Which of the following is a potential acquired cause of thrombophilia?
Which of the following is a potential acquired cause of thrombophilia?
Homocysteinuria
Protein C deficiency
Factor V Leiden
Antiphospholipid antibodies
Question 3Phalen’s test, 90°wrist flexion for 60 seconds, reproduces symptoms of:
Ulnar tunnel syndrome
Carpal tunnel syndrome
Tarsal tunnel syndrome
Myofascial pain syndrome
Question 4Which patient would benefit most from screening for type 2 diabetes?
A 30 year old female with unintended weight loss.
A 25 year old male with family history of type 1 diabetes
An obese female with recurrent vaginitis
A 50 year old hyperlipidemic male
Question 5 A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis?
Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Lupus
Peripheral neuropathy
Question 6A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be:
Trimethoprim-sulfamethoxazole for 3 days
Ciprofloxacin for 7-10 days
Trimethoprim-sulfamethoxazole for 14 days
Ciprofloxacin for 3 days
A thymectomy is usually recommended in the early treatment of which disease?
Parkinson’s disease
Multiple sclerosis
Myasthenia gravis
Huntington’s
chorea
Question 8The diagnosis of human papilloma virus (HPV) infection in males is usually made by:
Clinical appearance
Viral culture
Tzanck smear
KOH prep
Question 9The most effective intervention(s) to prevent stroke is (are): 81 mg of aspirin daily
Carotid endarterectomy for patients with high-grade carotid lesions
Routine screening for carotid artery stenosis with auscultation for bruits
Smoking cessation and treatment of hypertension
Question 10 What is the most common cause of Cushing’s syndrome?
Excessive ACTH production
Administration of a glucocorticoid or ACTH
Pituitary adenoma or a non-pituitary ACTH- producing tumor
Autonomous cortisol production from adrenal tissue
Question 11Diagnostic radiological studies are indicated for low back pain:
Routinely after 3 weeks of low back pain symptoms.
To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain.
When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection.
As a part of a pre-employment physical when heavy lifting is included in the job description.
Question 12After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured?
An enzyme-linked immunosorbent assay titer
A urea breath test A rapid urease test
A repeat endoscopy
Question 13Which appropriate test for the initial assessment of Alzheimer’s disease provides the performance ratings on 10 complex, higher order activities?
MMSE
CAGE questionnaire
FAQ – Functional Activities Questionnaire
Holmes and Rahe social readjustment scale
Question 14Major depression occurs most often in which of the following conditions?
A. Myocardial infarction
Parkinson’s disease
Stroke
Alzheimer’s disease
Question 15Which of the following statements about multiple sclerosis (MS) is correct?
MS is a chronic, untreatable illness that is almost always fatal.
MS is a disease of steadily progressive and unrelenting neurologic deterioration.
MS is a chronic, treatable illness with unknown cause and a variable course.
Patients with MS who take active steps to improve their health have the best cure rate.
Question 16Diagnostic evaluation of hypothyroidism reveals:
Elevated TSH and decreased T4
Decreased TSH and increased T4
Decreased TSH and decreased T3
Elevated TSH and increased T4
Question 17Risk factors for prostate cancer include all of the following except:
Family history
Benign prostatic hypertrophy
African American race Age
Question 18What information should patients with diabetes and their families receive about hypoglycemia?
Hypoglycemia is a rare complication.
Hypoglycemia requires professional medical treatment.
Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly.
Hypoglycemia occurs only as a result of insulin overdose.
Question 19Which history is commonly found in a patient with glomerulonephritis?
Beta-hemolytic strep infection
Frequent urinary tract infections
Kidney stones
Hypotension
Question 20Which of the following is characteristic of a manic episode? weight loss of gain
insomnia or hypersomnia
diminished ability to think or concentrate
grandiose delusions
Question 21Central obesity, “moon” face, and dorsocervical fat pad are associated with: Metabolic syndrome
Unilateral pheochromocytoma
Cushing’s syndrome
None of the above
Question 22Which of the following is the most common cause of low back pain?
Lumbar disc disease
Spinal stenosis
Traumatic fracture
Osteoporosis
Question 23A middle-aged female presents complaining of recent weight loss. The physical exam reveals an enlarged painless cervical lymph node. The differential diagnosis for this patient’s problem includes:
Infection
Toxoplasmosis
Mononucleosi s
All of the above
None of the above
Question 24An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects?
Weight gain
Fracture risk
Hypoglyce mia
Weight loss
Question 25A patient has HIV infection and is having a problem with massive diarrhea. You suspect the cause is:
cryptococcosi s
toxoplasmosi s
cryptosporidi osis
cytomegalovi ru
Question 26Which of the following is the most common causative organism of nongonococcal urethritis?
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Trichonomas vaginalis
Question 27The most common symptoms of transient ischemic attack (TIA) include: Nausea, vomiting, syncope, incontinence, dizziness, and seizure.
Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes.
Headache and visual symptoms such as bright spots or sparkles crossing the visual field.
Gradual onset of ataxia, vertigo, generalized weakness, or lightheadedness
Question 28What is the first symptom seen in the majority of patients with Parkinson’s disease?
Rigidity Bradykinesi
Rest tremor
Flexed posture
Question 29A 21-year-old female presents to the office complaining of urinary frequency and urinary burning. The nurse practitioner suspects a urinary tract infection when the urinalysis reveals
1–4 red blood cells per high- powered field
Specific gravity 1.012 Urobilinogen
10- white blood cells per high- powered field
Question 30A 26 year old female presents with elbow pain that is described as aching and burning. There is point tenderness along the lateral aspect of the elbow and painful passive flexion and extension. She reports she has been playing tennis almost daily for the past month. The most likely diagnosis is:
Radial tunnel syndrome
Ulnar collateral ligament sprain
Olecranon bursitis
Lateral epicondylitis
Question 31Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis?
Depression
Panic disorder
Anxiety
Post-traumatic stress disorder
Question 32An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patient’s pain is:
Trauma
Tight shoes
Arthritis flare
Hydrochlorothia zide
Question 33Which of the following is a contraindication for metformin therapy?
Insulin therapy
Creatinine > 1.5
Edema
None of the above
Question 34A positive drawer sign supports a diagnosis of: Sciatica
Cruciate ligament injury
Meniscal injury
Patellar ligament injury
Question 35Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?
Apples
Pepperm int
Cucumb ers
Popsicles
Question 36 A patient taking levothyroxine is being over-replaced. What condition is he at risk for?
Osteoporo sis
Constipati on
Depressio n
Exopthal mia
Question 37Diabetes screening recommendations for asymptomatic adults age 45 and over include which of the following:
HbA1C
2-hour 75 gram oral glucose tolerance test
C-peptide level
A and B
All of the above
Question 38Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action?
Prescribe systemic antibiotics
Prescribe antibiotic ear drops
Prescribe nasal steroids and oral decongestants
Refer him to an ear, nose, and throat specialist
Question 39Josh, age 22, is a stock boy and has an acute episode of low back pain. You order and NSAID and tell him which of the following?
Maintain moderate bed rest for 3-4 days
Call the office for narcotics if there is no relief with the NSAID in 24-48 hours
Begin lower back strengthening exercises depending on pain tolerance
Wear a Boston brace at night
Question 40Risk factors for Addison’s disease include which of the following?
Tuberculosis
Autoimmune disease
AIDS
All of the above
Question 41Urine cultures should be obtained for which of the following patients?
Suspected urinary tract infection in pregnancy
Febrile patients
Young men
All of the above
Question 42Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?
“Caffeine has not effect on osteoporosis.”
“A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.”
“Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix.”
“Caffeine increase bone resorption.”
Question 43The diagnosis which must be considered in a patient who presents with a severe headache of sudden onset, with neck stiffness and fever, is:
Migraine headache
Subarachnoid hemorrhage
Glaucoma
Meningitis
Question 44What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?
You must initiate the plan of care for the patient
The physician must be on-site and engaged in patient care
You must be employed as an independent contractor
You must be the main health care provider who sees the patient
Question 45The most commonly recommended method for prostate cancer screening in a 55 year old male is:
Digital rectal examination (DRE) plus prostate specific antigen (PSA)
Prostate specific antigen (PSA) alone
Transrectal ultrasound (TRUS) alone
Prostate specific antigen (PSA) and transrectal ultrasound (TRUS)
Question 46The primary goals of treatment for patients with alcohol abuse disorder are: Reduction in withdrawal symptoms and reduction in desire for alcohol
Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol
Abstinence or reduction in use, relapse prevention, and rehabilitation
Marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment
Question 47You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the:
Lateral meniscus
Cruciate ligament
Medical meniscus
Collateral ligament
Question 48Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia?
Musculoskeletal pain
Difficulty sleeping
Depression
Fatigue
Question 49Differential diagnosis of proteinuria includes which of the following?
Orthostatic proteinuria
Nephrotic syndrome
Infection
Trauma A and B
Question 50A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as:
Underweigh t
Normal weight
Overweight
Obese
Question 51Reed-Sternberg B lymphocytes are associated with which of the following disorders: Aplastic anemia
Hodgkin’s lymphoma
Non Hodgkin’s lymphoma
Myelodysplastic syndromes
Question 53A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects:
Arthritis
Ulnar neuritis
Septic arthritis
Olecranon bursitis
Question 54Establishment of a definitive diagnosis of osteomyelitis requires:
A known causative injury such as a puncture wound, bite, or decubitus ulcer.
Biopsy of culture of the pathogen from blood or bone aspirate.
Visualization of purulent material draining into soft tissue.
Lucent areas identified on plain x-ray.
Question 55The most accurate measure of diabetes control is:
Avoidance of micro- and macro-vascular complications.
Insulin sensitivity.
Early morning glucose levels.
HgbA1c
Question 56A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder?
Alprazolam or diazepam
Venlafaxine or buspirone
Trazodone or sertraline
Venlafaxine or hydroxyzine pamoate
Question 57The most common presentation of thyroid cancer is:
Generalized enlargement of the thyroid gland.
A solitary thyroid nodule.
A multinodular goiter.
Abnormal thyroid function tests.
Question 58Which of the following accounts for half of the bladder tumors among men and one-third in women?
Cigarette smoke, both active and passive inhalation
Chemicals from plastic and rubber
Chronic use of phenacetin-containing analgesic agents
Working long hours and not voiding often
Question 59You have a new patient that presents with generalized lymphadenopathy. You know that this is indicative of:
Sjogren’s syndrome
Pancreatic cancer
Disseminated malignancy of the hematologic system
Cancer of the liver
Question 60Sally, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to:
Refer her to a hand surgeon
Take a more complete history
Try neutral position wrist splinting and oral NSAID
Order a nerve conduction study such as am electromyography
Question 61Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
Corticosteroids
Inhaled beta-2 agonist bronchodilators
Inhaled anticholinergic bronchodilators
Xanthines
Question 62Potential causes of septic arthritis include which of the following?
Lyme disease
Prosthetic joint infection
Reiter’s syndrome A and B
All of the above
Question 63The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is:
Oral ciprofloxacin (Cipro)
Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
Oral trimethoprim-sulfamethoxazole (Bactrim DS)
Intramuscular penicillin
Question 64A patient has been taking fluoxetine (Prozac) since being diagnosed with major depression, first episode, 2 months ago. She reports considerable improvement in her symptoms and her intention to discontinue the medication. What should be the nurse practitioner’s recommendation?
Advise the patient to stop the antidepressant medication
Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication
Recommend that the patient continue the antidepressant medication for at least 4 more months
Discuss with the patient the need to take the antidepressant medication indefinitely
Question 65Your patient has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis?
Iron-deficiency anemia
Hemolytic anemia
Lead poisoning
Liver disease
Question 66Which of the following medications increase the risk for metabolic syndrome?
Antihistamines
Proton pump inhibitors
Protease inhibitors
A and C
All of the above
Question 67The hallmark of neurofibromatosis (von Recklinghausen’s disease) present in almost 100% of patients is:
Acoustic neuroma
Astrocytoma of the retina
Distinctive osseous lesions
Café au lait spots
Question 68The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:
Acetaminophen or an NSAID
A muscle relaxant as an adjunct to an NSAID
An oral corticosteroid and diazepam (Valium)
Colchicine and an opioid analgesic
Question 69Legal authority for advanced practice nursing rests with:
The Health Care Financing Administration
Federal statutes
State laws and regulations
Certifying bodies
Question 70Which of the following physical modalities recommended for treatment of rheumatoid arthritis provides the most effective long term pain relief?
Superficial and deep heat
Application of cold
Transcutaneous electrical nerve stimulation (TENS)
Exercise
Question 71 A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals onatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but
the patient returns 6 weeks later with the same symptoms of hyperpigmentation, kness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take?
Obtain a thorough history and physical, and check serum cortisol and ACTH levels.
Obtain a diet history and check CBC and FBS.
Provide utritional guidance and have the patient return in 1 month.
Consult home health for intravenous administration of fluids and electrolytes.
Parkinson’s disease
Epilepsy
Multiple sclerosis
Diabetes mellitusQuestion 72
Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be?
Start him on an ACE Inhibitor
Start him on a diuretic
Have him monitor his blood pressure at home
Try nonpharmacological methods and have him monitor his blood pressure at home
Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is:
Question 74 Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?
Hypertriglyceridemia and low high-density lipoprotein (HDL)
Gestational diabetes and polycystic ovarian syndrome
Hispanic, African-American, Native-American, and Pacific Islander ethnicity
Postprandial hypoglycemia
Question 75 A 28-year-old female presents to the office requesting testing for diagnosis of hereditary thrombophilia. Her father recently had a deep vein thrombosis and she is concerned about her risk factors. The nurse practitioner explains that:
The patient should start anticoagulant therapy immediately.
Hereditary thrombophilia does not always require anticoagulation therapy.
Women of childbearing age cannot take anticoagulant therapy.
Genetic and risk management counseling are recommended.
B and D
Question 76The 4 classic features of Parkinson’s disease are: Mask-like facies, dysarthria, excessive salivation, and dementia.
Tremor at rest, rigidity, bradykinesia, and postural disturbances.
Depression, cognitive impairment, constipation and shuffling gait.
Tremor with movement, cogwheeling, repetitive movement, and multi-system atrophy.
Question 77Which of the following set of symptoms should raise suspicion of a brain tumor?
Recurrent, severe headaches that awaken the patient and are accompanied by visual disturbances.
Vague, dull headaches that are accompanied by a reported sense of impending doom.
Periorbital headaches occurring primarily in the evening and accompanied by pupillary dilation and photophobia.
Holocranial headaches present in the morning and accompanied by projective vomiting without nausea.
Question 78The most common cause of elevated liver function tests is: Hepatitis
Biliary tract obstruction
Chronic alcohol abuse
A drug-induced injury
Question 79The physiological explanation of syncope is:
Accelerated venous return and increased stroke volume resulting in deactivation of the parasympathetic nervous system.
A cycle of inappropriate vasodilation, bradycardia, and hypotension.
A sudden rise in blood pressure due to overly efficient vasoconstriction.
Emotional stress resulting in hypertension, tachycardia, and increased venous return.
Question 80A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing problem?
Thiazide diuretic
Insulin
Famotidine (Pepcid)
Albuterol
Question 81Affected joint is painful at rest, with movement and weight bearing
Rapid onset that wakes the patient during the night
Long history of severe pain with associated joint swelling
None of the above
Question 82A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner
ains:
Primary hyperparathyroidism is treated with Vitamin D restriction
Primary hyperparathyroidism is treated with parathyroidectomy
Primary hyperparathyroidism is treated with daily magnesium
Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)
Question 83Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis?
Doxycycline 100 mg qd
Nitrofurantoin 100 mg qd
Bactrim DS qd
Erythromycin qd
Question 84Who is at a higher risk for developing nephrolithiasis?
Jack, who exercises every day and drinks copious amounts of water
Mary, who watches her weight and eats a low-sodium diet
Harvey, a “couch potato” who drinks a lot of no- sodium soda
Bill, who runs every day and takes excessive amounts of vitamin C
Question 85Potential side effects of levofloxacin include which of the following?
Confusion
Hypoglycemia
Achilles tendon rupture
All of the above
tient has just been diagnosed with Bell’s palsy. He is understandably upset and has questions about the prognosis. You response should be:
Although most of your symptoms will disappear, some will remain but can usually be camouflaged by altering your hairstyle or growing a beard
Question 87A diabetic patient is taking low-dose enalapril for hypertension. A record of the patient’s blood pressure over 4 weeks ranges from 130 to 142 mmHg systolic and 75 to 85
Hg diastolic. How should the nurse practitioner respond?
Unfortunately there is no cure but you have a mild case
The condition is self-limiting and most likely complete recovery will occur
With suppressive drug therapy you can minimize the symptoms
Change to a different class of antihypertensive medication to get better control.
Increase the dosage of the current BP medication.
Continue the current medication and dosage for 4 more weeks.
Add a beta-blocker to the current medication regimen.
Question 881, 2,
3
2, 3,
4
1, 3,
4
1, 2,
4
Question 89Diagnostic confirmation of acute leukemia is based on:
Bone marrow aspiration and biopsy
Pancytopenia
Hyperuricemia
All of the above
Question 90 The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy:
A dipstick strip done during routine urinalysis in the office
A 24-hour urine collection
An early morning spot urine collection
A serum albumin test
Question 91 h of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester?
Trimethoprim-
sulfamethoxazole
Erythromycin
Cefuroxime
Levofloxacin
Question 92 Martin, a 58 year old male with diabetes, is at your office for his diabetes follow up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Martin receive today regarding the care if his feet?
Wash your feet with cold water daily
See a podiatrist every 2 years, inspect your own feet monthly, and apply lotion to your feet daily
Go to a spa and have a pedicure monthly
See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes; inspect your feet daily for lesions; apply lotion to dry areas
Question 93 The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is:
Psychotherapy
Electroconvulsive therapy (ECT)
A selective serotonin reuptake inhibitor (SSRI)
A tricyclic antidepressant (TCA)
Question 94The initial clinical sign of Dupuytren’s contracture is: Pain with ulnar deviation
Painless nodule on palmer fascia
Pain and numbness in the ring finger
Inability to passively extend finger
Question 95 Which of the following is the most common complication of the myelodysplastic syndromes?
Fatigue
Cardiomyopa thy
Falls
Bleeding
Question 96 What information should a 42 year old patient with newly diagnosed diabetes receive about exercise?
Buy good walking shoes with support and a flexible sole.
Exercise at least 5 days per week.
Snack before exercise.
Do not exercise if your blood sugar is greater than 180 mg/dL
Question 97What is the most commonly abused substance?
Heroin
Cocaine
Alcohol
Marijua na
Question 98 Sam, age 67, is a diabetic with worsening renal function. He has frequent hypoglycemic episodes, which he believes means that his diabetes is getting “better.” How do you respond?
“You’re right; it seems like your diabetes is improving.”
“Because your kidneys are not functioning well, your insulin is not being metabolized and excreted as it should, so you need less of it.”
“You have watched your diet for all these years and as a result, your body is using less insulin.”
“I will have to change your oral hyperglycemic agents as it seems your body is making more insulin.”
Question 99 A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition?
Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am.
Instruct the child’s parents on physical activities to help weight loss.
Increase the evening insulin dose and check CBG at 2:00 am.
Refer the child for instruction on a strict diabetic diet.
Question 100At what age is screening most likely to detect scoliosis?
4 to 6 years
8 to 10 years
12 to 14 years
18 to 20 years
Question 101 The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are):
Patient report of bladder dysfunction, saddle anesthesia, and motor weakness of limbs.
History of significant trauma relative to the patient’s age.
Decreased reflexes, strength, and sensation in the lower extremities.
Patient report of pain with the crossed straight leg raise.
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