NSG 6001 APEA 3P Exam / NSG6001 APEA 3P’s Exam

NSG 6001 APEA 3P Exam / NSG6001 APEA 3P’s Exam 1. When performing a visual acuity test the nurse practitioner notes 20/30 in the left eye and 20/40 in the right eye using the Snellen eye chart. This means: a) have the patient returning in two weeks for a follow up vision screen b) dilated the eye and retest c) refer the patient to an ophthalmologist d) document this as a normal finding 2. The American psychiatric association’s diagnostic and statistical manual of mental disorder defines Munchausen Syndrome By Proxy a) a self-inflicted injury to gain attention b) a caregiver making up or causing an illness or injury in a person under his or her care c) an abusive behavior that does not involve the caregiver d) a situation in which the abuser is often inattentive and uncaring toward the victim Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick. 3. Symptoms of depression are a side effect of which neurotransmitter medication? a) dopamine serotonin, norepinephrine b) gabapentin c) mil d) cortisol 4. Which lesion is dark raised and asymmetric with irregular border? Quizlet Bates Chapter 20 a) Nevus b) Actinic keratosis c) Keratoacanthoma d) Melanoma 5. A 32 years old woman presents with dull puffiness of the ayes pronounced not pitting periorbital edema this finding is suggestive of this condition? APEA a) Nephrotic syndrome b) Myxedema c) Cushing syndrome d) Sinusitis Myxedema is a deposition of mucopolysaccarides in the dermis. Is commonly found if patients with advanced hypothyroidism. The classic skin changes are: swelling of face, lips, eyelids, and tongue or swelling and thickening of skin anywhere on the body, especially in the lower legs. Myxedema is the hallmark of Grave’s disease, an autoimmune form of hyperthyroidism. Myxedema can also occur in Hashimoto’s thyroiditis a form of hypothyroidism. 6. A 42 years old woman with a past medical history of migraine headaches is requesting prophylactic medication treatment. Which medication should the Nurse practitioner prescribe? a) Sumatriptan (Imitrex) b) Amitriptyline (Elavil) c) Verapamil (verelan) d) Metoprolol (Lopressor) Amitriptyline (Elavil) is a tricyclic antidepresant and is considered offlabel use for prophylactic treatment of migrane. Sumatriptan (Imimtrex) Is aTriptans used to abort migraine 7. A pediatric patient has areas of scaling on the scalp with round patches of alopecia. This clinical finding is consistent with: a) Tinea capitis b) Seborrheic dermatitis c) Trichotillomania d) Alopecia areata 8. What is the appropriate prophylactic medication for an 18 years old woman with a past medical history of migraine headaches? a) Sumatriptan (Imitrex) b) Propanolol (Inderal) c) Ibuprofeno (motrin) d) Dihydroergotamine (DHE) 9. Why would a combined hormonal contraceptive be contraindicated in a 36 year old patient with a past medical history of type 2 diabetes, obesity, chronic smoking and sedentary life a) She is obese b) She has type 2 diabetes mellitus c) Her age and tobacco use d) She leads a sedentary lifestyle Combined oral contraceptive is contraindicated in women older than 45, breastfeeding, smoking, HTN, diabetes or hx of stroke 10. During the breast examination of a perimenopausal woman the NP detects a bloody spontaneous discharge from the right nipple. This indicates further evaluation. a) Fibroadenoma b) Polycystic breast disease Generalized breast pain or tenderness. Green or dark brown nonbloody nipple discharge that tends to leak without pressure or squeezing c) An intraductal papilloma d) Pituitary prolactinoma Intraductal papillomas are usually solitary and smaller than 1 cm. They are located in large lactiferous sinuses or ducts and have a tendency to bleed. Quizlet Nipple Discharge 11. Rh negative women should receive Rho (D) immunoglobulin at what gestational time? a) 6 weeks b) 12 weeks c) 28 weeks d) 35 weeks What happens is the client is Rh negative and has a negative antibody screen? She will need repeat antibody screens and should receive Rho(D) immune globulin (RhoGAM) at 28 weeks' gestation (Quizlet Antepartum Diagnostic Testing Saunders) 12. When interpreting a complete blood count (CBC) lab report which of the following results describes the size of the RBCs? a) Hemoglobin b) Mean corpuscular volume (MCV) c) Red cell distribution width (RDw) d) Hematocrit The mean corpuscle (cell) volume (MCV) is a measurement of the average size of the RBCs. Small-sized RBCs result in a lower MCV, while larger RBCs result in a higher MCV. 13. What medication should be avoided when prescribe prophylactic therapy for headache a) Verapamil b) Propranolol c) Venlataxin (Effexor) d) Nimodipine Serotonin Norepinephrine Reuptake inhibitor have the most serious side effect. Patients should have drug free period for 3-4 weeks after every 6 months of treatment (pharmacology book page 1047) 14. What is the mechanism of action of prostaglandin E1 (PG1) in a patient with transposition of the great arteries a) To maintain equal pressure in the ventricles b) To maintain patency of the great arteries c) To produce vasodilation on ……………. d) To prevent cyanotic episodes by trapping blood in the lower ………… 15. Which of the following complaints best describes lower extremity calf pain associated with peripheral artery disease a) A sharp stabbing pains b) A dull pain or cramp c) An electric shock d) A pulsating pain Peripheral artery disease signs and symptoms include: Painful cramping in one or both of your hips, thighs or calf muscles after certain activities, such as walking or climbing stairs (claudication) Leg numbness or weakness. Coldness in your lower leg or foot, especially when compared with the other side. (Mayoclinic) 16. Which of the following conditions is NOT a typical finding of hyperprolactinemia in a 47- year-old premenopausal woman? a) Hirsutism b) Gynecomastia c) Oligomenorrhea d) Acne Hyperprolactinemia causes typical symptoms in premenopausal women and in men, but not in postmenopausal women. Premenopausal women — Hyperprolactinemia in premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea and less often galactorrhea. ( 17. When treating a patient with asthma who is experiencing acute wheezing which medication should be given to relieve the symptom? a) Short acting bronchodilator b) Long acting bronchodilator c) Inhaled corticosteroid d) Combination of methylxanthine and long acting bronchodilator Short-Acting Beta Agonist (SABA) inhalers; used for acute asthma attacks; quickly reduce airway constriction & restore normal airflow; agonists/stimulators of adrenergic receptors in SNS (sympathomimetics); albuterol (Ventolin), levalburterol (Xopenex), pirbuterol (Maxair), terbutaline (Brethine), metaproterenol (Alupent). (Quizlet Pharm Ch 37 Respiratory drugs) 18. Which immunization reduces a patient’s risk for infection with the virus that causes painful localized blistering rash? a) Smallpox vaccine b) Varicella vaccine (chicken Pox) c) Shingles (herpes zoster) vaccine d) Meningococcal vaccine Shingles (herpes zoster) is an extremely painful skin rash caused by the varicella zoster virus, the same virus that causes chickenpox. In people who have had chickenpox, the virus is never fully cleared from the body; instead, it remains dormant in the nerve tissues. ( 19. Headache warning signs that need prompt investigation include all of the following EXCEPT: a) new onset after age 50 b) aggravated or relieved by change of position c) precipitated by Valsalva maneuver d) Headache relieved with mild infrequent use of analgesics 20. The client with iron deficiency anemia should be advised to take the iron supplement a) With milk to avoid stomach upset b) With milk of magnesia at bedtime to avoid constipation c) On an empty stomach between meals d) For 30 days to 5 weeks Because iron is best absorbed on an empty stomach, patients should be advised to take the supplement an hour before meals. Most patients can use the less expensive, more standard forms of ferrous sulfate (Quizlet Hematology Cht 33) 21. Which one of the following statements is true of Munchausen syndrome by proxy? a) The injury is self-inflicted as the patient is seeking attention from others b) Under the supervision of adults other than the abuser, the patient does not exhibit symptoms c) The caregiver is usually not involver in the abusive behavior d) The abuser is often inattentive and uncaring towards the victim Munchausen syndrome by proxy (MSP) is a mental illness. It is also a form of child abuse. It affects caregivers, especially caregivers of children. It is also known as factitious disorder by proxy. Mothers of small children are most often affected by this condition. Fathers or other caregivers can have it as well. 22. Which of the following is the most common presenting sign of substance abuse in adolescents? a) Poor school performance b) change in sleep habits c) increased blood pressure d) changes in behavior 23. A woman is 11 weeks pregnant and has a maternity history of one full term vaginal delivery, a set of premature triplets delivered vaginally, and a first trimester abortion. Using her TPAL system to document her maternal status a) Gravida 4 para 1114 b) Gravida 4, para 1314 4 is the number of living children GTPAL c. Gravida 3, para 1114 c) Gravida 3, para 1112 Gravida, Term babies, Preterm babies, Abort and Living child 24. The nurse practitioner palpates an enlarged right epitrochlear lymph node in a 30 years old patient. The Nurse Practitioner should asses the patents a) Throat, face, and right ear b) Neck and supraclavicular region c) Right forearm and hand d) Right groin and abdomen Lower arm and hand for erythema and swelling 25. Anticholinergics are indicated for the treatment of a) Asymptomatic bacteriuria b) Renal insufficiency c) Urge incontinence d) Overflow incontinence Anticholinergics are drugs that block the action of acetylcholine. Anticholinergics can treat a variety of conditions, including: urinary incontinence, overactive bladder, COPD, They also help block involuntary muscle movements associated with certain diseases such as Parkinson’s disease. 26. A patient presents with signs of chest pain, the nurse practitioner observes jugular venous distention. Their finding is consistent with a) Hypertension b) Heart failure c) Asthma d) Pneumonia Heart failure causes decreased cardiac output when the heart fails as a pump and the circulation becomes backed up and congested. Signs and symptoms: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, decreased blood pressure, dependent, pitting edema; anxiety; confusion; jugular vein distention; fatigue. The S3 may be the earliest sign of heart failure.(Studyblue) 27. On examination of the neck, a dome shaped lesion in the dermis forming a benign closed firm sac attached to the epidermis is noted on the right lateral side of the neck. The type of lesion is known as a) Keloid b) Tophi c) A cutaneous cyst d) Chondrodermatitis Dome-shaped lump in the dermis forms a benign closed firm sac attached to the epidermis. A dark dot (blackhead) may be visible on its surface. Usually either an Epidermoid cyst (common on face/neck) or pilar (trichilemmal) cyst (common in the scalp). Both may become inflamed. Error! Filename not specified. 28. Symptoms of heartburn and regurgitation are associated with: a) Hiatal hernia b) Gastroesophageal reflux c) Peptic ulcer disease d) Esophageal cancer Classic GERD symptoms are: Heartburn, Regurgitation: bitter, acidic fluid in the mouth when lying down or bending over 29. A 70 years old man walks 20 minutes most days of the week. He has begun to complain of pain of his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 20 minutes walks without stopping to rest. What choice best describes the pain associated with peripheral artery disease? a) A sharp, stabbing pain b) A dull pain and cramp c) An electric shock d) A pulsating pain Peripheral Artery disease signs and symptoms include: Painful cramping after certain activities, such as walking or climbing stairs (claudication), Leg numbness or weakness, Coldness in leg or foot, especially when compared with the other side, Sores on toes, feet or legs that won't heal, A change in the color , Hair loss or slower hair growth, Shiny skin, No pulse or a weak pulse in legs or feet 30. Papilledema is a cause for concern because it is suggestive of a) Optic atrophy b) Microaneurysms c) Increased intracranial pressure d) Retinal hemorrhage Papilledema is the swelling of the optic disc caused by increased intracranial pressure. 31. A 38-year-old patient with a history of abdominal pain presents to the nurse practitioner. Findings reveal superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. Hemorrhagic pancreatic is suspected because of which finding? a) A positive Gray Turner’s sign b) A positive Cullen’s sign c) Kaposi’s sarcoma d) Petechiae 32. A 57 years old post-menopausal female presents with a complaint of vaginal burning, pruritus and painful intercourse. On examination, the nurse practitioner would be most concern with the findings a) A thin, pale, dry vaginal mucosa b) Absence of rugae c) A friable cervix d) Raised yellowish cervical lesion The term "friable" refers to tissue that is easily irritated, which makes it more prone to inflammation, bleeding, or tearing. Vaginal rugae disappear in those with an estrogen deficiency and those women who are older. Nabothian cysts (also called epithelial cyst ) are common and benign and are considered a normal feature of the adult cervix.. They may be translucent or opaque, whitish to yellow. Atrophic vaginitis is a vaginal disorder that usually happens after menopause appearing as thin, pale and dry. 33. What intervention does the American College of Rheumatology recommend as first line therapy for Osteoarthritis, rheumatoid arthritis or something else a) Diagnostic workup to rule out rheumatic arthritis b) NSAID use at lowest effective dose c) Acetaminophen use up to 4 grams/day d) Exercise and weight loss Weight loss and exercise are useful in OA. Excess weight puts stress on knee joints and hips and low back. For every 10 pounds of weight lost over 10 years, reduces the chance of developing knee OA by up to 50 %. Exercise can improve muscle strength, decrease joint pain and stiffness, and lower the chance of disability due to OA. 34. Which of the following drugs is not contraindicated for concurrent use with warfarin (Coumadin)? a) Amoxicillin (Amoxil) b) Trimethroprim/sulfamethaxazole (Bactrim) c) Cirpofloxacin (Cipro) d) Clarithromycin (Biaxin) 35. The lymphatic ducts drain into the (APEA) a) arterial system b) venous system c) vertebral bodies of the spine d) shoulder 36. Which of the following is the most appropriate treatment for trichomoniasis in a non- pregnant woman? a) Metronidazole (flagyl) b) Doxycycline (Vibramycin) c) Clindamycin (Cleocin) d) Clotrimazole (lotrimin) 37. Osteosarcoma in a pediatric patient is most often diagnosed when there is: a) Pain in the affected bone b) Pathologic fracture c) Repeat fracture d) Apophyseal avulsion Osteosarcoma is the most common type of bone cancer in children and teens. Bone pain and tenderness the most common symptom. It arises most often in the wide ends of long bones, such as the femur and tibia in the upper and lower leg, and the humerus in the upper arm. 38. In a patient who has a history of migraine headaches, which characteristics is most common? a) Focal deficits b) Family history c) Weakness d) Initial onset after age 35 39. Symptoms associated with small bowel obstruction usually include: a) Nausea and diarrhea b) Vomiting and pain c) Hematemesis and bloody stool d) Indigestion and anorexia Symptoms of a small bowel obstruction include vomiting from vagal nerve stimulation, pain from bowel wall distention, and abdominal distension from accumulation of chyme or ascites. (Quizlet Patho GI System) 40. Unilateral rhinitis could be caused by all of the following except a) A foreign body in the nasal canal b) A nasal polyp c) Drug induced rhinitis d) A deviated sputum 41. A 7 years old child has been diagnosed with acute sinusitis. The drug class that should be avoided is: a) Antihistamines b) Expectorants c) Decongestants d) Nasal steroids 42. A patient present with an elongated head with bony prominence of the forehead, nose and lower jaw. These facial features could be suggestive of: a) Nephrotic syndrome b) Acromegaly c) Cushing’s syndrome d) Parkinson’s disease Increased growth hormone produces enlargement of bone and soft tissues. Head elongated with bony prominence of forehead nose, and lower jaw. Soft tissues enlarge. Coarsened features. (Quizlet HEENT Abnormality Tables) 43. Why would a child diagnosed with beta thalassemia and hemosiderosis receive deferoxamine (desferal)? a) To prevent blood transfusion reactions b) To simulate red blood cell production c) To improve the oxygen carrying capacity of RBCs d) To eliminate excessive iron and prevent organ damage given SQ by pump overnight to prevent free iron released with RBC destruction from building up in tissues; binds the free iron so it doesn't do damage in tissues (Quizlet Hematology and Oncology Unit 6) 44. A patient has newly diagnosed hypothyroidism. What are the patients TSH level expected to be? a) Higher than normal b) Lower than normal c) Within normal range d) TSH is not used to diagnose hypothyroidism Suggest that the provider lower the dose. 45. Which of the following symptoms would be a clinical manifestation noted during the secondary stage of syphilis? a) Absence of symptoms b) Single painless lesion, chancre on the genital area. c) Rash marked by red or reddish-brown, penny-sized lesions over the palms and soles d) Poor muscle coordination Other symptoms of secondary syphilis include: sore throat. fever. swollen lymph glands. headaches. fatigue. muscle aches. wart-like patches around skin folds or genitals. 46. An 84-year-old male with prostatic hypertrophy is at increased risk of: a) Constipation b) Fecal incontinence c) Urinary tract infections d) Prostate cancer BPH increases the risk of: Acute urinary retention , UTI and Sepsis. 47. A characteristic lesion observed in a male with primary syphilis is a: A) Group of small scattered vesicles B) Chancre C) Papule of many shapes D) Non-tender penile indurated nodule Primary syphilis typically presents as a solitary, painless chancre, whereas secondary syphilis can have a wide variety of symptoms, especially fever, lymphadenopathy, rash, and genital or perineal condyloma latum. 48. During an acute attack of gout, the nurse practitioner knows NOT to prescribe a) Colchicine (Colcrys) b) Allopurinol (zyloprim) c) Steroids d) NSAIDS Colchicine has two distinct applications in gout. First, it can be used to treat an acute gouty attack. Second, it can help prevent attacks in chronic gout 49. What two vitamins and minerals should be included in oral multivitamins in women a) Folic Acid and Vitamin C b) Iron and Vitamin B12 c) Vitamin D and Iron d) Folic Acid and Iron 50. In a patient with bacterial meningitis, the most common reason for finding of headaches: a) Meningeal erythema b) Increased intracranial pressure c) Meningeal irritation d) Swelling of the spinal cord 51. Janeway lesions, petechiae and Oster nodes are associated with: a) Gonococcemia b) Infective endocarditis c) Hyperthyroidism d) Peripheral vascular disease 52. A patient present with decreased hearing related to antibiotic use. Which class of antibiotics is this? a) Aminoglycosides b) Beta-lactams c) Cephalosporins d) Macrolides Aminoglycosides antibiotics, vancomycin and aspirin are some medication that can cause hearing loss. 53. Which antihypertensive would be appropriate to prescribe for a hypertensive patient (B/P 150/95) that is in her third trimester? a) Candesartan b) Lisinopril c) Methyldopa d) Furosemide Oral methyldopa has been assigned to pregnancy category B. Methyldopa is a drug of first choice for control of mild to moderate hypertension in pregnancy and is the most widely prescribed antihypertensive 54. A 40-year-old admits to multiple sex partners presents with several lesions over his body. Finding reveals hemorrhagic vesiculopustular lesions over the hands and feet. These lesions are most likely associated with: a) Gonococcemia b) Infective endocarditis c) Hyperthyroidism d) Peripheral vascular disease 55. Which agent is NOT useful in prophylactic treatment of migraine headaches? a) Sumatriptan (Imitrex) b) Amitriptyline (elavil) c) Verapamil (verelant) d) Metropolol (lopresor) Sumatriptan is used to treat migraines (not to prevent it). It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, sensitivity to light/sound). 56. The right lymph duct drains lymphatic fluid from all the following expect the (APEA) a) Right side of the heard b) Right upper thorax c) Right arm d) Right leg 57. Acute lymphocytic leukemia is usually diagnosed by: a) A completed blood count b) Magnetic resonance imaging c) A nuclear bone scans d) A bone marrow examination 58. The medication that blocks the transportation of glucose across the intestines into the blood stream to target prandial blood glucose is: a) Metformin (Glucophage XR) b) Acarbose (Precose) c) Rosiglitazone (Avandia) d) Glipizide (Glucotrol XL) Acarbose inhibits enzymes (glycoside hydrolases) needed to digest carbohydrates, specifically, alpha-glucosidase enzymes in the brush border of the small intestines, and pancreatic alpha- amylase. 59. Prostate pain is usually located in the: a) Supra pubic area b) Back c) Perineum d) In the glans penis Prostate pain is usually lo acted in the lower abdomen, back, or groin 60. A nurse practitioner examines the skin of an elderly patient which finding below is NOT benign lesion associated with the aging process? a) Xerosis b) Cherry angiomas and senile purpura c) Senile keratosis and senile lentigines d) Dermatophytosis Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. 61. A 65-year-old male presents with findings of symmetric thorax with moderate kyphosis and anterior diameter. Chest expansion is decreased and the diaphragm descending 2 cm bilaterally. These findings relate to: a) Pneumothorax b) Plural effusion c) A fractured rib d) Chronic obstructive pulmonary disease 62. Phenazopyridine (Pyridium) is recommended for very short-term use in patients with urinary tract infections (UTIs) because: a) Possible resistance b) Occurrence of hemolytic anemia c) Gastritis d) Cost Headache, rash, pruritus and occasional gastrointestinal disturbance. An anaphylactoid-like reaction has been described. Methemoglobinemia, hemolytic anemia, renal and hepatic toxicity have been reported, usually at overdosage levels 63. Estrogen-progestin contraceptives should be avoided in women with: a) Tension headaches b) Migraines with aura c) Unilateral headaches d) Cluster headaches Combine contraceptives is a good choice for patients childbearing age younger than 35 with NO aura migraine (hollier video part 1) 64. The addition of benzoyl peroxide to erythromycin for the topical treatment of acne: a) Improve the efficacy of erythromycin b) Decrease the risk of desquamation c) Decreases the risk of resistance to erythromycin d) Increases the time patient can be exposed to sunlight 65. An elderly male with benign prostate hyperplasia (BPH) should be advised to avoid antihistamines. What is the reason for this? a) Urinary incontinence b) Constipation c) Orthostatic hypotension d) Urinary retention 66. Examination of the hair reveals a fine silky appearance. This finding may be seen in patients that have: a) Hypothyroidism b) Hyperthyroidism c) Type 2 diabetes d) Celiac disease 67. A patient develops a cough secondary to an angiotensin-converting-enzyme (ACE). The most appropriate statement related to ACE-I cough is that the cough typically: a) Resolves within a week after stopping the ACE inhibitor b) Resolves with splitting the daily dose to twice daily dosing c) Occurs with an angiotensin- II receptor blocker (ARB) d) Affects men more than women A dry hacking cough usually begins 1-2 weeks of starting ACE, but may occur up to 6 months later. Typically resolves 1-4 days of discontinuation of therapy, buy may linger up to 4 weeks 68. A patient with a diagnosis of giardiasis is being treated with metronidazole (flagyl). What information would be important to obtain before prescribing this medication? a) If the patient allergic to sulfa b) If the patient has peptic ulcer disease c) If the patient is at least 18 year of age d) If the patient drinks alcohol 69. A 20 years old male living in the college dorm, complains of a dry cough for the past month. Assessment finding associated with an atypical, community acquired pneumonia would include: a) A low-grade fever, malaise, and clear lung fields on auscultation b) A low-grade fever, malaise, and crackles audible throughout the lung fields c) Temperature of 1010 F, sore throat, and diminished breath sounds on auscultation d) Temperature of 1020 F, dyspnea, and diminished lung sounds on auscultation 70. The most appropriate medication indicated for reversing the anticoagulated effects of dabigatran etexilate (Pradaxa) a) Idarucizumab (Praxbind) b) Vitamin K c) Protamine sulfate d) Fondaparinux (Arixtra) 71. A common pathological finding in patient with asthma a) Necrosis of small airway b) Absence of goblet cells c) Absence of ciliary regeneration d) Hypertrophy of smooth muscle 72. Which cranial nerves are responsible for eye movement? a) CN II, III, IV b) CN III, IV, VI c) CN II, IV, VI d) CN III, IV, VII oculomotor (III) nerve, trochlear (IV) nerve and the abducen (VI) nerve. 73. The typical presentation of severe acute aortic regurgitation (AR) includes sudden severe shortness of breath rapidly developing heart failure, and: a) Dry cough b) Chest pain c) Decreased blood pressure d) Systolic murmur 74. Disorders in the kidneys and the ureters may cause pain in all of the following areas except the: a) Flank b) Abdomen c) Back d) Suprapubic Renal and urethral pain is usually located in the flank area, abdomen or groin. 75. When palpating the prostate gland during the rectal exam, the prostate feels tender, swollen, boggy and warm. This finding is consistent with: a) A normal prostate gland b) Acute bacterial prostatitis c) Benign prostatic hyperplasia d) Carcinoma of the prostate. A boggy prostate describes a gland that is edematous and tender such as in patients with bacterial prostatitis. 76. This contagious disease causes fever, headache, stiff neck, photophobia, nausea, vomiting, and altered mental status. What immunization prevents this? a) Meningococcal vaccine b) Pneumococcal vaccine c) Measles, Mumps, and Rubella (MMR) vaccine d) Varicella vaccine 77. Headache warning signs that need prompt investigation include all of the following a) New onset after 50 b) Aggravated or relieved by change or position c) Precipitated by Valsalva maneuver d) Headaches relieved with mild recurrent use of analgesics 78. Serotonin Syndrome is a potentially life-threatening condition associated with: a) Depression b) Anxiety c) Increased levels of serotonin d) Chlylothorax 79. Which one of the following statements about treating scabies with lindane (Kewell) is correct? Know that Nix is the treatment. a) Lindane is safe to use in pregnant women, babies, children, and the elderly b) Lindane lotion and/or shampoo in not considered first-line therapy c) Repeated applications of lindane can be used if there has been a twelve-hour interval d) Lindane can be used in patient with a history of seizures. Lindane is used to treat lice and scabies, but it may cause serious side effects. Safer medications are available to treat these conditions. You should only use lindane if there is some reason you cannot use the other medications 80. Symptoms consistent with later stage human deficiency disease (HIV) typically include all of the following except, a) Night sweats b) Lymphadenopathy for more than 3 months c) Persistent vomiting d) Persistent, unexplained fatigue This is the late stage of HIV infection: symptoms include: Rapid weight loss, Recurring fever or profuse night sweats, Extreme and unexplained tiredness, Prolonged swelling of the lymph glands in the armpits, groin, or neck, Diarrhea that lasts for more than a week, Sores of the mouth, anus, or genitals, Pneumonia, Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids, Memory loss, depression, and other neurologic disorders 81. The earliest clinical manifestation of diabetic nephropathy is: a) An elevation in blood urea nitrogen (BUN) b) An elevation in blood urea nitrogen (BUN) and creatinine (CR) c) A decreased glomerular filtration rate d) Microalbuminuria 82. When fluid accumulates between the visceral and parietal pleural spaces, the term used is: a) Pericardial effusion b) Pleural effusion c) Pleural empyema 83. Children born with down syndrome often have other anomalies. They especially require evaluation of what body system? a) Orthopedic b) Gastrointestinal c) Cardiac d) Endocrine 84. What finding is typical in a patient with a meniscal tear? (APEA) a) Positive McMurray’s test b) Positive anterior drawer test c) Audible click at the join line d) Fixed patellar subluxation 85. The nurse practitioner diagnoses a female patient with trichomoniasis. A common chief complaint of a patient whit trichomoniasis is: a) Painless, ulcerated vulvar lesion with vaginal discharged b) Fever, papules, and vaginal discharged with burning c) Vaginal discharge d) Dyspareunia and upper abdominal pain 86. When deciding on an initial treatment option for an acute flare of atopic dermatitis, unresponsive to emollient therapy, the next best choice for treatment is: a) Oral corticosteroids (prednisone) b) Betamethasone dipropionate 0.05% (betanate) c) Desonide 0.5% d) Pimecrolimus 1% cream (Elidel) 87. When examining the breast, the “tail of Spence” would be located a) In the upper inner quadrant b) In the lower inner quadrant c) In the lower outer quadrant d) Laterally across the anterior axillary fold 88. Headaches with symptoms of nausea and vomiting may be associated with all of the following, EXCEPT: a) Migraine headache b) Brain tumors c) Subarachnoid hemorrhage d) Tension headache 89. Which of the following finding could indicate a need for further evaluation of the cardiac patient? a) Hematocrit 42% b) Potassium 4.2 mg/dl c) Sodium 140 mEq/dl d) Low density lipoprotein of 190 mg/dl 90. Alpha-adrenergic blocker increases urine outflow in males by: a) Improving detrusor muscle stability b) Shrinking the prostate gland c) Relaxing prostate smooth muscle d) Dilating the urethral vasculature 91. The scoliosis patient who would cause the greatest concern for the nurse practitioner is a: a) 13 y/o female with a 100 curve b) 17 y/o female with a 100 curve c) 12 y/o female with a 50 curve d) 18 y/o female with a 50 curve 92. Which finding bellow would be unusual in a patient with diabetic retinopathy? a) Papilledema b) Dot and blot hemorrhages c) Microaneurysms d) Cotton wool spots 93. Where should the uterine fundus be palpable at 12 weeks? a) At the level of the umbilicus b) At the level of the symphysis pubis c) Midway between the symphysis and umbilicus d) Bellow the symphysis pubis 94. Ophthalmoscopic examination of a 40 years old carpenter reveals a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. This condition is termed: a) Corneal arcus b) Corneal scar c) Pterygium d) Cataract A pterygium is a growth of the conjunctiva (triangular thickening) that covers the cornea. 95. A patient calls the nurse practitioner, and states that he missed his morning daily dose of warfarin, 5 mg yesterday and today. The nurse practitioner instructs the patient to: a) Wait until tomorrow and resume daily dosing of warfarin 5 mg. b) Take warfarin 10 mg now c) Take warfarin 5 mg now, warfarin 5 mg at 5 pm, today and resume the daily warfarin 5 mg dose in the morning as schedule d) take warfarin 5 mg now and resume the warfarin 5 mg daily dose in the morning as schedule. 96. What common clinical finding is present in a patient who has croup? a) Barking cough b) Sudden onset of symptoms c) Nighttime symptoms d) Shortness of breath 97. A type of breast cancer that begins with erythema and swelling of the breast and progresses rapidly is termed: a) Paget’s disease b) Invasive ductal carcinoma c) Inflammatory breast cancer d) Invasive locular carcinoma 98. Salmeterol (sereventR) in combination with an inhaled steroid is prescribed for a patient with moderate persistent asthma. What is the most important teaching point about salmeterol? a) It is not effective during an acute asthma attack b) It may take 2 to 3 weeks to begin working c) The drug works within 10 minutes d) The drug may be used bay patients 6 years older. 99. A 50 years old male has a non-tender, enlarged scrotum. The nurse practitioner suspects which of the following conditions: a) Orchitis b) Epididymitis c) Hydrocele d) Prostatitis Hydrocele is produced by fluid in the sac which normally surrounds the testicle. It often presents as painless swelling in the scrotum 100. Risk factors associated with breast cancer include all of the following except: a) Personal family history of breast cancer b) Use of hormone replacement therapy c) Post-menopausal obesity d) Low socioeconomic status. 101. A patient who has a sulfa allergy can safely take: a) A sumatriptan (Imitrex) b) Celecoxib (Celebrex) c) Glimepiride (amaryl) d) Silver sulfadiazine (Silvadene) 102. Which group of lymph nodes are locating on the medial surface of the arm approximately 3 cm above the elbow? a) Lateral axillary nodes b) Infraclavicular nodes c) Epitrochlear nodes d) Submental nodes The epitrochlear lymph nodes, also known as the cubital or supraepitrochlear lymph nodes, are part of the superficial lymphatic system of the upper limb. The epitrochlear nodes are in the subcutaneous connective tissue on the medial aspect of the elbow, about 4–5 cm above the humeral epitrochlea. 103. An elderly patient has been diagnosed with a cataract. What structure in the eye has become diseased? a) Retina b) Cornea c) Lens d) Optic nerve A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. 104. A patient presents with pain in the shoulder. The nurse practitioner knows that there are four rotator cuff muscles. The muscle that initiates abduction movement at the shoulder is known as the: a) Supraspinatus b) Infraspinatus c) Levator scapulae muscle d) Subscapularis Muscles: supraspinatus (initiates abduction - first 15 degrees), deltoid (up to 90 degrees), trapezius and serratus anterior (scapular rotation, for abduction beyond 90 degrees). The deltoid muscle abducts the arm, but at 90 degrees the humerus bumps into the acromion. 105. A patient with bulimia is likely to be: a) Very overweight b) Very underweight c) Of average weight d) Not concerned with weigh 106. Chronic bloody diarrhea could be suggestive of: a) Irritable bowel syndrome b) Crohn’s disease c) Hepatitis A d) Celiac disease 107. On examination a patient is noted to have a “mask-like” face with decreased blinking and a characteristic stare. These features may be characteristic of: a) Nephrotic syndrome b) Myxedema c) Cushing’s syndrome d) Parkinson disease 108. An appropriate initial treatment for benign positional vertigo is: (APEA) a) Hydrochlorothiazide b) Meclizine (Antivert) c) pseudoephedrine (Sudafed) d) promethazine (Phenergan) 109. Conductive and sensorineural phases are necessary for hearing to take place. The sensorineural phase of hearing pathways involves the: a) cochlea and the cochlear nerve b) external ear canal and the middle ear c) ossicles and the inner ear d) transfer of sounds from the external environment into de external auditory canal. Involve the cochlea and the cochlear nerve 110. A 65 years old has a history of one kidney with early renal insufficiency. He is diagnosed with pneumonia and will require: a) Shorter course of antibiotics b) Longer course of antibiotics c) Lower dose of antibiotics d) A higher dose of antibiotic 111. A 44 years old male presents to the nurse practitioner for an employment physical and is concerned about testing positive for amphetamines on a drug screen, even though he is not taking amphetamines. His current medication list includes metformin, lisinopril, glyburide and bupropion. The most likely medication cause for a false positive result for amphetamines would be: a) Metformin b) Lisinopril c) Glyburide d) Bupropion Bupropion is a commonly prescribed, monocyclic antidepressant often used as an aid for smoking cessation. Several case reports have described false positive amphetamine urine drug screens (UDS) associated with bupropion 112. Desmopressin acetate (DDAVP) nasal spray has been found to be useful in the management of enuresis in children. In which of the following situations is the drug especially beneficial? a) Daytime incontinence b) Hypertensive children with enuresis c) Secondary enuresis d) Sleepovers DDAVP Nasal Spray is indicated for the management of primary nocturnal enuresis. It may be used alone or adjunctive to behavioral conditioning or other nonpharmacological intervention 115) Rapid Human Immunodeficiency virus (HIV) testing would be appropriate for a patient with complains of a) painful bower movement, anal itching, and painful or swollen testicles or abnormal menstrual bleeding. b) Painful urination, dyspareunia, and vaginal or penile discharge c) Fever, headache, and lymphadenopathy Indicative for patients presenting symptoms of acute HIV infection such as rash, fever, headache, sore throat. 116) which of the following condition is NOT associated with the symptoms of hemoptysis? a) Pulmonary emboli b) Chronic bronchitis c) Viral pneumonia d) Neoplasm of the lung 117) which condition is associated with end-stage renal disease in pediatric patients and requires recombinant erythropoietin treatment? a) Osteodystrophy b) Hyperkalemia c) Hypertension d) Anemia 118) when evaluating a 17 y/o girl with infrequent menstrual periods, which findings suggest probable hyperandronism? a) High pitch voice b) Hirsutism c) Polycystic ovaries d) Obesity 119) which form of urinary incontinence is present in a patient with Alzheimer’s disease who is unable to reach the toilet in time? (APEA) a) Functional incontinence b) Overflow incontinence c) Urge incontinence d) Stress incontinence Possible causes of functional incontinence include: poor vision, psychological issues, environmental barriers to using the restroom, cognitive issues, including forms of dementia, delirium, and intellectual disabilities, neurological or muscular limitations, such as arthritis 120) a 27y/o male patient presents with a painless chancre on the shaft of his penis and regional lymphadenopathy. He is diagnosed with primary syphilis. The best initial treatment is: a) Ceftriaxone (Rocephin) b) Clindamycin (cleocin) c) Metronidazole (flagyl) d) Benzathine penicillin G (Bicillin L.A) 121) An 80 y/o man is being evaluated for recent episodes of incontinence and confusion. His family states that he is usually independent with no altered mental issues, but has become forgetful within the last 2 weeks. Which medication is most likely associated with there symptoms ? a) Cimetidine (tagamet) b) Warfarin (coumadin) c) Ramipril (altace) d) Vitamin b12 122) When ordering an oral diabetes medication for a 72 y/o patient with a recent hx of decreased appetite and ongoing risk of hypoglycemia. The NP should Rx. a) Tolbutamide (orinase) b) Glipizide (Glucotol XL) c) Metformin (Gucophage) d) Chlorpopamide (diabinese) 123) to increases urine outflow in men with BPH, the NP should prescribe a) An alpha blocker b) An alpha agonist c) A calcium channel blocker d) A diuretic 124) A 64 y/o man c/o leg pain and occasional numbness that worsens with ambulation and improves with lumbar flexion. The symptoms are consistent with: a) Ankylosing spondylitis b) Spinal stenosis c) Bursitis d) Cauda equina syndrome Spinal stenosis or pseudoclaudication refer to pain in the back or legs when the patient walks but improves with rest, lumbar flexion or both. 125) which is a true statement about varicose veins? a) They are due to congenital valve deformities b) They are usually dx on clinical presentation c) They are not affected by pregnancy d) They are more symptomatic during ovulation Varicose veins are most often diagnosed with a physical exam, including examining your legs while you are standing. A weakened valve allows backflow of blood to the previous valve in a vein 126) a 17 y/o is dx. With mild bronchospasm. Which of the following would provide relief? a) Inhaled mometasone ( Asmanex) b) Inhaled levalbuterol (Xopenex) c) Oral mentelukast (Singulair) d) Oral dextromethorphan/guaifenesin product 127) a common cause of decrease libido in men is due to? a) Decrease blood flow in the hypogastric arterial system b) Endocrine dysfunction c) Neurologic deficit d) Impaired neural innervation 128) what should be included in the initial tx of bacterial epididymitis in a sexually active 22 y/0 male? a) Doxycycline and ceftriaxone b) Ceftriaxone and metronidazole c) Ciprofloxacin and fluconazole d) Levofloxacin and cephalexin In young men the usual cause is a sexually transmitted microorganism 129) which assessment findings are NOT associated with pyloric stenosis in a 2 month old infant? a) Projectile vomiting b) Severe dehydration as demonstrated by sunken eyeballs and depressed anterior fontanelle c) A bloated and tense tympanic abdomen d) A palpable mass the size and shape of an olive, located in the right upper quadrant of the abdomen 130) hyperkalemia is associated with a) Increase BP b) Alpha-blockers c) Diminished renal function d) Loop diuretics chronic renal failure, hypoaldosteronism, and massive tissue breakdown as in rhabdomyolysis, are typical conditions leading to hyperkalemia. 131) the assessment of a 72 y/o male causes the NP to have concerns that the pt. is a suicide risk. Risk factors for suicide in the elderly do NOT include a) Chronic pain b) Comorbid physical illness c) Family hx of suicide d) Retirement 132) A pregnant pt presents for a routine 16 week prenatal visit. Her BP has decreased from 119/78 mm/Hg at her 12 week visit to 110/69 mmHg. What hemodynamic for the decrease BP? a) Decrease preload b) Decrease in stroke volume c) Decrease cardiac output d) Decrease in systemic vascular resistance The increase cardiac output and slight decrease in DP during pregnancy is associated with a marked reduction in systemic vascular resistance 133) the most common treatment for Helicobacter pylori is a triple therapy, interpreted as: a) 2 antibiotics and proton pump inhibitor for 7-14 days b) 3 different antibiotics for 7-20 days c) 3 rounds of the same antibiotic over 3 weeks d) 2 proton pump inhibitors and 1 antibiotic for 7-14 days 134) Patients with psoriasis frequently have a) Pruritus, positive auspitz sign, and pitted nails b) Pruritus, pitted nails and satellite lesions c) Pitted nails and plaques d) Dermatomal rash and satellite lesions 135) which condition is best treated using alpha adrenergic antagonist? a) Functional incontinence b) Renal insufficiency c) Urge incontinence d) Overflow incontinence 136) a patient who is taking an oral glococorticosteroid should be advice to a) Crush it in applesauce b) Chew it prior to a high fat meal c) Take it on an empty stomach d) Take it with food Corticosteroids are recommended to take with food to prevent stomach upset 137) which of the following drug classes is not indicated for the treatment of depression? a) Buspirone (Buspar) b) Selective Serotonin reuptake inhibitor (SSRI) c) Tricyclic antidepressant (TCA) d) Bupropion (Wellbutrin) Buspirone is an anti-anxiety medicine 138) A Hispanic woman who is 26 weeks pregnant states that she recently began eating ice chips between meals. a) Have the patient checked for diabetes b) Asses the patient for iron deficiency anemia c) Encourage the patient to eat more at meal times d) Tell the patient that this cultural practice can be harmful 139) Snellen chart evaluation indicated that the patient vision is 20/30. What is the proper description of this result? a) At 20 feet, this patient can see what a person with normal vision can see at 30 feet b) At 30 feet, this patient can see what a person with normal vision can see at 20 feet c) At 20 feet, this patient can see what few people can see at 30 feet d) This patient has sight abilities that are worse than a patient with 20/40 vision 140) which of the following is NOT a common symptom of Vit b12 deficiency a) Sore tongue b) Fatigue c) Constipation d) Vomiting 141) during a migraine, the cerebral arteries a) Constrict b) Dilate c) Pulsate d) vibrate 142) which is the appropriate medication for a 31 y/o pregnant diagnosed with UTI a) Cefuroxime (Zinafed) or nitrofurantoin (Macrobid) b) Nitrofurantoin (Macrobid) or Ciprofloxacin (cipro) c) Ciprofloxacin (cipro) or tetracycline (Sumycin) d) tetracycline (Sumycin) or amoxicillin (Amoxil) The safest choices are amoxicillin (moxatag), cefuroxime (Zinafed), cephalexin (Keflex) and Nicrofurantoin (Microbid) 143) which of the following medication is not indicated for the treatment of muscle spasms? a) Baclofen (lioresal) b) Tizanidine (Zanaflex) c) Cyclobenzaprine (Flexeril) d) Carisoprodol (Soma) Antispastics are used to treat muscle spasticity. They should NOT be use to treat muscle spasms. Baclofen is used to relieve spasticity caused by MS. 144) during an abdominal examination the NP percusses the bulging area of the abdomen. Which sounds suggest the presence a) Tympanic b) Dullness c) Hyperresonant sounds d) Normal resonance 145) which pathogen is associated with common urinary tract infections? a) b) klebsiella c) streptococcus d) proteus mirabilis 146) which condition is caused by an insufficient production of intrinsic factor by gastric mucosa and vitamin B insufficiency? a) Diarrhea b) Pernicious anemia c) Osteoporosis d) Muscle weakness 147) A multiparous pregnant patient presents at 24 weeks gestation with complain of painless vaginal bleeding. This presentation is consistent with: a) Placenta accreta b) Placenta previa c) Placenta percreta d) Placental abruption Placenta accreta poses a major risk of severe vaginal bleeding (hemorrhage) after delivery. Placenta previa vary, but the most common symptom is painless bleeding during the third trimester. 148) when measuring the fundal high of a pregnant female at 32 weeks gestation, which measurement would the NP suspect fetal growth a) 29 cm b) 30cm c) 31cm d) 32 cm Fundal height is generally defined as the distance from the pubic bone to the top of the uterus measured in centimeters. After 20 weeks of pregnancy, your fundal height measurement often matches the number of weeks you've been pregnant. 149) A 40 y/o female, the overall texture of the breast is soft, with an uneven contour bilaterally. The NP informs the patient that: a) Warrants a mammogram b) Is considered normal c) May be suggestive of fibroadenoma d) May indicate cystic breast 150) A 74 y/o man who recently lost his spouse of 50 years in an auto accident tells the NP that “ he has no purpose in this life” a. Have you told your family how you feel? b. Have you thought about hurting yourself? c. Are you taking your medication? d. Do you have any friends? 151) A 67 y/o woman with Hx of A-fib and an ejection fraction of 48% has had normal digoxin levels. Which can cause a decrease of digoxin level? a. Decrease creatinine clearance b. Weight loss c. Increase exercise d. Regular use of antacid 152) 5-alpha reductase inhibitor work to improve symptoms of benign prostatic hyperplasia by? a. Decreasing the size of the prostate b. Increasing blood flow to the prostate c. Relaxing smooth muscle in the bladder neck d. Relaxing smooth muscle in the prostate capsule 5-alpha reductase such as finasteride reduced amount of dihydrotestosterone in the prostate causing it to shrink. This helps you to pass urine more easily. 153) which medication is indicated for patients with generalized anxiety disorder? a. Buspirone (Buspar) b. Citalopram (Celexa) c. Imipramine (Tofranil) d. Bupropion HCL (Welbutrin) Buspirone (Buspar) is an antianxiolytic, the other choices are antidepressants 154) pregnant women are evaluated for syphilis with serology testing because: a. Syphilis during pregnancy predisposes the fetus to spontaneously abort or the newborn to have congenital syphilis b. Hormonal changes associated with pregnancy may trigger activation of latent syphilis c. Syphilis may be passed to the fetus beginning in the third trimester d. Untreated syphilis can cause neonatal respiratory distress Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillborn, non- immune hydrops, intrauterine growth restriction and perinatal death, as well as liveborn infected children 155) when treating a patient with asthma who is experiencing acute wheezing, which medication should be given to relieve the symptoms? a. Short acting bronchodilator b. Long acting bronchodilator c. Inhaled corticosteroid d. Combination of methylaxanthine and long acting bronchodilator 156) Recommended combination therapy for uncomplicated anorectal and pharyngeal gonorrhea is? a) Ceftriaxone and benzathine penicillin b) benzathine penicillin and doxycycline c) Doxycycline and ciprofloxacin d) Ceftriaxone and azithromycin 157) An example of synovial joints would be a) Vertebrate bodies of the spine b) Scalp c) Shoulder d) Pubic symphysis of the pelvis