell lesions
3. Seborrheic keratosis
4. Squamous cell lesions - ------------ANS: 3. Seborrheic keratosis
17. The MOST common bacterial cause of cellulitis in patients with diabetes mellitus
is:
1. group A beta-hemolytic Streptococcus.
2. Vibrio vulnificus.
3. Pseudomonas aeruginosa.
4. Staphylococcus aureus. - ------------ANS: 4. Staphylococcus aureus.
18. An adult with coronary artery disease has had angioplasty twice, as well as a
two-vessel bypass graft. The patient presents with increasing shortness of breath,
dyspnea on exertion, paroxysmal and nocturnal dyspnea, and mild edema of the
lower extremities. Which of the following findings is MOST likely?
1. Diastolic murmur
2. Systolic ejection murmur
3. Pericardial friction rub
4. Third heart sound - ------------ANS: 4. Third heart sound
19. An elderly male farmer presents with an oval, pearly nodule, 0.6 inch (1.5 cm)
long, on the lower eyelid. The lesion has a rolled, translucent border and is
surrounded by multiple small telangiectasias. The MOST likely diagnosis is:
